Do promotions of healthier or more sustainable foods increase sales? Findings from three natural experiments in UK supermarkets.

BACKGROUND: Dietary changes are necessary to improve population health and meet environmental sustainability targets. Here we analyse the impact of promotional activities implemented in UK supermarkets on purchases of healthier and more sustainable foods. METHODS: Three natural experiments examined the impact of promotional activities on sales of a) no-added-sugar (NAS) plant-based milk (in 199 stores), b) products promoted during 'Veganuary' (in 96 stores), and c) seasonal fruit (in 100 non-randomised intervention and 100 matched control stores). Data were provided on store-level product sales, in units sold and monetary value (£), aggregated weekly. Predominant socioeconomic position (SEP) of the store population was provided by the retailer. Analyses used interrupted time series and multivariable hierarchical mixed-effects models. RESULTS: Sales of both promoted and total NAS plant-based milks increased significantly during the promotional period (Promoted:+126 units, 95%CI: 105-148; Overall:+307 units, 95%CI: 264-349). The increase was greater in stores with predominately low SEP shoppers. During Veganuary, sales increased significantly for plant-based foods on promotion (+60 units, 95%CI: 37-84), but not for sales of plant-based foods overall (dairy alternatives: -1131 units, 95%CI: -5821-3559; meat alternatives: 1403 units, 95%CI: -749-3554). There was no evidence of a change in weekly sales of promoted seasonal fruit products (assessed via ratio change in units sold: 0.01, 95%CI: 0.00-0.02), and overall fruit category sales slightly decreased in intervention stores relative to control (ratio change in units sold: -0.01, 95%CI: -0.01-0.00). CONCLUSION: During promotional campaigns there was evidence that sales of plant-based products increased, but not seasonal fruits. There was no evidence for any sustained change beyond the intervention period.

Association between meal context and meal quality: an ecological momentary assessment in Japanese adults.

PURPOSE: The purpose was to assess the relationship between the quality of meals and its context. METHODS: We conducted a cross-sectional study of 222 Japanese adults aged 30-76 years in 2021. The following information was obtained from the 4-d weighed dietary records: the recording day (working or not), meal type (breakfast, lunch, or dinner), eating companions (alone or with someone), eating location (at home or away from home), and screen-based activity (yes or no). The nutritional quality of each meal was evaluated using the Healthy Eating Index 2020 (HEI-2020). RESULTS: The analysis included 1,295 meals for males and 1,317 for females. The mean HEI-2020 ranged from 43.0 (lunch) to 51.9 (dinner) in males and from 45.7 (breakfast) to 52.0 (dinner) in females. Multilevel linear regression showed that, in males, lunch had a significantly lower HEI-2020 score compared to breakfast (ß = -1.81, 95% confidence interval [CI]: -3.42, - 0.20), while dinner had a significantly higher HEI-2020 score (ß = 6.77, 95% CI: 5.34, 8.20). Eating with someone was significantly associated with a higher HEI-2020 score (ß = 2.22, 95% CI: 0.76, 3.67). Among females, dinner had a higher HEI-2020 score than breakfast (ß = 5.21, 95% CI: 3.72, 6.70). Eating away from home was associated with higher HEI-2020 scores (ß = 2.14, 95% CI: 0.04, 4.24). CONCLUSION: Meal type, location, and eating companions were associated with meal quality in this population, with differences between males and females. Incorporating these factors in nutrition education and interventions can enhance diet quality.

Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income.

INTRODUCTION: Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. METHODS: The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected. RESULTS: A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities. CONCLUSIONS: Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.

Food Insecurity and Changes in Diet Quality and Body Mass Index z-Scores Among Elementary School Students.

Background: Previous research has identified food insecurity as a risk factor for obesity but those studies employed cross-sectional designs and were largely focused on adults and young children. In addition, there is a paucity of studies examining the association between food insecurity and changes in children's overall diet quality. This study aimed to assess whether food insecurity is associated with subsequent changes in diet quality and BMI z-scores over 2 years among 7- to 12-year-old children. Methods: We used 2011-2019 secondary data (n = 404) from three randomized controlled trials in Minnesota. Food insecurity was identified using the U.S. Household Food Security Survey Module at baseline (Time 0). Diet quality was determined using the Healthy Eating Index (HEI)-2015 from 24-hour recalls, and BMI z-scores were calculated using measured height and weight. These two outcomes were measured at Time 0, Time 1 (10-12 months from Time 0), and Time 2 (15-24 months from Time 0). Results: Compared with children from food-secure households, those from food-insecure households experienced a 0.13 greater increase in BMI z-scores from Time 0 to Time 2 [95% confidence interval (CI): 0.04 to 0.21] and a 4.5 point increase in HEI-2015 from Time 0 to Time 1 (95% CI: 0.99 to 8.01). Conclusion: Household food insecurity may widen weight disparities among elementary school-aged children. Further studies are needed to identify the role of diet quality in weight changes among children with food insecurity. Clinical Trial Registration Number: NCT01538615, NCT02029976, NCT02973815.

The Intake of Phosphorus and Nitrites through Meat Products: A Health Risk Assessment of Children Aged 1 to 9 Years Old in Serbia.

This study provides the data on dietary exposure of Serbian children to nitrites and phosphorus from meat products by combining individual consumption data with available analytical data of meat products. A total of 2603 and 1900 commercially available meat products were categorized into seven groups and analysed for nitrite and phosphorous content. The highest mean levels of nitrite content, expressed as NaNO2, were found in finely minced cooked sausages (40.25 ± 20.37 mg/kg), followed by canned meat (34.95 ± 22.12 mg/kg) and coarsely minced cooked sausages (32.85 ± 23.25 mg/kg). The EDI (estimated daily intake) of nitrites from meat products, calculated from a National Food Consumption Survey in 576 children aged 1-9 years, indicated that the Serbian children population exceeded the nitrite ADI (acceptable daily intake) proposed by EFSA (European Food Safety Authority) in 6.4% of children, with a higher proportion in 1-3-year-old participants. The mean phosphorus concentration varied from 2.71 ± 1.05 g/kg to 6.12 ± 1.33 g/kg in liver sausage and pate and smoked meat products, respectively. The EDI of phosphorus from meat products was far below the ADI proposed by EFSA, indicating that the use of phosphorus additives in Serbian meat products is generally in line with legislation.

Nutritional Analysis of Foods and Beverages Posted in Social Media Accounts of Highly Followed Celebrities.

Importance: Celebrity social media posts engage millions of young followers daily, but the nutritional quality of foods and beverages in such posts, sponsored and unsponsored, is unknown. Objective: To quantify the nutritional quality of foods and beverages depicted in social media accounts of highly followed celebrities and assess whether nutritional quality is associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Design, Setting, and Participants: This cross-sectional study analyzed the content of food- and beverage-containing posts from Instagram (a photo- and video-sharing social media platform) accounts of 181 highly followed athletes, actors, actresses, television personalities, and music artists. Data were collected from May 2019 to March 2020. Main Outcomes and Measures: The nutritional quality of foods and beverages posted in celebrity social media accounts was rated using the Nutrient Profile Index (NPI) based on the sugar, sodium, energy, saturated fat, fiber, protein, and fruit and/or vegetable content per 100-g sample (a score of 0 indicated least healthy and 100, healthiest); foods with scores less than 64 and beverages with scores less than 70 were rated as "less healthy." Secondary outcomes were whether the nutritional quality of foods and beverages in social media posts was associated with post sponsorship, celebrity profession or gender, and followers' likes and comments. Mixed-effects regression models were used to estimate how outcomes differed across fixed effects. Results: The sample included social media accounts of 181 celebrities (66 actors, actresses, and television personalities [36.5%]; 64 music artists [35.4%]; and 51 athletes [28.2%]). A total of 102 celebrities (56.4%) were male, and the median age was 32 years (range, 17-73 years). Among 3065 social media posts containing 5180 total foods and beverages (2467 foods [47.6%]; 2713 beverages [52.4%]), snacks and sweets (920 [37.3%] of the foods) and alcoholic beverages (1375 [50.7%] of the beverages) were most common. Overall, 158 celebrity social media accounts (87.3%) earned a less healthy overall food nutrition score and 162 (89.5%) earned a less healthy overall beverage nutrition score, which would be unhealthy enough to fail legal youth advertising limits in the UK. For foods, social media posts with healthier nutrition scores were associated with significantly fewer likes (b, -0.003; 95% CI, -0.006 to 0.000; P = .04) and comments (b, -0.006; 95% CI, -0.009 to -0.003; P < .001) from followers. For beverages, nutrition scores were not significantly associated with likes (b, -0.010; 95% CI, -0.025 to 0.005; P = .18) or comments (b, -0.003; 95% CI, -0.022 to 0.016; P = .73). Only 147 food- or beverage-containing posts (4.8%) were sponsored by food- or beverage-relevant companies. Beverages in sponsored posts contained more than twice as much alcohol as those in nonsponsored posts (10.8 g [95% CI, 9.3 g to 12.3 g] per 100 g of beverage vs 5.3 g [95% CI, 4.7 g to 5.9 g] per 100 g of beverage). Conclusions and Relevance: In this cross-sectional study, most highly followed celebrity social media accounts depicted an unhealthy profile of foods and beverages, primarily in nonsponsored posts. These results suggest that influential depictions of unhealthy food and beverage consumption on social media may be a sociocultural problem that extends beyond advertisements and sponsorships, reinforcing unhealthy consumption norms.

Academy of Nutrition and Dietetics Nutrition Research Network: The Saqmolo' Project Rationale and Study Protocol for a Randomized Controlled Trial Examining the Influence of Daily Complementary Feeding of Eggs on Infant Development and Growth in Guatemala.

Adequate nutrition during the complementary feeding period is critical for optimal child growth and development and for promoting long-term educational attainment and economic potential. To prioritize limited public health resources, there is a need for studies that rigorously assess the influence of multicomponent integrated nutrition interventions in children younger than age 2 years in different contexts. This study aimed to describe the rationale and protocol for the Saqmolo' Project using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. The Saqmolo' (ie, "egg" in the Mayan language, Kaqchiquel) Project is an individually randomized, partially blinded, controlled comparative effectiveness trial to evaluate the influence of adding delivery of a single whole egg per day to local standard nutrition care (ie, growth monitoring, medical care, deworming medication, multiple micronutrient powders for point-of-use food fortification [chispitas], and individualized complementary and responsive feeding education for caregivers) for 6 months, compared with the local standard nutrition care package alone, on child development, growth, and diet quality measures in rural indigenous Mayan infants aged 6 to 9 months at baseline (N = 1,200). The study is being executed in partnership with the Wuqu' Kawoq/Maya Health Alliance, a primary health care organization located in central Guatemala. Primary outcomes for this study are changes in global development scores, assessed using the Guide for Monitoring Global Development and the Caregiver Reported Child Development Instruments. Secondary outcomes include changes in infant hemoglobin, anthropometric measures (including z scores for weight for age, length for age, weight for length, and head circumference for age), and diet quality as measured using the World Health Organization's infant and young child feeding indicators. The results of the Saqmolo' Project may help to inform public health decision making regarding resource allocation for effective nutrition interventions during the complementary feeding period.

Diet Quality Assessment and the Relationship between Diet Quality and Cardiovascular Disease Risk.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in the U.S. and globally. Dietary risk factors contribute to over half of all CVD deaths and CVD-related disability. The aim of this narrative review is to describe methods used to assess diet quality and the current state of evidence on the relationship between diet quality and risk of CVD. The findings of the review will be discussed in the context of current population intake patterns and dietary recommendations. Several methods are used to calculate diet quality: (1) a priori indices based on dietary recommendations; (2) a priori indices based on foods or dietary patterns associated with risk of chronic disease; (3) exploratory data-driven methods. Substantial evidence from prospective cohort studies shows that higher diet quality, regardless of the a priori index used, is associated with a 14-29% lower risk of CVD and 0.5-2.2 years greater CVD-free survival time. Limited evidence is available from randomized controlled trials, although evidence shows healthy dietary patterns improve risk factors for CVD and lower CVD risk. Current dietary guidance for general health and CVD prevention and management focuses on following a healthy dietary pattern throughout the lifespan. High diet quality is a unifying component of all dietary recommendations and should be the focus of national food policies and health promotion.

Development of a Food-Based Diet Quality Scale for Brazilian Schoolchildren Using Item Response Theory.

Item response theory (IRT) is a psychometric method that provides probabilistic model-based measurements. Its use is relatively recent in the assessment of food consumption, especially through dietary assessment tools. This study aims (1) to develop a food-based diet quality scale for Brazilian schoolchildren using IRT, and (2) to apply the scale to a representative sample of schoolchildren from a Southern Brazilian city. The scale was developed with daily consumption frequency of foods from 835 students who completed the Food Intake and Physical Activity of Schoolchildren questionnaire. Questionnaire foods were grouped into 10 items according to their nutritional similarities and were evaluated by full-information factor analysis that indicated a dominant factor explaining 28% of the variance. Psychometric item analysis was performed using Samejima's model. The scale covered all levels of diet quality, from "very poor" (scores < 95) to "very good" (scores ≥ 130). Children who had higher diet quality scores consumed beans, meat, fish, eggs, fruits, vegetables, dairy products, and water more frequently, while reducing the consumption of ultraprocessed sugary foods, ultraprocessed savoury snacks and sausages, and sugary drinks. Of 6323 children, an average of less than 10% consumed the highest diet quality scores (good or very good diet quality) and about 60% of children consumed low diet quality scores. The scale can be applied to other schoolchildren with the same measure precision.

Food Waste and Its Association with Diet Quality of Foods Purchased in South Florida.

The objective of this study was to explore the associations between food waste and the diet quality of foods purchased and with grocery purchasing behaviors. This was a cross-sectional study among 109 primary household food providers conducting primary shopping. Participants were recruited outside of local grocery stores and were asked to complete a survey assessing amounts of avoidable food waste and grocery purchasing behaviors. The diet quality of the foods purchased was assessed from grocery receipts using the Grocery Purchase Quality Index-2016 (GPQI-2016). Variables were associated using linear regression, analysis of covariance, and point biserial correlations. We found that fresh fruits (63%) and leafy greens (70%) were the foods that were the most wasted. The GPQI-2016 total score was significantly inversely associated with the total amount of food wasted (ß = -0.63; 95% CI: -1.14,-0.12) after adjusting for important confounders. The reason "food past the date printed on the package" was directly correlated with food wasted (r = 0.40; p < 0.01) but inversely correlated with GPQI-2016 score (r = -0.21; p = 0.04). Food wasted, but not the GPQI-2016 score, was significantly higher among those who grocery shop 2-4 times per week compared to 1 time every 1-2 weeks (p = 0.02). In conclusion, food waste is inversely associated with diet quality and directly associated with grocery purchasing frequency.

Association between Emotional Eating and Frequency of Unhealthy Food Consumption among Taiwanese Adolescents.

Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwan Adolescent to Adult Longitudinal Study (TAALS) were fitted into multivariate logistic regression models adjusted for sex, school type, Body Mass Index (BMI), eating while doing something, nutrition label reading, skipping breakfast, smoking, binge drinking, sedentary lifestyle, physical activity, peer and school support, and parental education level. Among the 18,461 participants (48.5% male and 51.5% female), those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18-2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12-2.49), processed meat products (OR = 1.92, 95% CI: 1.78-2.08), dessert foods (OR = 2.49, 95% CI: 2.31-2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70-1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups. In conclusion, adolescents with high emotional eating were more likely to report frequent consumption of unhealthy foods in Taiwan. Our findings showed that male participants appeared to consume fast foods, high-fat snacks, processed meat, and SSBs more often and dessert foods less often than females. Future longitudinal studies are recommended for understanding the causal relationship between emotional eating and unhealthy food consumption.

Influence of COVID-19 Pandemic Restrictions on College Students' Dietary Quality and Experience of the Food Environment.

The COVID-19 pandemic restrictions sent college students online and off campus, potentially reducing access to healthy food. The objective of this cross-sectional, internet-based study was to use qualitative and quantitative survey methods to evaluate whether COVID-19 pandemic restrictions in Texas, USA affected college students' ability to buy food, how/what they shopped for, how they prepared food, what they ate, how they felt about eating, and overall dietary quality (assessed using Healthy Eating Index [HEI] scores). Survey responses from 502 students (87.5% female; 59.6% nonwhite, mean age 27.5 ± 0.4 years, >50% graduate students) were analyzed. The qualitative analysis of open-ended questions revealed 110 codes, 17 subthemes, and six themes. Almost all students experienced changes in at least one area, the most common being changes in shopping habits. Participants with low or very low food security had lower HEI scores compared to food secure students (p = 0.047). Black students were more likely to report changes in their ability to buy food (p = 0.035). The COVID-19 restrictions varied in their impact on students' ability to access sufficient healthy food, with some students severely affected. Thus, universities should establish procedures for responding to emergencies, including identifying at-risk students and mobilizing emergency funds and/or food assistance.

Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet.

BACKGROUND: Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. OBJECTIVE: This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. DESIGN: This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls. PARTICIPANTS/SETTING: The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. MAIN OUTCOME MEASURES: A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. STATISTICAL ANALYSIS: Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. RESULTS: Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. CONCLUSIONS: In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.

Process Evaluation of a Farm-to-WIC Intervention.

BACKGROUND: Despite the promise of farm-to-institution interventions for addressing limited vegetable access as a barrier to intake, programs designed for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lacking. As such, little is known about the implementation of, and mechanisms of action through which, farm-to-WIC interventions affect vegetable intake and participant satisfaction with such programs. OBJECTIVE: To examine whether a farm-to-WIC intervention to promote vegetable intake was implemented as intended, differences between participants who received the intervention relative to those in a usual-care control group in intermediate outcomes of vegetable-related knowledge, attitudes, and behaviors, and secondary outcomes of physical activity and weight status; and participant satisfaction with the intervention. DESIGN: A process evaluation encompassing descriptive and comparative analyses of implementation fidelity logs and survey data collected as part of a pilot study was conducted. PARTICIPANTS/SETTING: The setting was a large, New Jersey-based, urban WIC agency. Recruited between June 3 and August 1, 2019 through 3 of the agency's 17 sites (1 intervention and 2 control sites), participants were 297 primarily Hispanic adults (160 enrolled at the intervention site and 137 at control sites). INTERVENTION: The intervention combined behaviorally focused instruction and handouts with the introduction of a WIC-based farmers' market, field trips to an area farmers' market, telephone coaching and support, and recipe demonstrations and tastings. MAIN OUTCOME MEASURES: Primary outcomes were vegetable intake (measured via self-report and objectively using dermal carotenoids as a biomarker of intake) and the redemption of vouchers provided by WIC for fruit and vegetable purchases at farmers' markets (measured objectively using data provided by WIC). For the process evaluation, logs were used to document program activities. Vegetable-related knowledge, attitudes, and behaviors, physical activity, and satisfaction with the intervention were assessed with participant questionnaires. Weight status was assessed with direct measures of height and weight. Data were collected at baseline and at mid- and post-intervention (3 and 6 months post-baseline, respectively). STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to characterize implementation fidelity. Associations between intermediate and secondary outcomes and vegetable intake were examined at baseline with Pearson correlations. Post-baseline between-group differences in the outcomes were examined with linear mixed-effects models adjusted for baseline values and covariates. Satisfaction with the intervention was assessed with inferential and thematic analyses. RESULTS: Post-intervention, measures of vegetable intake were higher in the intervention relative to the control study group. Receipt of the intervention was also associated with a greater likelihood of voucher redemption. Nearly all participants (≥94%) received the intervention as intended at the WIC-based farmers' market; smaller percentages completed 1 or more planned trips to the area farmers' market (28%) and telephone coaching and support calls (88%). Although most intermediate and secondary outcomes were associated with measures of vegetable intake at baseline, the variables did not differ between study groups post-intervention. Mean satisfaction ratings were ≥6.8 on a 7-point scale. Recipe demonstrations, learning about vegetables, field trips, and the rapport with staff were liked most about the program. Although adding days and times for field trips was suggested, limited market days and hours of operation limited the ability to do so. CONCLUSIONS: Preliminary data highlight the promise of this well-received intervention. Intermediate outcome findings suggest that other potential intervention mechanisms of action should be considered in future large-scale trials of this program. Broad-scale initiatives are needed to improve access to farmers' markets in underserved communities.

Association Between Diet Quality and Cardiometabolic Risk Factor Clustering Stratified by Socioeconomic Status Among Chinese Children.

BACKGROUND: Few studies have evaluated the long-term relationship between diet quality and cardiometabolic risk factor clustering among children. The moderating effect of socio-economic status (SES) is of interest. OBJECTIVE: To investigate the association between diet quality with cardiometabolic risk among Chinese children and to explore the moderating effect of SES. DESIGN: In this cohort study, 5 waves (1997-2009) of the China Health and Nutrition Survey were used. Diet quality was measured by a modified version of the Chinese Children Dietary Index (mCCDI) based on Dietary Guidelines for Chinese. PARTICIPANTS: Children between the ages of 7 and 17 (n = 2903) who completed at least 2 surveys were included. Those who missed measures or had hypertension or diabetes at baseline were excluded. MAIN OUTCOME MEASURES: The fasting blood samples were collected in 2009. Waist circumference (WC) and blood pressure (BP) were measured in each survey. STATISTICAL ANALYSIS PERFORMED: A continuous cardiometabolic risk score (MetScore) was derived by a confirmatory factor analysis of 5 components: WC, BP, glucose, triglycerides, and high-density lipoprotein cholesterol. Considering the latency period of the effect of behaviors, the mCCDI was lagged by the period between surveys. Linear regression was used to analyze the association of mCCDI with MetScore and its components. Mixed effect linear regression and lagged mCCDI were used for WC and BP models. RESULTS: Higher mCCDI was independently associated with a lower MetScore at follow-up (ß: -.11; 95% CI: -.18 to -.04). Higher lagged mCCDI over time was associated with a lower WC z score overall (ß: -.05; 95% CI: -.08 to -.01) and among children in the low SES group (ß: -.09; 95% CI: -.14 to -.04) but not those in the high SES group. When examining the 15 mCDDI components separately, scores for 5 components: more grains, vegetables, soybeans and its products; less sugar-sweetened beverages; and more diet variety were significantly associated with a lower MetScore. CONCLUSIONS: Among Chinese children, higher diet quality measured by mCCDI was independently associated with a lower MetScore at follow-up.

Trends in Food Sources and Diet Quality Among US Children and Adults, 2003-2018.

Importance: Time trends and population disparities in nutritional quality of foods from major US sources, including grocery stores, restaurants, schools, worksites, and other sources, are not well established. Objective: To investigate patterns and trends in diet quality by food sources among US children and adults overall and in sociodemographic subgroups. Design, Setting, and Participants: This serial, cross-sectional survey study included respondents from 8 National Health and Nutrition Examination Survey cycles (2003-2018) with valid dietary recalls. Data were analyzed from April 16, 2020, to July 20, 2020. Exposures: Survey cycle, food source, and key sociodemographic subgroups. Main Outcomes and Measures: Mean diet quality of foods (meals, snacks, and beverages) consumed per person, characterized by the American Heart Association diet score (range, 0-80, with higher scores indicating healthier diets), the Healthy Eating Index 2015 (range, 0-100, with higher scores indicating healthier diets), and their components. For the American Heart Association diet score, poor diet was defined as less than 40.0% adherence (score, <32.0), intermediate diet as 40.0% to 79.9% adherence (score, 32.0-63.9), and ideal as 80.0% or greater adherence (score, ≥64.0). Results: The study included 20 905 children 5 to 19 years of age (mean [SD] age, 12.1 [5.24] years; 51.0% male) and 39 757 adults 20 years or older (mean [SD] age, 47.3 [15.1] years; 51.9% female). Diet quality of foods consumed from grocery stores increased modestly in children (53.2% to 45.1% with poor diet quality; P = .006 for trend) and adults (40.1% to 32.9% with poor diet quality; P = .001 for trend), with smaller changes for restaurants among children (84.8% to 79.6% with poor diet quality; P = .003 for trend). Changes for restaurants among adults were not statistically significant (65.4% to 65.2% with poor diet quality; P = .07 with poor diet quality); the same was true of worksites (adults: 55.6% to 50.7% with poor diet quality; P = .25 for trend). Food quality from other sources worsened (children: 40.0% to 51.7% with poor diet quality; adults: 33.8% to 43.8% with poor diet quality; P < .001 for trend each). The largest improvement in diet quality was in schools, with the percentage with poor diet quality decreasing from 55.6% to 24.4% (P < .001 for trend), mostly after 2010, and with equitable improvements across population subgroups. Findings were similar for Healthy Eating Index 2015. Significant disparities in diet quality trends were seen by sex, race/ethnicity, educational level, and household income for food consumed from grocery stores. For example, the proportion of foods consumed from grocery stores that were of poor diet quality decreased among high-income adults (from 36.9% to 26.5%; P = .001 for trend) but not among low-income adults (from 45.8% to 41.3%; P = .09 for trend). Conclusions and Relevance: By 2017-2018, foods consumed at schools improved significantly and provided the best mean diet quality of major US food sources, without population disparities. Additional improvements are needed from all major US food sources, with particular attention on equity.

Trajectories of Eating Behaviour Changes during Adolescence.

Adolescence represents a critical transition phase during which individuals acquire eating behaviours that can track into adulthood. This study aims to characterise trends in eating behaviours throughout adolescence by investigating the presence of sub-groups of individuals presenting distinct trajectories of vegetable and fruit, sugary beverage, breakfast and fast-food consumption. Data from 744 MATCH study Canadian participants followed from 11 to 18 Years old (2013-2019) were included in the analyses. Participants reported how often they ate breakfast and consumed vegetables and fruits, sugary beverages and fast foods. Trajectories of eating behaviours over seven years were identified using group-based multi-trajectory modelling. For girls, three different groups were identified, namely 'stable food intake with a decline in daily breakfast consumption' (39.9%), 'moderate food intake and worsening in overall eating behaviours' (38.0%) and 'stable high food intake' (22.1%). For boys, five different groups were identified, namely 'low food intake with stable daily breakfast consumption' (27.3%), 'breakfast-skippers and increasing fast food intake' (27.1%), 'low food intake with a decline in daily breakfast consumption' (23.9%), 'high food intake with worsening of eating behaviours' (13.3%) and 'average food intake with consistently high breakfast consumption' (8.4%). Eating behaviours evolve through various distinct trajectories and sub-group-specific strategies may be required to promote healthy eating behaviours among adolescents.

Can Healthy and Sustainable Dietary Patterns That Fit within Current Dutch Food Habits Be Identified?

This study investigated major healthy and sustainable dietary patterns in the Dutch population. Two 24-hour dietary recalls were collected in 2078 participants aged 19-79 years in the Dutch National Food Consumption Survey 2012-2016. Dietary patterns were identified using reduced rank regression. Predictor variables were food groups and response variables were Dutch Healthy Diet index 2015 (DHD15-index) score, greenhouse gas emissions (GHGE), and blue water use. Three patterns were discovered, including a "high fruit and vegetable dietary pattern", a "low meat dietary pattern", and a "high dairy, low fruit juices dietary pattern". Diets in the highest quartile of these patterns had higher DHD15-index score than the average population. However, diets of the "high fruit and vegetable dietary pattern" were associated with higher dietary GHGE (14%) and blue water use (69.2%) compared to the average population. Diets of the "low meat dietary pattern" were associated with lower GHGE (19.6%) and higher blue water use (7.7%). Concluding, the "low meat dietary pattern" was the most healthy and sustainable dietary pattern in this population. The addition of blue water use as an environmental impact indicator shows the difficulty of finding existing dietary patterns that have low environmental impact in all determinants.

A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017-2020.

BACKGROUND: The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016-2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers' purchases and diets. METHODS: Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017-2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases ("bag checks"); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. RESULTS: There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1-12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores' HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. CONCLUSIONS: Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.