Determinantes del consumo de alimentos no básicos de alta densidad energética en población mexicana (Ensanut 2012) / Determinants of non-essential energy-dense food consumption in Mexican population (Ensanut 2012)

Resumen: Objetivo: Caracterizar el perfil sociodemográfico que se asocia con las probabilidades de consumo de alimentos no básicos de alta densidad energética (ANBADE), gravados desde 2014. Material y métodos: Se utilizó la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012. Se identificó el grupo de ANBADE y se estimaron modelos probit sobre las probabilidades de consumo (PC) y de alto consumo después de ajustar por energía total (PAC), en función de características sociodemográficas. Resultados: Los escolares tienen 10.7 puntos porcentuales (pp) más PAC frente a los preescolares. Pertenecer a hogares con el mayor gasto o escolaridad del jefe se asocia con una PC 3.3 y 3.2 pp mayor en comparación con los hogares de menor gasto o escolaridad del jefe, respectivamente. Vivir en localidades metropolitanas se asocia con una PAC 5.2 pp mayor frente a localidades rurales. Conclusiones: El estudio identificó las condiciones sociodemográficas que se asocian con las mayores PC o PAC de ANBADE, que podrán considerarse en el diseño y evaluación de la política alimentaria.

Abstract: Objective: To characterize the sociodemographic profile associated with the probabilities of consumption of nonessential energy-dense foods (ANBADE), taxed since 2014. Materials and methods: We used the National Health and Nutrition Survey (Ensanut) 2012. ANBADE group was identified and probit models were estimated for the probabilities of consumption (PC) and of belonging to the high quintile of consumption after adjusting for total energy intake (PAC), as a function of sociodemographic characteristics. Results: School-aged children have a PAC 10.7 percentage points (pp) higher vs. preschool-aged. Belonging to households with the highest expenditures or education of the head of the household are associated with a PC 3.3 or 3.2 pp higher vs. households with lower expenditures or education of the head, respectively. Living in metropolitan areas is associated with a PAC 5.2 pp higher vs. rural areas. Conclusions: The study identified the sociodemographic conditions associated with the largest PC or PAC of ANBADE, which may be considered in the design and evaluation of food policy.

Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia.

BACKGROUND: In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14-49 NTDs each year. OBJECTIVE: Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. METHODS: We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. RESULTS: We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. CONCLUSIONS: This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.

Breaking bread: examining the impact of policy changes in access to state-funded provisions of gluten-free foods in England.

BACKGROUND: Coeliac disease affects approximately 1% of the population and is increasingly diagnosed in the United Kingdom. A nationwide consultation in England has recommend that state-funded provisions for gluten-free (GF) food should be restricted to bread and mixes but not banned, yet financial strain has prompted regions of England to begin partially or fully ceasing access to these provisions. The impact of these policy changes on different stakeholders remains unclear. METHODS: Prescription data were collected for general practice services across England (n = 7176) to explore changes in National Health Service (NHS) expenditure on GF foods over time (2012-2017). The effects of sex, age, deprivation and rurality on GF product expenditure were estimated using a multi-level gamma regression model. Spending rate within NHS regions that had introduced a 'complete ban' or a 'complete ban with age-related exceptions' was compared to spending in the same time periods amongst NHS regions which continued to fund prescriptions for GF products. RESULTS: Annual expenditure on GF products in 2012 (before bans were introduced in any area) was £25.1 million. Higher levels of GF product expenditure were found in general practices in areas with lower levels of deprivation, higher levels of rurality and higher proportions of patients aged under 18 and over 75. Expenditure on GF food within localities that introduced a 'complete ban' or a 'complete ban with age-related exceptions' were reduced by approximately 80% within the 3 months following policy changes. If all regions had introduced a 'complete ban' policy in 2014, the NHS in England would have made an annual cost-saving of £21.1 million (equivalent to 0.24% of the total primary care medicines expenditure), assuming no negative sequelae. CONCLUSIONS: The introduction of more restrictive GF prescribing policies has been associated with 'quick wins' for NHS regions under extreme financial pressure. However, these initial savings will be largely negated if GF product policies revert to recently published national recommendations. Better evidence of the long-term impact of restricting GF prescribing on patient health, expenses and use of NHS services is needed to inform policy.

Gluten-Free Foods in Rural Maritime Provinces: Limited Availability, High Price, and Low Iron Content.

We investigated the price difference between gluten-free (GF) and gluten-containing (GC) foods available in rural Maritime stores. GF foods and comparable GC items were sampled through random visits to 21 grocery stores in nonurban areas of Nova Scotia, New Brunswick, and Prince Edward Island, Canada. Wilcoxon rank tests were conducted on price per 100 g of product, and on the price relative to iron content; 2226 GF foods (27.2% staple items, defined as breads, cereals, flours, and pastas) and 1625 GC foods were sampled, with an average ± SD of 66 ± 2.7 GF items per store in rural areas and 331 ± 12 in towns. The median price of GF items ($1.76/100 g) was more expensive than GC counterparts ($1.05/100 g) and iron density was approximately 50% less. GF staple foods were priced 5% higher in rural stores than in town stores. Although the variety of GF products available to consumers has improved, higher cost and lower nutrient density remain issues in nonurban Maritime regions. Dietitians working in nonurban areas should consider the relative high price, difficult access, and low iron density of key GF items, and work together with clients to find alternatives and enhance their food literacy.

Polycyclic aromatic hydrocarbons in cereal products on the Turkish market.

The contamination level of four EU marker polycyclic aromatic hydrocarbons (PAHs) in some cereal-derived products was surveyed in this study. Thirty-eight samples, 20 bread and 18 breakfast cereals, were purchased from retail shops and local markets of East Black sea region in Turkey. The samples were analysed for four EU marker PAHs, using ultrasonic extraction, solid-phase extraction (SPE) clean up and stable-isotope dilution gas chromatography with mass-spectrometric (GC/MS) detection. The method was validated with the parameters linearity, accuracy, precision, limit of detection (LOD), limit of quantitation (LOQ) and uncertainty. Total content of the four PAHs in bread varied from 0.19 to 0.46 µg kg(-1) and in breakfast cereals from 0.10 to 0.87 µg kg(-1).

Effect of rye bread enriched with tomato pomace on fat absorption and lipid metabolism in rats fed a high-fat diet.

BACKGROUND: Tomato pomace (TP), obtained as a residue of tomato processing, was used to enrich rye bread (RB). The sensory profile of this functional bread (RB+TP) was characterised, and its fat absorption and lipid metabolism properties in high-fat-fed rats were studied. RESULTS: Intake of the HF diet containing RB, RB+TP, or TP alone increased faecal energy and fat excretion, but did not affect animal growth or visceral fat weight. Both RB and RB+TP diminished the negative impact of the HF diet, lowering the atherogenic index of plasma (AIP) and the total liver lipid contents by 31.6% and 24%, respectively. The experimental diets had no effect on liver S-adenosylhomocysteine (SAH) concentrations or on the S-adenosylmethionine (SAM) to SAH ratio, though the lowest SAM levels were observed in the HF+TP group. No significant differences were detected in blood homocysteine, triglycerides, glucose or insulin levels. CONCLUSIONS: Although RB+TP incorporated into a HF diet may lead to a decrease in AIP and total liver lipid content, this effect does not depend on the components of TP, but rather on the RB ingredients. However, pure TP, in the doses used in this study, may potentially play a role in the energy balance via faecal loss of lipids.

White grape pomace as a source of dietary fibre and polyphenols and its effect on physical and nutraceutical characteristics of wheat biscuits.

BACKGROUND: Grapes are one of the world's staple fruit crops, with about 80% of the yield being utilised for winemaking. Since grape by-products still contain large amounts of secondary metabolites, uses other than as fertilisers might be appropriate. In this study, white grape pomace (WGP) was incorporated in wheat flour at levels of 10, 20 and 30% (w/w) to investigate its influence on rheological, nutraceutical, physical and sensory properties. RESULTS: Farinograph characteristics of dough with different levels of WGP showed a decrease in water absorption from 56.4% (0% WGP) to 45.9% (30% WGP). Addition of WGP reduced hardness and caused a deterioration in brightness and yellowness of all enriched samples. The smallest addition of WGP (10%) caused an approximately 88% increase in total dietary fibre content as compared with the control. The content of phenolic compounds increased from 0.11 mg g⁻¹ with 0% WGP to 1.07 mg g⁻¹ with 30% WGP. The most stable phenols were as follows: γ-resorcylic acid < gallic acid < tyrosol < catechin < isovanilic acid. An assay of radical-scavenging activity showed that WGP addition greatly enhanced the antioxidant properties of biscuits. Acceptable biscuits were obtained when incorporating 10% WGP. CONCLUSION: WGP might be utilised for the novel formulation of biscuits as an alternative source of dietary fibre and phenols.

The cost-effectiveness of mandatory folic acid fortification in Australia.

The Australian government recently introduced mandatory folic acid fortification of bread to reduce the incidence of neural tube defects (NTDs). The economic evaluation of this policy contained a number of limitations. This study aimed to address the limitations and to reconsider the findings. Cost-effectiveness analysis was used to assess the cost and benefits of mandatory versus voluntary folic acid fortification. Outcomes measures were quality-adjusted life-years (QALYs), life-years gained (LYG), avoided NTD cases, and additional severe neuropathy cases. Costs considered included industry costs and regulatory costs to the government. It was estimated that mandatory fortification would prevent 31 NTDs, whereas an additional 14 cases of severe neuropathy would be incurred. Overall, 539 LYG and 503 QALYs would be gained per year of mandatory compared with voluntary fortification. Mandatory fortification was cost-effective at A$10,723 per LYG and at A$11,485 per QALY. Probabilistic sensitivity analysis showed that at A$60,000 and A$151,000 per QALY, the probability that mandatory fortification was the most cost-effective strategy was 79% and 85%, respectively. Threshold analysis of loss of consumer choice indicated that with a compensation value above A$1.21 [assuming a willingness to pay (WTP) threshold of A$60,000 per QALY] or A$3.19 (assuming a WTP threshold of A$151,000 per statistical life-year) per capita per year mandatory fortification would not be cost-effective. Mandatory fortification was found to be cost-effective; however, inclusion of the loss of consumer choice can change this result. Even with mandatory fortification, mean folate intake will remain below the recommended NTD preventive level.

Optimization of iodine intake in Belgium.

Mild iodine deficiency (MID) is a long-standing problem in Belgium and was recognized only recently as public health issue by the Ministry of Health (MOH). The main MID-related health problems in Belgium are a high prevalence of thyroid nodules and multinodular goiter. The economic cost of thyroid nodular disease only in Belgium was estimated at about €40 millions per year. The Belgian health authorities adopted a selective strategy to optimize iodine intake through the fortification of bread with iodized salt. A progressive, step-by-step increase of the iodine content of salt was chosen in order to minimize the incidence of hyperthyroidism. MOH monitors this strategy by assessing periodically the urinary iodine concentration in school-aged children and pregnant women, as well as by a yearly follow-up of TSH concentrations in all Belgian newborns. Although the implementation of this strategy was an important step, the main drawback of the current situation is the absence of a legal framework to support the strategy. The utilization of iodized salt in bread on a voluntary basis was endorsed by the bakery industry and MOH. However a legal framework is required to assure the effectiveness and continuity of the program and to avoid a higher than optimal iodine intake in the population.

Survey of aflatoxins in maize tortillas from Mexico City.

In Mexico, maize tortillas are consumed on a daily basis, leading to possible aflatoxin exposure. In a survey of 396 2-kg samples, taken over four sampling days in 2006 and 2007 from tortilla shops and supermarkets in Mexico City, aflatoxin levels were quantified by HPLC. In Mexico, the regulatory limit is 12 µg kg⁻¹ total aflatoxins for maize tortillas. In this survey, 17% of tortillas contained aflatoxins at levels of 3-385 µg kg⁻¹ or values below the limit of quantification (12 µg kg⁻¹ and 87% were below the regulatory limit. Average aflatoxin concentrations in 56 contaminated samples were: AFB1 (12.1 µg kg⁻¹); AFB2 (2.7 µg kg⁻¹); AFG1 (64.1 µg kg⁻¹) and AFG2 (3.7 µg kg⁻¹), and total AF (20.3 µg kg⁻¹).

[Genetic analysis of contribution of low-molecular-weight glutenin subunits to dough strength in common wheat].

Locus-specific primers of low-molecular-weight glutenin subunit (LMW-GS) genes and gliadin bands tightly linked to LMW-GS genes were analyzed to evaluate the effect of LMW-GS genes on dough strength in common wheat (Triticum aestivum L.). Analysis of the F9 progeny from two crosses '99G45/Jing771' and 'Pm97034/J771' showed that the LMW-GS genes located at the Glu-B3 locus from the three parents had six Cysteine, but 'PB' (define) had a seven amino-acid deletion in the repetitive to 'GB' and 'JB' (define these abbreviations) and amino-acid substitution, two of which would be expected to cause changes in hydrophilicity.

Use of the think-aloud method to identify factors influencing purchase of bread and cereals by low-income African American women and implications for whole-grain education.

The think-aloud method was used to determine factors influencing bread and cereal purchase by low-income African American women that have implications for whole-grain education. Women (N=70) were audiotaped as they thought aloud while purchasing groceries. Because bread and cereal account for the majority of whole-grain products consumed, transcribed verbalizations regarding purchase of bread and cereals were analyzed using content analysis procedures. Cost, preferences, eating and buying habits, and nutrition were the most important factors that influenced purchase. Nutrition issues included a general desire to eat healthy foods and specific concerns about fat, calcium, and calories, but no mention of wanting to purchase whole-grain products. Whole-grain education should focus on identification of whole-grain products, health benefits, and low-cost and tasty whole-grain options for mothers and children.

Panis populi--bread and public health in Australia.

The 'standard loaf, 680 gm, white, supermarket-purchased' as expressed in the Consumer Price Index, is but the basic form of bread sold to the Australian public. In the public health context, three themes have been intimately associated with bread--quality control, price control and bread used as a vehicle for supplementary nutritive agents important in preventive medicine. Price control, through assizing, has been a feature of bread marketing in western communities for seven centuries; and bread remains the last item on which price control (although seldom enforced) exists in Australia. Quality control, for public health, is determined both by regulation and by the force of increasingly literate consumers, of whom women occupy the most important determinant. From the preventive medicine point of view, important themes in bread quality, such as its use to reduce laxative sales on the one hand and to reduce the demographic incidence of colonic cancer on the other, remains outside formal regulation. Australia is a relatively conservative nation in the context of nutritional additives. It was not until 1953 that the National Health and Medical Research Council approved the addition of extra B vitamins to bread. Currently, folic acid is added as a discretion to selected high-premium breakfast cereals in Australia in one attempt to reduce the incidence to neural tube defects. The addition of such ingredients to bread remains an unrealised, but potentially important aspect of preventive medicine in Australia.

Consumo de fibras de la dieta por el hombre y mujer tipo en la ciudad de La Paz / Fiberconsuption in the diet of men and women in the city of La Paz

Se estudio el consumo de fibras de la dieta en cada tiempo alimentario practicado por hombres y mujeres de 20 a 50 años de edad que viven permanentemente en area urbana de la ciudad de La Paz, los primeros ingieren en promedio de 4.8 grs/24 hrs. y las segundas 4.2 grs/24 hrs. La ingesta mas abundante resulto ser en el almuerzo en proporcion del 50 por ciento de la cantidad diaria. El salvado o cascara de cereales no se utilizo corrientemente en la composicion de las dietas. La fuente mas comun fue el pan de harina blanca refinada, luego en menor frecuencia legumbres y frutas y cereales enteros. Por lo tanto, es posible concluir que este tipo de dieta refinada estaria condicionando una determinada respuesta fisiologica del tracto gastrointestinal y la tendencia al desarrollo de patologias relacionadas.