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To investigate the relationship between sweetened beverage consumption and depressive symptoms among adolescents.
Design
In a cross-sectional study, adolescents were asked how often they drank soda and fruit drinks in the past 7 d. Depressive symptoms were measured using a brief adapted version of the Modified Depression Scale. Summation scores were standardized using the Z-transformation. We used multilevel multiple linear regression models to estimate the association between soda and fruit drink consumption and depressive symptoms.
Setting
The 2008 Boston Youth Survey.
Subjects
Adolescents (n 1878), high-school students in grades 9–12 of Boston public schools, Massachusetts, USA.
Results
Compared with those who never drank soda in the past 7 d, those who consumed soda 2–6 times/week (β=0·18; 95 % CI 0·04, 0·32) or ≥1 times/d (β=0·29; 95 % CI 0·13, 0·45) had higher depressive symptoms. Similarly, those who consumed fruit drinks 2–6 times/week (β=0·14; 95 % CI 0·00, 0·28) and those who consumed ≥1 times/d (β=0·22; 95 % CI 0·04, 0·40) had higher depressive symptoms.
Conclusions
Frequent consumption of both soda and fruit drinks is associated with greater depressive symptoms among adolescents.
A tax on sugar-sweetened beverages (SSB) has been proposed to address population weight gain but the effect across socio-economic position (SEP) is unclear. The current study aimed to clarify the differential impact(s) of SSB taxes on beverage purchases and consumption, weight outcomes and the amount paid in SSB taxes according to SEP.
Design
Databases (OVID and EMBASE) and grey literature were systematically searched in June 2015 to identify studies that examined effects of an SSB price increase on beverage purchases or consumption, weight outcomes or the amount paid in tax across SEP, within high-income countries.
Results
Of the eleven included articles, three study types were identified: (i) those that examined the association between variation in SSB taxes and SSB consumption and/or body weight (n 3); (ii) price elasticity estimation of SSB demand (n 1); and (iii) modelling of hypothetical SSB taxes by combining price elasticity estimates with population SEP-specific beverage consumption, energy intake or body weight (n 7). Few studies statistically tested differences in outcomes between SEP groups. Nevertheless, of the seven studies that reported on changes in weight outcomes for the total population following an increase in SSB price, all reported either similar reductions in weight across SEP groups or greater reductions for lower compared with higher SEP groups. All studies that examined the average household amount paid in tax (n 5) reported that an SSB tax would be regressive, but with small differences between higher- and lower-income households (0·10–1·0 % and 0·03 %–0·60 % of annual household income paid in SSB tax for low- and high-income households, respectively).
Conclusions
Based on the available evidence, a tax on SSB will deliver similar population weight benefits across socio-economic strata or greater benefits for lower SEP groups. An SSB tax is shown to be consistently financially regressive, but to a small degree.
Taxation of unhealthy food is considered a regulation tool to improve diets. In 2011 Denmark introduced a tax on saturated fat in food products, the first country in the world to do so. The objective of the present paper is to investigate the effects of the tax on consumers’ intake of saturated fat within three different types of food product group: minced beef, regular cream and sour cream.
Design
We use an augmented version of the Linearized Almost Ideal Demand System (LAIDS) functional form for econometric analysis, allowing for tax-induced structural breaks.
Setting
Data originate from one of the largest retail chains in Denmark (Coop Danmark) and cover January 2010 to October 2012, with monthly records of sales volume, sales revenue and information about specific campaigns from 1293 stores.
Results
The Danish fat tax had an insignificant or small negative effect on the price for low- and medium-fat varieties, and led to a 13–16 % price increase for high-fat varieties of minced beef and cream products. The tax induced substitution effects, budget effects and preference change effects on consumption, yielding a total decrease of 4–6 % in the intake of saturated fat from minced beef and regular cream, and a negligible effect on the intake from sour cream.
Conclusions
The Danish introduction of a tax on saturated fat in food in October 2011 had statistically significant effects on the sales of fat in minced beef and cream products, but the tax seems to have reduced the beyond-recommendation saturated fat intake to only a limited extent.
To assess whether exposure to fast-food outlets around schools differed depending on socio-economic status (SES).
Design
Binary logistic regression was used to investigate the presence and zero-inflated Poisson regression was used for the count (due to the excess of zeroes) of fast food within 1000 m and 15000 m road network buffers around schools. The low and middle SES tertiles were combined due to a lack of significant variation as the ‘disadvantaged’ group and compared with the high SES tertile as the ‘advantaged’ group. School SES was expressed using the 2011 Australian Bureau of Statistics, socio-economic indices for areas, index of relative socio-economic disadvantage. Fast-food data included independent takeaway food outlets and major fast-food chains.
Setting
Metropolitan Adelaide, South Australia.
Subjects
A total of 459 schools were geocoded to the street address and 1000 m and 1500 m road network distance buffers calculated.
Results
There was a 1·6 times greater risk of exposure to fast food within 1000 m (OR=1·634; 95 % 1·017, 2·625) and a 9·5 times greater risk of exposure to a fast food within 1500 m (OR=9·524; 95 % CI 3·497, 25·641) around disadvantaged schools compared with advantaged schools.
Conclusions
Disadvantaged schools were exposed to more fast food, with more than twice the number of disadvantaged schools exposed to fast food. The higher exposure to fast food near more disadvantaged schools may reflect lower commercial land cost in low-SES areas, potentially creating more financially desirable investments for fast-food developers.
To assess the level of agreement between children and their parents when reporting a child’s food consumption.
Design
Cross-sectional study in which children and parents independently completed 7 d food diaries describing the foods and drinks the child consumed at every meal and snack. The association between child and parent reporting was assessed for nineteen food groups using Kendall’s tau-b non-parametric correlations, Spearman’s rank correlations, kappa coefficients and Lin’s concordance measure of agreement. Results were also stratified by gender of the child and his/her grade at school.
Setting
Households in Ticino, Switzerland, April–June 2014.
Subjects
Two hundred and ninety-nine children aged 6–12 years and one of their parents participated, with 264 providing complete data (35 % completion rate).
Results
Results showed a high level of agreement between child and parent reporting. Spearman correlations ranged from 0·55 (sauces) and 0·57 (fatty meat) to 0·80 (fruit), 0·83 (starchy foods) and 0·84 (pastries). All nineteen Spearman correlations were significant at the 0·001 level. Kendall’s tau-b correlations ranged from 0·44 (fat meat) to 0·81 (puff pastry). Kappa values showed low to high levels of agreement, ranging from 0·15 (sweets) to 0·77 (puff pastry). Lin’s concordance correlation coefficients ranged from 0·39 (whole grains) to 0·86 (puff pastry).
Conclusions
When assessing the eating behaviour of children using a 7 d food diary, children’s reports might be as reliable as their parents’.
The purpose of the present study was to develop and assess the construct validity of a tool to measure knowledge, attitudes and practices of registered dietitians/nutritionists (RD/N) regarding an intuitive eating lifestyle.
Design
Cross-sectional study design that utilized a survey administered to a random sample and remaining full population of RD/N.
Setting
A national survey conducted via online survey software.
Subjects
A random sample of 10 % of all RD/N in the USA (n 8834) was invited to participate. Survey completion rate was 22·2 % (n 1897). After initial validation, the survey was distributed to the remaining 90 % of RD/N to confirm validation.
Results
After removing items with insufficient factor loadings, results were consistent with a four-factor solution: (i) knowledge of intuitive eating; (ii) attitudes towards intuitive eating; (iii) traditional and restrictive practices; and (iv) non-restrictive and intuitive eating practices. Confirmatory factor analysis provided further evidence of the validity of the four factors and the factors had strong reliability.
Conclusions
Unlike the hypothesized three-factor solution (knowledge, attitudes and practices), validation analysis revealed that the survey measures knowledge of intuitive eating, attitudes towards intuitive eating, use of traditional and restrictive weight-management practices, and use of non-restrictive and intuitive eating practices. With the landscape of weight management and health promotion undergoing a shift towards a health centred, size acceptance approach, this instrument will provide valuable information regarding the current knowledge, attitudes and practices of RD/N and other health promotion professionals.
To introduce the concept ‘nutrition activation’ (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities.
Design
Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes.
Setting
USA.
Subjects
Adult participants (n 7825) in the 2007–2010 National Health and Nutrition Examination Survey.
Results
Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger ‘spike’ in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d).
Conclusions
Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.
To receive stakeholders’ feedback on the new structure of the Nutritional Disorders section of the International Classification of Diseases, 11th Revision (ICD-11).
Design
A twenty-five-item survey questionnaire on the ICD-11 Nutritional Disorders section was developed and sent out via email. The international online survey investigated participants’ current use of the ICD and their opinion of the new structure being proposed for ICD-11. The LimeSurvey® software was used to conduct the survey. Summary statistical analyses were performed using the survey tool.
Setting
Worldwide.
Subjects
Individuals subscribed to the mailing list of the WHO Department of Nutrition for Health and Development.
Results
Seventy-two participants currently using the ICD, mainly nutritionists, public health professionals and medical doctors, completed the questionnaire (response rate 16 %). Most participants (n 69) reported the proposed new structure will be a useful improvement over ICD-10 and 78 % (n 56) considered that all nutritional disorders encountered in their work were represented. Overall, participants expressed satisfaction with the comprehensiveness, clarity and life cycle approach. Areas identified for improvement before ICD-11 is finalized included adding some missing disorders, more clarity on the transition to new terminology, links to other classifications and actions to address the disorders.
Conclusions
The Nutritional Disorders section being proposed for ICD-11 offers significant improvements compared with ICD-10. The new taxonomy and inclusion of currently missing entities is expected to enhance the classification and health-care professionals’ accurate coding of the full range of nutritional disorders throughout the life cycle.
The present study assessed the impact of the retailer-led removal of unhealthy beverages from display at a self-service café within a major health service. While unhealthy beverages remained available from behind the counter upon request, this was not communicated directly to customers.
Design
Drinks were categorised based on the state government nutrient profiling system, classifying drinks as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit). Total drink sales (as number of items sold per week) in the café were measured for five weeks. All unhealthy ‘red’ beverages were removed from display (but were still available for purchase) and the sales of all beverages were measured for another six weeks.
Results
We found that, in response to this strategy, the proportion of ‘red’ drinks sold decreased from 33 % to 10 % of total drink sales. As ‘amber’ and ‘green’ drink sales increased in response to this strategy, total retailer sales remained steady. Most consumers appeared to switch to purchasing ‘amber’ drinks rather than the healthiest option, ‘green’ drinks.
Conclusions
The removal of unhealthy beverages from display can result in consumers making healthier purchases, while not significantly affecting retailers’ sales.
The specific role of major socio-economic indicators (education, occupation, income) in influencing consumer choice of animal foods (AF) intake could reveal distinct socio-economic facets, thus enabling elucidation of mechanisms leading to social inequalities in health. We investigated the independent association of each indicator with intake of different AF and their effect modification.
Design
Cross-sectional study. AF intake was estimated using three 24 h dietary records. Associations between socio-economic factors and AF intake and interactions between socio-economic indicators were assessed using ANCOVA adjusted for age and energy intake. Analyses were performed separately for men and women, since gender interactions were found.
Setting
France.
Subjects
Adults (n 92 036) participating in the NutriNet-Santé Study.
Results
Low educated persons had higher intake of red meat (+9–12 g/d), processed meat (+6–9 g/d) and poultry (for men, +7 g/d) than those with a higher education level. Percentage of fish consumers was lower in individuals of the lowest income class compared with those in higher classes. Manual workers had a higher intake of cream desserts (for men, +14 g/d) than managerial staff. Few significant interactions were found. In stratified analyses, persons with the highest income consumed more yoghurt than those who had lower income, only in low educated individuals.
Conclusions
Socio-economic disparities in AF intake varied according to the socio-economic indicator, suggesting the specific influence of each indicator on AF intake. In particular, lower education was associated with higher intake of red and processed meats and cream desserts, and had an effect modification on the relationship between income and AF intake.
To study social patterning of overeating and symptoms of disordered eating in a general population.
Design
A representative, population-based cohort study.
Setting
The Australian Longitudinal Study on Women’s Health (ALSWH), Survey 1 in 1996 and Survey 2 in 2000.
Subjects
Women (n 12 599) aged 18–23 years completed a questionnaire survey at baseline, of whom 6866 could be studied prospectively.
Results
Seventeen per cent of women reported episodes of overeating, 16 % reported binge eating and 10 % reported compensatory behaviours. Almost 4 % of women reported symptoms consistent with bulimia nervosa. Low education, not living with family, perceived financial difficulty (OR=1·8 and 1·3 for women with severe and some financial difficulty, respectively, compared with none) and European language other than English spoken at home (OR=1·5 for European compared with Australian/English) were associated with higher prevalence of binge eating. Furthermore, longitudinal analyses indicated increased risk of persistent binge eating among women with a history of being overweight in childhood, those residing in metropolitan Australia, women with higher BMI, smokers and binge drinkers.
Conclusions
Overeating, binge eating and symptoms of bulimia nervosa are common among young Australian women and cluster with binge drinking. Perceived financial stress appears to increase the risk of binge eating and bulimia nervosa. It is unclear whether women of European origin and those with a history of childhood overweight carry higher risk of binge eating because of genetic or cultural reasons.
To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women.
Design
BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey.
Setting
Participants were part of the Women’s Health Initiative Observational Study (WHI OS), where participants’ health was followed over time via questionnaires and clinical assessments.
Subjects
Postmenopausal women (n 76 016; mean age 63·5 (sd 7·3) years).
Results
Women with overweight (BMI=25·0–29·9 kg/m2) or obesity (BMI≥30·0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1·51 (1·35, 1·69) and 2·14 (1·72, 2·65), respectively) than normal-weight (BMI=18·5–24·9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<18·5 kg/m2) were associated with greater odds of SPI (1·97 (1·84, 2·11) and 1·35 (1·06, 1·71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1·52 (1·11, 2·09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0·52 (0·39, 0·71)).
Conclusions
Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.
The present study evaluated the association between energy intake, energy required and mortality in older adults.
Design
A cohort study with a mean of 10·67 (sd 4·74) years of follow-up. Participants completed a 24 h dietary recall. Energy required per day was computed by BMR. Deaths through 2006 were identified from the National Death Index. A Cox regression was used to estimate the hazard ratios (HR) of quantiles of energy intake and energy required on all-cause and CVD mortality, adjusting for demographics, socio-economic status and co-morbidity.
Setting
The National Health and Nutrition Examination Survey (NHANES) III, 1988–1994.
Subjects
A total of 4846 participants aged 60 years or above were analysed.
Results
Within the follow-up period, there were a total of 2954 deaths (61·0 %), 51·9 % were caused by CVD. Relative to those in quartile 1 of energy intake, only quartile 4 was associated with all-cause mortality and CVD mortality with HR of 0·86 (95 % CI 0·77, 0·96, P=0·006) and 0·76 (95 % CI 0·65, 0·89, P=0·001), respectively. On the other hand, relative to those in quartile 1 of energy required, all quartiles of participants had a lower risk of all-cause mortality and CVD mortality. The interaction effects between energy intake and energy required with all-cause and CVD mortality were insignificant (P=0·70 and 0·61, respectively).
Conclusions
Independent of energy required, higher energy intake was associated with lower HR of both all-cause and CVD mortality in older adults.
To determine the contribution of forest foods to dietary intake and estimate their association with household food insecurity.
Design
Cross-sectional survey conducted among 279 households. Using a 7 d recall questionnaire, information on household food consumption was collected from women and used to determine the household dietary diversity score, food variety score and forest food consumption score (FFCS). Household Food Insecurity Access Scale (HFIAS) score was determined and Spearman rank correlation was used to establish the relationship between consumption of forest foods and HFIAS score. Women’s dietary intake was estimated from two 24 h recalls. The contribution of forest foods to women’s nutrient intakes was calculated and women’s nutrient intakes were compared with estimated average nutrient requirements.
Setting
Rural forest-dependent households in twelve villages in eastern and southern Cameroon.
Subjects
Household heads and their non-pregnant, non-lactating spouses.
Results
Forty-seven unique forest foods were identified; of these, seventeen were consumed by 98 % of respondents over the course of one week and by 17 % of women during the two 24 h recall periods. Although forest foods contributed approximately half of women’s total daily energy intake, considerably greater contributions were made to vitamin A (93 %), Na (100 %), Fe (85 %), Zn (88 %) and Ca (89 %) intakes. Despite a highly biodiverse pool of foods, most households (83 %) suffered from high food insecurity based on the HFIAS. A significant inverse correlation was observed between the HFIAS score and the FFCS (r2=−0·169, P=0·0006), demonstrating that forest foods play an important role in ensuring food security in these forest-dependent communities.
Conclusions
Forest foods are widely consumed by forest-dependent communities. Given their rich nutrient content, they have potential to contribute to food and nutrition security.
To evaluate the nutritional situation of the victims of the 2010 landslide disaster in Uganda, food varieties consumed and coping strategies were assessed.
Design
Cross-sectional. Food variety scores (FVS) were obtained as the total of food items eaten over the last week while an index was based on severity weighting of household food insecurity coping strategies. We included 545 affected and 533 control households.
Setting
Victims in the affected Bududa district in Eastern Uganda and those victims resettled in the Kiryandongo district, Western Uganda.
Results
Adjusted for covariates, in Bududa significantly higher mean FVS were observed among: affected than controls; farmers than others; and relief food recipients. Control households scored higher means (se) on severity of coping: 28·6 (1·3) v. 19·2 (1·2; P<0·01). In Kiryandongo, significantly higher FVS were observed among: control households; household heads educated above primary school; those with assets that complement food source; and recipients of relief food. Severity of coping was significantly higher among affected households and non-recipients of relief food. Affected households had a higher likelihood to skip a day without eating a household meal in Bududa (OR=2·31; 95 % CI 1·62, 3·29; P<0·01) and Kiryandongo (OR=1·77; 95 % CI 1·23, 2·57; P<0·01).
Conclusions
Whereas FVS and severity of coping showed opposite trends in the two districts, resettlement into Kiryandongo led to severe coping experiences. Administrative measures that provide a combination of relief food, social protection and resettlement integration may offset undesirable coping strategies affecting diet.
Routine high-dose Fe supplementation in non-anaemic pregnant women may induce oxidative stress and eventually affect birth outcomes. The aim of the present study was to measure oxidative stress markers in pregnant women with low/normal and high Hb values in trimester 1 (Hb1) and to relate these to birth weight.
Design
A cross-sectional study where selected oxidative stress markers were analysed in both maternal (trimester 1; T1) and cord blood samples and correlated with birth weight.
Setting
A tertiary hospital in urban South India.
Subjects
One hundred women were chosen based on their Hb1 values (forty women with low/normal Hb1 (<110 g/l) and sixty women with high Hb1 (≥120 g/l)).
Results
In T1, women with high Hb1 values were found to have lower paraoxonase-1 (PON-1) activity (424·7 (sd 163·7) v. 532·9 (sd 144·7) pmol p-nitrophenol formed/min per ml plasma, P=0·002) and higher lipid peroxides compared with women with low/normal Hb1. Routine supplementation of Fe to these women resulted in persistent lower PON-1 activity in cord blood (P=0·02) and directionally lower (P=0·142) birth weights. Furthermore, women with high Hb1 who delivered low-birth-weight babies were observed to have lowest PON-1 activity in T1. No changes were observed in other markers (myeloperoxidase activity and total antioxidant levels).
Conclusions
Routine Fe supplementation in pregnant women with high Hb1 associated with increased oxidative stress, as reflected by low PON-1 activity in T1, could potentially lead to deleterious effects on birth weight.
To systematically review the potential impact of reducing the set of Supplemental Nutrition Assistance Program (SNAP)-eligible foods (e.g. not allowing purchase of sugar-sweetened beverages with SNAP benefits) on expenditures for restricted foods.
Design
The impact on food expenditures of a $US 1 reduction in available SNAP benefits can be used to estimate the impact of restrictions on SNAP-eligible foods. An electronic search of EconPapers, AgEcon Search, EconLit, WorldCat, ProQuest Dissertations and Theses, PubMed and NALDC, and a snowball search were conducted to obtain a sample of studies up to March 2015 that estimate the impacts of SNAP and other income on household food expenditures. The studies were classified according to study population, study design and whether they attempted to correct for major study design biases.
Setting
Estimates were extracted from fifty-nine published and unpublished studies.
Subjects
US households.
Results
Fifty-nine studies were found, yielding 123 estimates of the impact of SNAP benefits on food expenditures and 117 estimates of the difference in impacts between SNAP benefits and other income. Studies correcting for or mitigating study design biases had less estimate variation. Estimates indicate that expenditures on the restricted item would decrease by $US 1·6 to $US 4·8 if $US 10 of SNAP benefits would have otherwise been spent, with a median overall impact of $US 3.
Conclusions
The present literature suggests that restrictions on SNAP-eligible items may result in a small but potentially meaningful decrease in SNAP expenditures for restricted items. Further research is needed to evaluate whether this would translate into improvements in diet quality.
It has been observed that diet quality and food choices vary depending on socio-economic status (SES), especially when measured through income and educational level. Although the reasons behind these differences are multiple, diet cost is a critical determinant in those groups that spend a higher proportion of their budget on food. Reference budgets are priced baskets containing the minimum goods and services necessary for well-described types of families to have an adequate social participation. In the current paper we describe the development and content of the Spanish Healthy Food Basket (SHFB).
Design
National dietary guidelines were translated into monthly food baskets. Next, these baskets were validated in terms of acceptability and feasibility through focus group discussions, and finally they were priced.
Setting
The focus group discussions and the pricing were performed in Barcelona, Spain.
Subjects
Twenty adults aged 30–50 years from different SES backgrounds and their children aged 2–22 years participated in three discussion groups.
Results
The SHFB complies with the dietary recommendations for the Spanish population. The monthly cost of this basket ranges from 131·63 € to 573·80 € depending on the type of family.
Conclusions
The SHFB does not have the purpose of prescribing what people should eat, but of estimating a minimum budget threshold below which healthy eating is not possible for well-described types of families. Thus, the SHFB is an educative guide on how to plan a healthy food budget and orient policies designed to guarantee food access and reduce SES inequalities.