Consumer perceptions of front-of-package labelling systems and healthiness of foods.

OBJECTIVE: The purpose of this study was to assess the impact of four different front-of-package (FOP) labelling systems on consumer perception and purchasing intent of food, and whether these systems help consumers select a balanced pattern of eating. METHODS: The four FOP labelling systems studied included two nutrient-specific systems ‒ the Traffic Light (TL) and the Guideline Daily Amount (GDA) ‒ and two summary indicator systems ‒ NuVal(®) and My-5(®). Phase 1 was a small study with 36 participants to determine consumer understanding of the four FOP labelling systems and to inform the development of the questions for Phase 2, which consisted of a survey of 2,200 adults obtained through an online panel. RESULTS: Although the TL and GDA were rated similar to the Nutrition Facts table in terms of attributes, these FOP systems were considered more visually appealing. Consumers indicated that the numeric summary indicator systems did not provide sufficient information. Approximately half of the respondents indicated that the FOP systems would help them make healthier choices. However, due to the limitations of each, consumers often misinterpreted a food's healthiness compared to their baseline perceptions. Similarly, consumers' intent to purchase based on the FOP system did not show a consistent pattern. CONCLUSION: Although well received by consumers, FOP labelling systems can lead to confusion depending on perceived understanding of the system used. The nutrient-specific systems tend to be preferred by most consumers; however, the overall impact on selecting healthier eating patterns has yet to be demonstrated.

Long-term survival in patients with refractory angina.

AIMS: An increasing number of patients with severe coronary artery disease (CAD) are not candidates for traditional revascularization and experience angina in spite of excellent medical therapy. Despite limited data regarding the natural history and predictors of adverse outcome, these patients have been considered at high risk for early mortality. METHODS AND RESULTS: The OPtions In Myocardial Ischemic Syndrome Therapy (OPTIMIST) program at the Minneapolis Heart Institute offers traditional and investigational therapies for patients with refractory angina. A prospective clinical database includes detailed baseline and yearly follow-up information. Death status and cause were determined using the Social Security Death Index, clinical data, and death certificates. Time to death was analysed using survival analysis methods. For 1200 patients, the mean age was 63.5 years (77.5% male) with 72.4% having prior coronary artery bypass grafting, 74.4% prior percutaneous coronary intervention, 72.6% prior myocardial infarction, 78.3% 3-vessel CAD, 23.0% moderate-to-severe left-ventricular (LV) dysfunction, and 32.6% congestive heart failure (CHF). Overall, 241 patients died (20.1%: 71.8% cardiovascular) during a median follow-up 5.1 years (range 0-16, 14.7% over 9). By Kaplan-Meier analysis, mortality was 3.9% (95% CI 2.8-5.0) at 1 year and 28.4% (95% CI 24.9-32.0) at 9 years. Multivariate predictors of all-cause mortality were baseline age, diabetes, angina class, chronic kidney disease, LV dysfunction, and CHF. CONCLUSION: Long-term mortality in patients with refractory angina is lower than previously reported. Therapeutic options for this distinct and growing group of patients should focus on angina relief and improved quality of life.