Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs.

BACKGROUND: A healthy lifestyle program that appeals to, and supports, overweight and obese New Zealand (NZ) European, Maori (indigenous) and Pasifika men to achieve weight loss is urgently needed. A pilot program inspired by the successful Football Fans in Training program but delivered via professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, adherence to healthy lifestyle behaviors, and cardiorespiratory fitness in overweight and obese men. A full effectiveness trial is now needed. AIMS: To determine the effectiveness and cost effectiveness of Rugby Fans In Training-NZ (RUFIT-NZ) on weight loss, fitness, blood pressure, lifestyle change, and health related quality of life (HRQoL) at 12- and 52-weeks. METHODS: We conducted a pragmatic, two-arm, multi-center, randomized controlled trial in NZ with 378 (target 308) overweight and obese men aged 30-65 years, randomized to an intervention group or wait-list control group. The 12-week RUFIT-NZ program was a gender-sensitised, healthy lifestyle intervention delivered through professional rugby clubs. Each intervention session included: i) a 1-h workshop-based education component focused on nutrition, physical activity, sleep, sedentary behavior, and learning evidence-based behavior change strategies for sustaining a healthier lifestyle; and 2) a 1-h group-based, but individually tailored, exercise training session. The control group were offered RUFIT-NZ after 52-weeks. The primary outcome was change in body weight from baseline to 52-weeks. Secondary outcomes included change in body weight at 12-weeks, waist circumference, blood pressure, fitness (cardiorespiratory and musculoskeletal), lifestyle behaviors (leisure-time physical activity, sleep, smoking status, and alcohol and dietary quality), and health-related quality of life at 12- and 52-weeks. RESULTS: Our final analysis included 200 participants (intervention n = 103; control n = 97) who were able to complete the RUFIT-NZ intervention prior to COVID-19 restrictions. At 52-weeks, the adjusted mean group difference in weight change (primary outcome) was -2.77 kg (95% CI -4.92 to -0.61), which favored the intervention group. The intervention also resulted in favorable significant differences in weight change and fruit and vegetable consumption at 12-weeks; and waist circumference, fitness outcomes, physical activity levels, and health-related quality of life at both 12 and 52 weeks. No significant intervention effects were observed for blood pressure, or sleep. Incremental cost-effective ratios estimated were $259 per kg lost, or $40,269 per quality adjusted life year (QALY) gained. CONCLUSION: RUFIT-NZ resulted in sustained positive changes in weight, waist circumference, physical fitness, self-reported physical activity, selected dietary outcomes, and health-related quality of life in overweight/obese men. As such, the program should be recommended for sustained delivery beyond this trial, involving other rugby clubs across NZ. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered 18 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376740 Universal Trial Number, U1111-1245-0645.

New Zealand household purchases of sugar-sweetened, artificially sweetened, and unsweetened beverages: 2015-2019.

OBJECTIVE: To assess annual household purchases of sugar-sweetened beverages (SSBs), artificially sweetened beverages (AFSBs), and unsweetened beverages (USBs) by household composition and income, and over time. DESIGN: Observational cohort study using beverage purchasing data linked to a supermarket database. ANOVA was used to compare total household purchase volumes (L) and the contribution of beverages purchased by category, household composition (size), household income (four categories from New Zealand (NZ) < $30 000 to > $90 000), and over time (trend from 2015 to 2019). SETTING: Aotearoa NZ. PARTICIPANTS: ∼1800 households in the NielsenIQ Homescan® market research panel. RESULTS: In 2019, the mean (sd) annual household purchase volume and relative contribution to total beverage volume of SSBs were 72·3 (93·0) L and 33 %, respectively. Corresponding values for AFSBs were 32·5 (79·3) L (15 %), and USBs were 112·5 (100·9) L (52 %). Larger households purchased more of all beverage types except AFSBs. Total purchases were similar by income, but households earning < $NZ 30 000 purchased fewer AFSBs and USBs (but not SSBs) than households earning > $NZ 90 000. Total and USB purchases were unchanged over time, but SSBs dropped by 5·9 L (P-trend = 0·04), and AFSBs increased by 5·3 L (P-trend = 0·00). CONCLUSIONS: USBs contributed the most to household beverage purchases. Total purchases were higher for larger households and similar by income, including for SSBs. The reduction over time was too small for health benefits. Findings support policies and interventions to reduce SSB consumption and highlight the importance of focusing on equitable outcomes.

Seven-year trends in the availability, sugar content and serve size of single-serve non-alcoholic beverages in New Zealand: 2013-2019.

OBJECTIVE: To assess trends in relative availability, sugar content and serve size of ready-to-drink non-alcoholic beverages available for sale in supermarkets from 2013 to 2019. DESIGN: Repeat cross-sectional surveys. Data on single-serve beverages to be consumed in one sitting were obtained from an updated brand-specific food composition database. Trends in beverages availability and proportions with serve size ≤ 250 ml were assessed by χ2 tests. Sugar content trends were examined using linear regressions. The proportion of beverages exceeding the sugar threshold of the United Kingdom Soft Drinks Industry Levy (SDIL) was assessed. SETTING: New Zealand. RESULTS: From 2013 to 2019, there was (i) an increase in the availability of sugar-free/low-sugar beverages (n 25 (8·4 %) to n 75 (19·1 %); P < 0·001) and craft sugar-sweetened soft drinks (n 11 (3·7 %) to n 36 (9·2 %); P < 0·001), and a decrease in availability of fruit/vegetable juices/drinks (n 94 (31·8 %) to n 75 (19·4 %); P < 0·001); (ii) small decreases in sugar content (mean g/100 ml) of sugar-sweetened soft drinks (3·03; 95 % CI 3·77, 2·29); fruit/vegetable juices/drinks (1·08; 95 % CI 2·14, 0·01) and energy drinks (0·98; 95 % CI 1·63, 0·32) and (iii) slight reduction in the proportion of beverages with serve size ≤ 250 ml (21·6 to 18·9 %; P < 0·001). In 2019, most beverages were sugar-sweetened or had naturally occurring sugars (79·1 %) and serve size > 250 ml (81·1 %) and most sugar-sweetened beverages exceeded the SDIL lower benchmark (72·9 %). CONCLUSIONS: Most single-serve beverages available for sale in 2019 were sugary drinks with high sugar content and large serve sizes; therefore, changes made across the years were not meaningful for population's health.

Impact of a voluntary industry code for advertising food to children and young people: an analysis of New Zealand television data.

OBJECTIVE: To evaluate the impact of the 2017 update to the voluntary Advertising Standards Authority (ASA) code for advertising food on children and young people's exposure to unhealthy food advertisements on New Zealand television. DESIGN: Audience ratings data were analysed for New Zealand children and young people's television viewing for eight random days prior to (June to August 2015) and following (October to December 2018) the code update, from 06.00 to midnight (864 h). Food advertisements were coded using three nutrient profiling models. The number of children and young people watching television each year was compared. SETTING: Three free-to-air New Zealand television channels. PARTICIPANTS: New Zealand children aged 5-18 years. RESULTS: Television viewer numbers decreased over the 3 years (P < 0·0001). The mean rate of unhealthy food advertising on weekdays was 10·4 advertisements/h (2015) and 9·5 advertisements/h (2018). Corresponding rates for weekend days were 8·1 and 7·3 advertisements/h, respectively. The percentage of food advertisements which were for unhealthy foods remained high (63·7 % on weekdays and 65·9 % on weekends) in 2018. The ASA definition of children's 'peak viewing time' (when 25 % of the audience are children) did not correspond to any broadcast times across weekdays and weekend days. CONCLUSIONS: Between 2015 and 2018, children and young people's television exposure to unhealthy food advertising decreased. However, almost two-thirds of all food advertisements were still unhealthy, and the updated ASA code excluded the times when the greatest number of children was watching television. Consequently, government regulation and regular monitoring should reflect the evolving food marketing environment.

Dietary patterns associated with meeting the WHO free sugars intake guidelines.

OBJECTIVE: Emerging evidence suggests that free sugars intake in many countries exceeds that recommended by the WHO. However, information regarding real-world dietary patterns associated with meeting the WHO free sugars guidelines is lacking. The current study aimed to determine dietary patterns associated with meeting the guidelines to inform effective free sugars reduction interventions in New Zealand (NZ) and similar high-income countries. DESIGN: Dietary patterns were derived using principal component analysis on repeat 24-h NZ Adult Nutrition Survey dietary recall data. Associations between dietary patterns and the WHO guidelines (<5 and <10 % total energy intake) were determined using logistic regression analyses. SETTING: New Zealand. PARTICIPANTS: NZ adults (n 4721) over 15 years old. RESULTS: Eight dietary patterns were identified: 'takeaway foods and alcohol' was associated with meeting both WHO guidelines; 'contemporary' was associated with meeting the <10 % guideline (males only); 'fast foods, sugar-sweetened beverages and dessert', 'traditional' and 'breakfast foods' were negatively associated with meeting both guidelines; 'sandwich' and 'snack foods' were negatively associated with the <5 % guideline; and 'saturated fats and sugar' was negatively associated with the <10 % guideline. CONCLUSIONS: The majority of NZ dietary patterns were not consistent with WHO free sugars guidelines. It is possible to meet the WHO guidelines while consuming a healthier ('contemporary') or energy-dense, nutrient-poor ('takeaway foods and alcohol') diet. However, the majority of energy-dense patterns were not associated with meeting the guidelines. Future nutrition interventions would benefit from focusing on establishing healthier overall diets and reducing consumption and free sugars content of key foods.

Do purchases of price promoted and generic branded foods and beverages vary according to food category and income level? Evidence from a consumer research panel.

Price is a key determinant of food choice, particularly for low-income households who may be more sensitive to price-lowering strategies such as price promotions and generic/retailer-owned brands. Price-lowering strategies may therefore represent important policy targets to improve population nutrition and reduce inequities. This study aimed to describe household purchasing patterns of price promoted and generic branded foods and beverages in New Zealand (2016-2017). One year of grocery purchase data from a national consumer research panel in New Zealand (n = 1778 households) were analysed. Purchases were classified by processing level and food type. Linear mixed models were fitted to estimate the mean proportion of annual household purchases (unique items and volumes (kg/L)) that were price promoted or generic branded (overall and by food category), and to assess whether purchasing patterns were modified by income level. On average, price promoted products constituted 50% (95%CIs; 49,51) of all unique annual household grocery items purchased. Fifty-nine percent (95%CIs; 58,60) of processed, 55% (95%CIs; 54,56) of ultra-processed, 45% (95%CIs; 44,46) of unprocessed and 45% (95%CIs; 44,46) of ingredient purchases were price promoted. By volume, the proportion of purchases that were price promoted was highest for meat (65%[95%CIs; 64,66]), sugar-sweetened beverages (64%[95%CIs; 62,65]), dairy foods (64%[95%CIs; 63,66]), confectionary (64%[95%CIs; 63,66]), snack foods (63%[95%CIs; 61,64]), oils (61%[95%CIs; 60,62]) and non-sugar-sweetened beverages (60%[95%CIs; 58,62]), and lowest for dairy beverages (30%[95%CIs; 28,31]), sugar/honey (33%[95%CIs; 32,35]) and sauces/spreads (39%[95%CIs; 37,40]). On average, generic brands constituted 10% (95%CIs; 9,10) of all household purchases. Overall, a significantly greater proportion of purchases made by low and middle-income households were price promoted and generic branded compared to high-income households (p < 0.001 for both), a pattern generally observed across food categories. This study supports recent calls to address unhealthy food and beverage price promotions in comprehensive policy strategies aiming to improve population diets and weight.

Estimating the health benefits and cost-savings of a cap on the size of single serve sugar-sweetened beverages.

Sugar-sweetened beverage (SSB) intake is associated with tooth decay, obesity and diabetes. We aimed to model the health and cost impact of reducing the serving size of all single serve SSB to a maximum of 250 ml in New Zealand. A 250 ml serving size cap was modeled for all instances of single serves (<600 ml) of sugar-sweetened carbonated soft drinks, fruit drinks, carbonated energy drinks, and sports drinks in the New Zealand National Nutrition Survey intake data (2008/09). A multi-state life-table model used the change in energy intake and therefore BMI to predict the resulting health gains in quality-adjusted life-years (QALYs) and health system costs over the remaining life course of the New Zealand population alive in 2011 (N = 4.4 million, 3% discounting). The 'base case' model (no compensation for reduced energy intake) resulted in an average reduction in SSB and energy intake of 23 ml and 44 kJ (11 kcal) per day or 0.22 kg of weight modeled over two years. The total health gain and cost-savings were 82,100 QALYs (95% UI: 65100 to 101,000) and NZ$1.65 billion [b] (95% UI: 1.19 b to 2.24 b, (US$1.10 b)) over the lifespan of the cohort. QALY gains increased to 116,000 when the SSB definition was widened to include fruit juices and sweetened milks. A cap on single serve SSB could be an effective part of a suite of obesity prevention and sugar reduction interventions in high income countries.

Five year trends in the serve size, energy, and sodium contents of New Zealand fast foods: 2012 to 2016.

BACKGROUND: The nutritional composition of foods and beverages consumed away from the home has important implications for population health. Our objective was to determine if the serve size, energy, and sodium contents of fast foods sold at chain restaurants in New Zealand (NZ) changed between 2012 and 2016. METHODS: Serve size and nutrient data were collected in annual cross-sectional surveys of all products sold at 10 major fast food chains. Changes over time may occur due to alterations in product availability or individual product reformulation. Linear regression adjusting for food group and chain was used to estimate overall changes in serve size and nutrients. Random effects mixed models were used to estimate reformulation changes on same products available for two or more years. RESULTS: Across all products (n = 5468) increases were observed in mean serve size (+ 9 (3, 15) g, + 5%), energy density (+ 54 (27, 81) kJ/100 g, + 6%), energy per serve (+ 178 (125, 231) kJ, + 14%), and sodium per serve (+ 55 (24, 87) mg, + 12%). Sodium density did not change significantly. Four of 12 food groups (Desserts, Pizza, Sandwiches, and Salads) and four of 10 fast food chains (Domino's, Hell Pizza, Pizza Hut, and Subway) displayed large, undesirable changes for three or more (of five) outcomes (≥10%; p < 0.05). One food group (Asian) and one chain (St Pierre's) displayed large, desirable changes for two or more outcomes. The only significant reformulation change was a drop in sodium density (- 22 (- 36, - 8) mg/100 g, - 7%). CONCLUSIONS: The serve size and energy density of NZ fast food products has increased significantly over the past 5 years. Lower sodium concentration in new and reformulated products has been offset by overall increases in serve size. Continued monitoring and development and implementation of Government-led targets for serve size and nutrient content of new and existing fast food products are required.

Do nutrition labels influence healthier food choices? Analysis of label viewing behaviour and subsequent food purchases in a labelling intervention trial.

BACKGROUND: There are few objective data on how nutrition labels are used in real-world shopping situations, or how they affect dietary choices and patterns. DESIGN: The Starlight study was a four-week randomised, controlled trial of the effects of three different types of nutrition labels on consumer food purchases: Traffic Light Labels, Health Star Rating labels, or Nutrition Information Panels (control). Smartphone technology allowed participants to scan barcodes of packaged foods and receive randomly allocated labels on their phone screen, and to record their food purchases. The study app therefore provided objectively recorded data on label viewing behaviour and food purchases over a four-week period. A post-hoc analysis of trial data was undertaken to assess frequency of label use, label use by food group, and association between label use and the healthiness of packaged food products purchased. RESULTS: Over the four-week intervention, study participants (n = 1255) viewed nutrition labels for and/or purchased 66,915 barcoded packaged products. Labels were viewed for 23% of all purchased products, with decreasing frequency over time. Shoppers were most likely to view labels for convenience foods, cereals, snack foods, bread and bakery products, and oils. They were least likely to view labels for sugar and honey products, eggs, fish, fruit and vegetables, and meat. Products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased: mean difference in nutrient profile score -0.90 (95% CI -1.54 to -0.26). CONCLUSIONS: In a secondary analysis of a nutrition labelling intervention trial, there was a significant association between label use and the healthiness of products purchased. Nutrition label use may therefore lead to healthier food purchases.

Appetite for health-related food taxes: New Zealand stakeholder views.

There is increasing discussion globally of the value of health-related food taxes and subsidies to address obesity and noncommunicable diseases. In order for such policies to be successful it is important to understand the positions of key stakeholders. This research investigated New Zealand (NZ) stakeholders' views on the feasibility and acceptability of selected health-related food taxes and subsidies over the next 5 to 10 years. Twenty semi-structured interviews were undertaken by telephone from November 2014 to May 2015. The purposive sample of key stakeholders included politicians, bureaucrats, public health experts, food industry leaders and consumer representatives. Prior to interviews participants were sent summary information on the estimated impacts of a range of health-related food taxes and subsidies on dietary intake and mortality. According to key stakeholders there appears to be little appetite for taxes on foods high in saturated fat or salt in NZ. Stakeholders largely agreed that a tax on sugar-sweetened beverages (SSBs) and a subsidy on fruit and vegetables were both feasible and likely acceptable. There was strong support for starting with a SSBs tax, possibly framed around protecting children and dental health. Addressing obesity and noncommunicable diseases is a multidimensional challenge. A tax on SSBs and a subsidy on fruit and vegetables, possibly in tandem, could be part of the solution in NZ. There is growing interest in, and evidence for, health-related taxes and subsidies internationally. Given the critical role of stakeholder support for such policies similar research on stakeholders' views may assist the implementation of health-related food taxes and subsidies in other jurisdictions.

Effectiveness of mobile health (mHealth) interventions for promoting healthy eating in adults: A systematic review.

Unhealthy eating is a major risk factor for chronic disease. However, many current strategies to promote healthy eating are not sustainable over the longer-term. More cost-effective wide-reaching initiatives are urgently needed. Mobile health (mHealth) interventions, delivered via mobile devices, could provide a solution. This systematic review summarized the evidence on the effect of mHealth interventions for promoting healthy eating in adults. A comprehensive systematic search of five scientific databases was conducted using methods adapted from the Cochrane Handbook. Eligible studies were randomized controlled trials (RCTs), published up to 1 July 2016, which examined healthy eating interventions delivered via mobile device. Of 879 articles identified, 84 full text articles were potentially eligible and further assessed, and 23 included. Narrative review results indicated small positive effects of mHealth interventions on healthy eating (5/8 trials) and weight loss (5/13 trials). However, the current evidence base is insufficient (studies are of poor quality) to determine conclusive positive effects. More rigorous RCTs with longer-term (>6months) follow-up are warranted to determine if effects are maintained.

Estimating population food and nutrient exposure: a comparison of store survey data with household panel food purchases.

Population exposure to food and nutrients can be estimated from household food purchases, but store surveys of foods and their composition are more available, less costly and might provide similar information. Our aim was to compare estimates of nutrient exposure from a store survey of packaged food with those from household panel food purchases. A cross-sectional store survey of all packaged foods for sale in two major supermarkets was undertaken in Auckland, New Zealand, between February and May 2012. Longitudinal household food purchase data (November 2011 to October 2012) were obtained from the nationally representative, population-weighted New Zealand Nielsen HomeScan® panel. Data on 8440 packaged food and non-alcoholic beverage products were collected in the store survey. Food purchase data were available for 1229 households and 16 812 products. Store survey data alone produced higher estimates of exposure to Na and sugar compared with estimates from household panel food purchases. The estimated mean difference in exposure to Na was 94 (95 % CI 72, 115) mg/100 g (20 % relative difference; P<0·01), to sugar 1·6 (95 % CI 0·8, 2·5) g/100 g (11 %; P<0·01), to SFA -0·3 (95 % CI -0·8, 0·3) g/100 g (6 %; P=0·3) and to energy -18 (-71, 35) kJ/100 g (2 %; P=0·51). Compared with household panel food purchases, store survey data provided a reasonable estimate of average population exposure to key nutrients from packaged foods. However, caution should be exercised in using such data to estimate population exposure to Na and sugar and in generalising these findings to other countries, as well as over time.

Nutrition and health claims on healthy and less-healthy packaged food products in New Zealand.

Nutrition and health claims are displayed to influence consumers' food choices. This study assessed the extent and nature of nutrition and health claims on the front-of-pack of 'healthy' and 'less-healthy' packaged foods in New Zealand. Foods from eight categories, for which consumption may affect the risk of obesity and diet-related chronic diseases, were selected from the 2014 Nutritrack database. The internationally standardised International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) taxonomy was used to classify claims on packages. The Nutrient Profiling Scoring Criterion (NPSC) was used to classify products as 'healthy' or 'less healthy'. In total, 7526 products were included, with 47 % (n 3557) classified as 'healthy'. More than one-third of products displayed at least one nutrition claim and 15 % featured at least one health claim on the front-of-pack. Claims were found on one-third of 'less-healthy' products; 26 % of those products displayed nutrition claims and 7 % featured health claims. About 45 % of 'healthy' products displayed nutrition claims and 23 % featured health claims. Out of 7058 individual claims, the majority (69 %) were found on 'healthy' products. Cereals displayed the greatest proportion of nutrition and health claims (1503 claims on 564 products), of which one-third were displayed on 'less-healthy' cereals. Such claims could be misleading consumers' perceptions of nutritional quality of foods. It needs to be explored how current regulations on nutrition and health claims in New Zealand could be further strengthened (e.g. using the NPSC for nutrition claims, including general health claims as per the INFORMAS taxonomy) to ensure consumers are protected and not misled.

Modeling health gains and cost savings for ten dietary salt reduction targets.

BACKGROUND: Dietary salt reduction is included in the top five priority actions for non-communicable disease control internationally. We therefore aimed to identify health gain and cost impacts of achieving a national target for sodium reduction, along with component targets in different food groups. METHODS: We used an established dietary sodium intervention model to study 10 interventions to achieve sodium reduction targets. The 2011 New Zealand (NZ) adult population (2.3 million aged 35+ years) was simulated over the remainder of their lifetime in a Markov model with a 3 % discount rate. RESULTS: Achieving an overall 35 % reduction in dietary salt intake via implementation of mandatory maximum levels of sodium in packaged foods along with reduced sodium from fast foods/restaurant food and discretionary intake (the "full target"), was estimated to gain 235,000 QALYs over the lifetime of the cohort (95 % uncertainty interval [UI]: 176,000 to 298,000). For specific target components the range was from 122,000 QALYs gained (for the packaged foods target) down to the snack foods target (6100 QALYs; and representing a 34-48 % sodium reduction in such products). All ten target interventions studied were cost-saving, with the greatest costs saved for the mandatory "full target" at NZ$1260 million (US$820 million). There were relatively greater health gains per adult for men and for Maori (indigenous population). CONCLUSIONS: This work provides modeling-level evidence that achieving dietary sodium reduction targets (including specific food category targets) could generate large health gains and cost savings for a national health sector. Demographic groups with the highest cardiovascular disease rates stand to gain most, assisting in reducing health inequalities between sex and ethnic groups.

Nutrient profile of 23 596 packaged supermarket foods and non-alcoholic beverages in Australia and New Zealand.

OBJECTIVE: To compare the nutrient profile of packaged supermarket food products available in Australia and New Zealand. Eligibility to carry health claims and relationship between nutrient profile score and nutritional content were also evaluated. DESIGN: Nutritional composition data were collected in six major Australian and New Zealand supermarkets in 2012. Mean Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC) scores were calculated and the proportion of products eligible to display health claims was estimated. Regression analyses quantified associations between NPSC scores and energy density, saturated fat, sugar and sodium contents. RESULTS: NPSC scores were derived for 23,596 packaged food products (mean score 7.0, range -17 to 53). Scores were lower (better nutrient profile) for foods in Australia compared with New Zealand (mean 6.6 v. 7.8). Overall, 45% of foods were eligible to carry health claims based on NPSC thresholds: 47% in Australia and 41% in New Zealand. However, less than one-third of dairy (32%), meat and meat products (28%) and bread and bakery products (27.5%) were eligible to carry health claims. Conversely, >75% of convenience food products were eligible to carry health claims (82.5%). Each two-unit higher NPSC score was associated with higher energy density (78 kJ/100 g), saturated fat (0.95 g/100 g), total sugar (1.5 g/100 g) and sodium (66 mg/100 g; all P values<0.001). CONCLUSIONS: Fewer than half of all packaged foods available in Australia and New Zealand in 2012 met nutritional criteria to carry health claims. The few healthy choices available in key staple food categories is a concern. Improvements in nutritional quality of foods through product reformulation have significant potential to improve population diets.

Ultra-processed foods have the worst nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets.

OBJECTIVE: To examine the availability of packaged food products in New Zealand supermarkets by level of industrial processing, nutrient profiling score (NPSC), price (energy, unit and serving costs) and brand variety. DESIGN: Secondary analysis of cross-sectional survey data on packaged supermarket food and non-alcoholic beverages. Products were classified according to level of industrial processing (minimally, culinary and ultra-processed) and their NPSC. SETTING: Packaged foods available in four major supermarkets in Auckland, New Zealand. SUBJECTS: Packaged supermarket food products for the years 2011 and 2013. RESULTS: The majority (84% in 2011 and 83% in 2013) of packaged foods were classified as ultra-processed. A significant positive association was found between the level of industrial processing and NPSC, i.e., ultra-processed foods had a worse nutrient profile (NPSC=11.63) than culinary processed foods (NPSC=7.95), which in turn had a worse nutrient profile than minimally processed foods (NPSC=3.27), P<0.001. No clear associations were observed between the three price measures and level of processing. The study observed many variations of virtually the same product. The ten largest food manufacturers produced 35% of all packaged foods available. CONCLUSIONS: In New Zealand supermarkets, ultra-processed foods comprise the largest proportion of packaged foods and are less healthy than less processed foods. The lack of significant price difference between ultra- and less processed foods suggests ultra-processed foods might provide time-poor consumers with more value for money. These findings highlight the need to improve the supermarket food supply by reducing numbers of ultra-processed foods and by reformulating products to improve their nutritional profile.

Package size and manufacturer-recommended serving size of sweet beverages: a cross-sectional study across four high-income countries.

OBJECTIVE: To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand. DESIGN: Cross-sectional surveys. SETTING: The two largest supermarket chains of each country in 2012/2013. SUBJECTS: Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904). RESULTS: For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting. CONCLUSIONS: At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices.

Study protocol: combining experimental methods, econometrics and simulation modelling to determine price elasticities for studying food taxes and subsidies (The Price ExaM Study).

BACKGROUND: There is a need for accurate and precise food price elasticities (PE, change in consumer demand in response to change in price) to better inform policy on health-related food taxes and subsidies. METHODS/DESIGN: The Price Experiment and Modelling (Price ExaM) study aims to: I) derive accurate and precise food PE values; II) quantify the impact of price changes on quantity and quality of discrete food group purchases and; III) model the potential health and disease impacts of a range of food taxes and subsidies. To achieve this, we will use a novel method that includes a randomised Virtual Supermarket experiment and econometric methods. Findings will be applied in simulation models to estimate population health impact (quality-adjusted life-years [QALYs]) using a multi-state life-table model. The study will consist of four sequential steps: 1. We generate 5000 price sets with random price variation for all 1412 Virtual Supermarket food and beverage products. Then we add systematic price variation for foods to simulate five taxes and subsidies: a fruit and vegetable subsidy and taxes on sugar, saturated fat, salt, and sugar-sweetened beverages. 2. Using an experimental design, 1000 adult New Zealand shoppers complete five household grocery shops in the Virtual Supermarket where they are randomly assigned to one of the 5000 price sets each time. 3. Output data (i.e., multiple observations of price configurations and purchased amounts) are used as inputs to econometric models (using Bayesian methods) to estimate accurate PE values. 4. A disease simulation model will be run with the new PE values as inputs to estimate QALYs gained and health costs saved for the five policy interventions. DISCUSSION: The Price ExaM study has the potential to enhance public health and economic disciplines by introducing internationally novel scientific methods to estimate accurate and precise food PE values. These values will be used to model the potential health and disease impacts of various food pricing policy options. Findings will inform policy on health-related food taxes and subsidies. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000122459 (registered 3 February 2016).

Reds are more important than greens: how UK supermarket shoppers use the different information on a traffic light nutrition label in a choice experiment.

BACKGROUND: Colour coded front-of-pack nutrition labelling ('traffic light labelling') has been recommended for use in the UK since 2006. The voluntary scheme is used by all the major retailers and some manufacturers. It is not clear how consumers use these labels to make a single decision about the relative healthiness of foods. Our research questions were: Which of the four nutrients on UK traffic light labels (total fat, saturated fat, sugar and salt) has the most influence on decisions? Do green lights or red lights have a greater influence? Are there age and gender differences in how people use the colour and nutrient information? METHODS: We recruited participants from a UK supermarket chain membership list to conduct an online choice experiment in May 2014. We analysed data using multilevel logisitic models with food choices (n = 3321) nested in individuals (n = 187) as the unit of analysis. RESULTS: A food with more reds was 11.4 (95% confidence intervals: 10.3, 12.5) times less likely to be chosen as healthy, whereas a food with more greens was 6.1 (5.6, 6.6) times more likely to be chosen as healthy. Foods with better colours on saturated fat and salt were 7.3 (6.7, 8.0) and 7.1 (6.5, 7.8) times more likely to be chosen as healthy - significantly greater than for total fat (odds ratio 4.8 (4.4, 5.3)) and sugar (5.2 (4.7, 5.6)). Results were broadly similar for different genders and age groups. CONCLUSIONS: We found that participants were more concerned with avoiding reds than choosing greens, and that saturated fat and salt had a greater influence on decisions regarding healthiness than total fat and sugar. This could influence decisions about food reformulation and guidance on using nutrition labelling.

Plasma and erythrocyte fatty acids reflect intakes of saturated and n-6 PUFA within a similar time frame.

Erythrocytes, compared with plasma, are considered more robust markers of n-3 (ω-3) polyunsaturated fatty acid (PUFA) intake, because dietary-induced change in fatty acid (FA) composition takes longer to complete. The extent to which this applies to intakes of saturated fatty acid (SFA) or n-6 PUFA is unclear. We compared the pattern of change over time in the fatty acid composition of plasma, erythrocyte, buccal cell, and adipose tissue lipids when changing between diets high in SFA or n-6 PUFA. Twenty-four (n = 7 male) healthy participants were instructed to consume either an SFA-rich (18% energy) or n-6 PUFA-rich (10% energy) diet for 8 wk before crossing over, without washout, to the alternate diet. The FA composition of plasma triacylglycerol (TG), nonesterified FAs, cholesterol ester, total phospholipids, erythrocyte total phospholipids, erythrocyte phosphatidylcholine, and buccal cell total phospholipids was measured every 2 wk and adipose tissue TG every 4 wk during the 16-wk intervention. Linoleic acid composition of plasma, erythrocyte, and buccal cell lipids increased (P < 0.01) during the first 2 wk of the n-6 PUFA diet and remained unchanged during the remaining 6 wk. During the 8-wk SFA diet, the same pattern of change over time occurred for the pentadecanoic acid composition of plasma and erythrocyte lipids; however, the pentadecanoic acid composition of buccal cell lipids did not differ between the diet periods. There were no differences in linoleic or pentadecanoic acid composition of adipose tissue TG. These results suggest plasma and erythrocyte FAs reflect intakes of SFA and n-6 PUFA over a similar period of time.