Measuring Food Culture: a Tool for Public Health Practice.

PURPOSE OF REVIEW: Food culture is a ubiquitous aspect of all societies. This review provides an overview of methods for measuring food culture, and emphasizes the importance of these measures not just for description, but also for strengthening public health practice, primarily through the development of better interventions; to monitor and evaluate changes in diet and nutrition; and for the development of strategies for sustainability and dissemination. RECENT FINDINGS: Food culture measurement has enriched public health practice through its use of myriad approaches, including interviews, cultural domain analysis, visual methods, observation, time allocation studies, focus groups and community workshops, household studies, and textual analysis. Food culture measurement is essential for public health practice related to food and nutrition, and can lead to, among other outcomes, improved implementation research in nutrition, understanding household dynamics that impact nutritional outcomes, innovative textual analysis to identify food culture through language, and the selection of interventions conveyed through multiple strategies, including digital means, such as via social media.

Using Sensory Science to Evaluate Consumer Acceptance of Recipes in a Nutrition Education Intervention for Limited Resource Populations.

OBJECTIVE: This study evaluated consumer acceptance of recipes in a nutrition education intervention and assessed participants' intentions to change dietary behaviors. DESIGN: Study participants tasted and evaluated 16 recipes in the University of Georgia Food Talk curriculum using the 9-point hedonic scale and indicated their likelihood of engaging in behaviors to improve diet quality on a similar, ordinal scale. SETTING AND PARTICIPANTS: Convenience samples of 89 to 122 adult participants in the Expanded Food and Nutrition Education Program in Georgia evaluated each recipe. INTERVENTION: Eight interactive nutrition education sessions in which study participants sampled and evaluated 2 recipes per session. MAIN OUTCOME MEASURES: Mean scores for overall liking of each recipe and likelihood of engaging in promoted behaviors to improve diet quality were outcomes of interest. ANALYSIS: Descriptive statistics were generated. Relationships between overall liking of recipes and intention to engage in promoted behaviors were assessed with Spearman correlation coefficients. RESULTS: Results showed that 13 of the 16 recipes in the curriculum met criteria for acceptable sensory quality. Overall liking was significantly correlated with participants' intentions to engage in behaviors to improve diet quality. Notable age- and sex-related differences were identified. CONCLUSIONS AND IMPLICATIONS: Evaluations of consumer acceptance may be useful in interventions designed to improve diet quality through the introduction of new recipes as improving consumer acceptance of recipes may improve program outcomes.

Current nutritional status assessment tools for metabolic care and clinical nutrition.

PURPOSE OF REVIEW: The aim of this report is to critically review existing questionnaires and tools to assess nutritional status in different populations and pathological conditions. RECENT FINDINGS: A total of 16 instruments to evaluate nutritional status were recorded, which were based on anthropometrical determinations, biochemical markers, clinical examinations and subjective questionnaires, depending on the nutritional assessment focus, involving different concepts: screening of the risk, diagnosis and severity of malnutrition, as well as the consequences of undernutrition or overnutrition. SUMMARY: A variety of questionnaires, equations and tools were found with ability to assess nutritional status for metabolic care or clinical nutrition purposes, but apparently there is no optimal, universal and reliable nutritional status screening system for all metabolic conditions. Novel assessment instruments should provide high sensibility and specificity, be precise and reliable as well as inexpensive and simple, in order to avoid the additional burden of excessive loads of costs, work and time while dynamically overcoming the influence of disease diversity.

Feasibility of Reviewing Digital Food Images for Dietary Assessment among Nutrition Professionals.

Validity of image-assisted and image-based dietary assessment methods relies on the accuracy of portion size estimation based on food images. However, little is known on the ability of nutrition professionals in assessing dietary intake based on digital food images. This study aims to examine the ability of nutrition professionals in reviewing food images with regard to food item identification and portion size estimation. Thirty-eight nutritionists, dietitians, and nutrition researchers participated in this study. Through an online questionnaire, participants' accuracy in identifying food items and estimating portion sizes of two sets of digital food images presenting a meal on a plate (Image PL) and in a bowl (Image BW) were tested. Participants reported higher accuracy in interpreting Image BW compared to Image PL, both in terms of accuracy in food identification (75.3 ± 17.6 vs. 68.9 ± 17.1%) and percentage difference in portion size estimation (44.3 ± 16.6 vs. 47.6 ± 21.2%). Weight of raw vegetables was significantly underestimated (-45.1 ± 22.8% vs. -21.2 ± 37.4%), while drink was significantly overestimated (40.1 ± 45.8% vs. 26.1 ± 32.2) in both images. Less than one-third of the participants estimated portion size within 10% of actual weight for Image PL (23.7%) and Image BW (32.3%). Accuracy of nutrition professionals in reviewing food images could be further improved with training on better perception of portion sizes from images.

Methodological approach to moving nutritional science evidence into practice.

The Metabolically Optimized Brain study explored nutritional science believed to be ready to place into practice to help improve US service members' cognitive performance and, thereby, optimize mission-readiness. A transparent, step-wise, research approach was used for informing evidence-based decisions among and for various, diverse stakeholders. A steering committee and subject-matter experts convened to devise the protocol and independent systematic reviews were performed to determine the quality of the evidence for nutritional science in 4 areas relevant to military populations: (1) caffeinated foods and beverages; (2) omega-3 polyunsaturated fatty acids; (3) plant-based foods and beverages or their phytochemical constituents; and (4) whole dietary patterns. A research expert panel was asked to then recommend future research directions and solutions likely to benefit warfighters. An implementation expert panel further considered how to apply sound nutritional science in a cost-effective manner. This article summarizes the methodological processes, high-level results, global research recommendations, and priorities for implementation. Specific results of the individual dietary interventions, as well as recommendations for moving this field of research and practice forward, are detailed throughout the current supplement.

Nutrient profiling for front of pack labelling: how to align logical consumer choice with improvement of products?

The primary goal of front of pack (FOP) labelling is to help consumers make healthier choices through communication. A secondary goal is to encourage producers to improve the nutritional composition of their products. Evidence has shown that (FOP) labelling can help consumers to make healthier food choices and has been an incentive for producers to improve product composition. As FOP labelling is seen as an important tool to improve food environments for public health purposes, the WHO supports initiatives of governments to implement an FOP labelling system. Based on the experiences of a wide range of countries over many years, possible success factors for such an FOP system have been defined, six of which are discussed in the present paper and used to evaluate the Dutch Choices Programme that was started in 2006. In the course of time a large number of producers joined the programme and the logo was recognised by more than 90 % of the consumers, but by 2016 the Dutch consumer organisation argued on the basis of their own research that a quarter of the consumers did not understand the colour coding of the logo and as a result the Dutch government decided to no longer support this logo and to introduce a nutrition app. The challenge that remains is to find a system that consumers understand well and that still encourages manufacturers of food to improve product composition. New technology-based data collecting initiatives might provide the right tools to develop such a system.

Nutrient profiling for regulatory purposes.

In this paper, I first provide definitions of nutrient profiling and of a nutrient profile model. I set out the purposes of nutrient profiling: both general and specific. I give two examples of nutrient profile models that have been developed for regulatory purposes by the Food Standards Agency (FSA) in the UK and the WHO for its European Region - the UK FSA/Ofcom and the WHO-Euro models - and compare the way the models are constructed and function, how they have been developed, the extent to which they have been tested and validated and their use in regulation. Finally I draw some conclusions about the future use of nutrient profiling for regulatory purposes. I argue that its full potential has yet to be realised and give some reasons why. I pose some urgent research questions with respect to nutrient profiling.

Uses of nutrient profiling to address public health needs: from regulation to reformulation.

Nutrient profiling (NP) models rate the nutritional quality of individual foods, based on their nutrient composition. Their goal is to identify nutrient-rich foods, generally defined as those that contain more nutrients than calories and are low in fat, sugar and salt. NP models have provided the scientific basis for evaluating nutrition and health claims and regulating marketing and advertising to children. The food industry has used NP methods to reformulate product portfolios. To help define what we mean by healthy foods, NP models need to be based on published nutrition standards, mandated serving sizes and open-source nutrient composition databases. Specifically, the development and testing of NP models for public health should follow the seven decision steps outlined by the European Food Safety Authority. Consistent with this scheme, the nutrient-rich food (NRF) family of indices was based on a variable number of qualifying nutrients (from six to fifteen) and on three disqualifying nutrients (saturated fat, added sugar, sodium). The selection of nutrients and daily reference amounts followed nutrient standards for the USA. The base of calculation was 418·4 kJ (100 kcal), in preference to 100 g, or serving sizes. The NRF algorithms, based on unweighted sums of percent daily values, subtracted negative (LIM) from positive (NRn) subscores (NRn - LIM). NRF model performance was tested with respect to energy density and independent measures of a healthy diet. Whereas past uses of NP modelling have been regulatory or educational, voluntary product reformulation by the food industry may have most impact on public health.

From the SAIN,LIM system to the SENS algorithm: a review of a French approach of nutrient profiling.

Nutrient profiling aims to classify or rank foods according to their nutritional composition to assist policies aimed at improving the nutritional quality of foods and diets. The present paper reviews a French approach of nutrient profiling by describing the SAIN,LIM system and its evolution from its early draft to the simplified nutrition labelling system (SENS) algorithm. Considered in 2010 by WHO as the 'French model' of nutrient profiling, SAIN,LIM classifies foods into four classes based on two scores: a nutrient density score (NDS) called SAIN and a score of nutrients to limit called LIM, and one threshold on each score. The system was first developed by the French Food Standard Agency in 2008 in response to the European regulation on nutrition and health claims (European Commission (EC) 1924/2006) to determine foods that may be eligible for bearing claims. Recently, the European regulation (EC 1169/2011) on the provision of food information to consumers allowed simplified nutrition labelling to facilitate consumer information and help them make fully informed choices. In that context, the SAIN,LIM was adapted to obtain the SENS algorithm, a system able to rank foods for simplified nutrition labelling. The implementation of the algorithm followed a step-by-step, systematic, transparent and logical process where shortcomings of the SAIN,LIM were addressed by integrating specificities of food categories in the SENS, reducing the number of nutrients, ordering the four classes and introducing European reference intakes. Through the French example, this review shows how an existing nutrient profiling system can be specifically adapted to support public health nutrition policies.

Nutrition Society of New Zealand Annual Conference Held in Christchurch, New Zealand, 8-9 December 2016.

Background: Economic(structural)factors,includingincomeandfoodprice,maypartiallyexplain socioeconomic inequalities in diet quality, obesity and health outcomes. Internationally, healthy foods and dietary patterns tend to cost more than less healthy options. Calories from energy-dense foods (refined grains, fats/oils, added sugars) are relatively low cost; whereas, calories from nutrient-rich foods(freshfruits/vegetables,leanmeats/chicken)arerelativelyhighcost. Greatervarietyandcultural acceptability also increases food costs. The NZ Food Cost Survey has been monitoring retail food prices for a weekly basket of healthy food in New Zealand since 1972. In 2014 methodological updates ensured food types and amounts were culturally acceptable and achieved both dietary guidelines and nutrient requirements. Methods: The availability and retail price (ignoring 'specials') of 161 foods in four large supermarketsinAuckland,Wellington,ChristchurchandDunedinwererecordedannually. Theweekly estimated food costs for individuals following a basic (cooked from scratch), moderate and liberal diet were calculated by city. Results: Auckland 'basic' healthy food costs ranged from $27 (1 year old) to $67 (adolescent male) per week in 2016. For example, an Auckland household of four, basic healthy food costs were $233 per week (man $64, woman $55, adolescent boy $67, 10 years old $47), which is 41% of a full-time (pre-tax) income on the minimum wage. Most of this cost came from fruits/vegetables (30%), meats/proteins (27%) and dairy (17%). While food prices in New Zealand fell slightly in 2016, food costs have been rising over time. Full results are reported elsewhere (http://www.otago.ac.nz/humannutrition/ research/food-cost-survey). Conclusions: Threatstohealthyfoodaffordabilityincludeinadequateincomes(risingunemployment, declining real wages/benefits due to rising housing and other costs), reduced food supply (global climate change impacts), and increased food demand (global food security, population growth, bio-fuels). These threats can be managed with sustainable environmental, agricultural/food chain, economic and social welfare policies [added].

Nutrient profiling for product reformulation: public health impact and benefits for the consumer.

The food industry holds great potential for driving consumers to adopt healthy food choices as (re)formulation of foods can improve the nutritional quality of these foods. Reformulation has been identified as a cost-effective intervention in addressing non-communicable diseases as it does not require significant alterations of consumer behaviour and dietary habits. Nutrient profiling (NP), the science of categorizing foods based on their nutrient composition, has emerged as an essential tool and is implemented through many different profiling systems to guide reformulation and other nutrition policies. NP systems should be adapted to their specific purposes as it is not possible to design one system that can equally address all policies and purposes, e.g. reformulation and labelling. The present paper discusses some of the key principles and specificities that underlie a NP system designed for reformulation with the example of the Nestlé nutritional profiling system. Furthermore, the impact of reformulation at the level of the food product, dietary intakes and public health are reviewed. Several studies showed that food and beverage reformulation, guided by a NP system, may be effective in improving population nutritional intakes and thereby its health status. In order to achieve its maximum potential and modify the food environment in a beneficial manner, reformulation should be implemented by the entire food sector. Multi-stakeholder partnerships including governments, food industry, retailers and consumer associations that will state concrete time-bound objectives accompanied by an independent monitoring system are the potential solution.

Use of a mixed-method approach to evaluate the implementation of retention promotion strategies in the New York State WIC program.

This research assessed the implementation of strategies piloted at 10 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics aimed at increasing retention in the program, by enhancing participants' shopping experiences. Under WIC Retention Promotion Study: Keep, Reconnect, Thrive (WIC RPS), clinics were recruited and assigned to implement one or a combination of strategies: a standardized Shopping Orientation (SO) curriculum, a Guided Shopping Tour (GST), and a Pictorial Foods Card (PFC) from November 2012 through August 2013. This paper presents results from the process evaluation of the retention strategies, using a mixed-methods comparative case study design employing WIC administrative data, interviews, and focus groups. Qualitative data were inductively coded, analyzed and mapped to the following implementation constructs: organizational capacity, fidelity, allowable adaptations, implementation challenges, and participant responsiveness, while quantitative data were analyzed using SAS to assess reach and dose. Several sites implemented the SO and PFC interventions with the necessary fidelity and dose needed to assess impact on participants' shopping experiences. Sites that were assigned the GST strategy struggled to implement this strategy. However, use of the standardized SO enabled staff to use a "consistent list of shopping tips" to educate participants about the proper use of checks, while use of the PFC increased participants' awareness of the variety of WIC-allowable foods. During follow-up telephone calls, 91 percent of participants reported the shopping tips as helpful. Future analyses will assess the impact of enhanced shopping experience on retention at intervention sites.

New mobile methods for dietary assessment: review of image-assisted and image-based dietary assessment methods.

For nutrition practitioners and researchers, assessing dietary intake of children and adults with a high level of accuracy continues to be a challenge. Developments in mobile technologies have created a role for images in the assessment of dietary intake. The objective of this review was to examine peer-reviewed published papers covering development, evaluation and/or validation of image-assisted or image-based dietary assessment methods from December 2013 to January 2016. Images taken with handheld devices or wearable cameras have been used to assist traditional dietary assessment methods for portion size estimations made by dietitians (image-assisted methods). Image-assisted approaches can supplement either dietary records or 24-h dietary recalls. In recent years, image-based approaches integrating application technology for mobile devices have been developed (image-based methods). Image-based approaches aim at capturing all eating occasions by images as the primary record of dietary intake, and therefore follow the methodology of food records. The present paper reviews several image-assisted and image-based methods, their benefits and challenges; followed by details on an image-based mobile food record. Mobile technology offers a wide range of feasible options for dietary assessment, which are easier to incorporate into daily routines. The presented studies illustrate that image-assisted methods can improve the accuracy of conventional dietary assessment methods by adding eating occasion detail via pictures captured by an individual (dynamic images). All of the studies reduced underreporting with the help of images compared with results with traditional assessment methods. Studies with larger sample sizes are needed to better delineate attributes with regards to age of user, degree of error and cost.

Providing evidence to support the development of whole grain dietary recommendations in the United Kingdom.

Observational evidence suggests that increased whole grain (WG) intake reduces the risks of many non-communicable diseases, such as CVD, type 2 diabetes, obesity and certain cancers. More recently, studies have shown that WG intake lowers all-cause and cause-specific mortality. Much of the reported evidence on risk reduction is from US and Scandinavian populations, where there are tangible WG dietary recommendations. At present there is no quantity-specific WG dietary recommendation in the UK, instead we are advised to choose WG or higher fibre versions. Despite recognition of WG as an important component of a healthy diet, monitoring of WG intake in the UK has been poor, with the latest intake assessment from data collected in 2000-2001 for adults and in 1997 for children. To update this information we examined WG intake in the National Diet and Nutrition Survey rolling programme 2008-2011 after developing our database of WG food composition, a key resource in determining WG intake accurately. The results showed median WG intakes remain low in both adults and children and below that of countries with quantity-specific guidance. We also found a reduction in C-reactive protein concentrations and leucocyte counts with increased WG intake, although no association with other markers of cardio-metabolic health. The recent recommendations by the UK Scientific Advisory Committee on Nutrition to increase dietary fibre intake will require a greater emphasis on consuming more WG. Specific recommendations on WG intake in the UK are warranted as is the development of public health policy to promote consumption of these important foods.

Driving Along the Zinc Road.

After having written hundreds of research articles, reviews, and book chapters, I find it awkward to pen an autobiography. I still do use a pen. As stated by others in the nutrition field who have written of their own experiences in a perspective article for the Annual Review of Nutrition, my course through this field of science has been serendipitous. My interest in nutrition developed during my experiences with horses and then Angus cattle and entry into an animal science degree program. As the age of molecular biology was unfolding, I pursued a PhD in nutritional biochemistry with Hamilton Eaton at the University of Connecticut followed by postdoctoral work with Hector DeLuca at the University of Wisconsin, working on vitamins A and D, respectively. At Rutgers University, one of the two institutions where I have served on the faculty, I started my research program on trace elements with a focus on cadmium toxicity but soon thereafter began my research on zinc metabolism and function. I moved to the University of Florida in 1982 for an endowed position and have been a Florida Gator ever since. At the University of Florida, research expanded to include identification of zinc-responsive genes and physiological outcomes of zinc transport influencing health and disease, particularly as related to inflammation. I had the opportunity to contribute national science policy as president of both the Federation of American Societies for Experimental Biology and the American Society for Nutrition. As the time of this writing, I maintain an active laboratory.

A unifying vision for scientific decision making: the Academy of Nutrition and Dietetics' Scientific Integrity Principles.

In 2014, recognizing the need to have a single document to guide scientific decision making at the Academy of Nutrition and Dietetics (Academy), the Council on Research was charged with developing a scientific integrity policy for the organization. From the Council on Research, four members volunteered to lead this workgroup, which reviewed the literature and best practices for scientific integrity from well-respected organizations, including federal funders of research. It became clear that the scope of this document would be quite broad, given the many scientific activities the Academy is involved in, and that it would be unreasonable to set policy for each of these many situations. Therefore, the workgroup set about defining the scope of scientific activities to be covered and envisioned a set of guiding principles, to which policies from every organizational unit of the Academy could be compared to ensure they were in alignment. While many relevant policies exist already, such as the requirement of a signed conflict of interest disclosure for Food & Nutrition Conference & Expo speakers, the Evidence Analysis Library funding policy, and the Academy's sponsorship policy, the scientific integrity principals are unique in that they provide a unifying vision to which future policies can be compared and approved based on their alignment with the principles. The six principles outlined in this article were approved by the full Council on Research in January 2015 and approved by the Academy's Board of Directors in March 2015. This article covers the scope of the principles, presents the principles and existing related resources, and outlines next steps for the Academy to review and revise current policies and create new ones in alignment with these principles.