Examining the Prevalence, Nutritional Quality and Marketing of Foods with Voluntary Nutrient Additions in the Canadian Food Supply.

Foods with voluntary nutritional additions are a fast-growing sector of the global food industry. In Canada, while the addition of nutrients to foods has been regulated through fortification regulations, parallel policies which aim to encourage product innovation have also allowed for the voluntary addition of nutrients and other novel ingredients to 'supplemented' and 'functional' foods. Concerns have been raised that the consumption of these products may have negative repercussions on population health, such as high nutrient intakes inappropriate for certain population subgroups (e.g., children) and the shifting of dietary patterns to include more unhealthy foods. The aim of this study was to evaluate the prevalence, nutritional quality, and marketing characteristics of foods with added nutrients in the Canadian market. We found many nutritionally-enhanced foods contained high levels of nutrients beyond recommended intakes, despite these nutrients having no evidence of inadequacy in the Canadian population. Additionally, a large proportion of foods with added nutrients had poor nutrient profiles (were deemed 'less healthy' than their non-enhanced counterparts) and carried heavy marketing on their labels, regardless of their nutritional quality. Taken together these findings raise concerns about foods with voluntary nutrient additions and suggest the need to further investigate consumer attitudes and decision-making towards these foods.

Association of State Policies Allowing Medical Cannabis for Opioid Use Disorder With Dispensary Marketing for This Indication.

Importance: Misinformation about cannabis and opioid use disorder (OUD) may increase morbidity and mortality if it leads individuals with OUD to forego evidence-based treatment. It has not been systematically evaluated whether officially designating OUD as a qualifying condition for medical cannabis is associated with cannabis dispensaries suggesting cannabis as a treatment for OUD. Objective: To examine whether state-level policies designating OUD a qualifying condition for medical cannabis are associated with more dispensaries claiming cannabis can treat OUD. Design, Setting, and Participants: This cross-sectional, mixed-methods study of 208 medical dispensary brands was conducted in 2019 using the brands' online content. The study included dispensaries operating in New Jersey, New York, and Pennsylvania, where OUD is a qualifying condition for medical cannabis, and in Connecticut, Delaware, Maryland, Ohio, and West Virginia, where this policy does not exist. Exposures: Presence of OUD on the list of qualifying conditions for a state's medical cannabis program. Main Outcomes and Measures: Binary indicators of whether online content from the brand said cannabis can treat OUD, can replace US Food and Drug Administration-approved medications for OUD, can be an adjunctive therapy to Food and Drug Administration-approved medications for OUD, or can be used as a substitute for opioids to treat other conditions (eg, chronic pain). Results: After excluding duplicates, listings for nonexistent dispensaries, and those without online content, 167 brands across 7 states were included in the analysis (44 [26.3%] in states where OUD was a qualifying condition and 123 [73.7%] in adjacent states). A dispensary listed in a directory for West Virginia was not operational; therefore, comparison states were Connecticut, Delaware, Maryland, and Ohio. In policy-exposed states, 39% (95% CI, 23%-55%) more dispensaries claimed cannabis could treat OUD compared with unexposed states (P < .001). For replacing medications for OUD and being an adjunctive therapy, the differences were 14% (95% CI, 2%-26%; P = .002) and 28% (95% CI, 14%-42%; P < .001), respectively. The suggestion that cannabis could substitute for opioids (eg, to treat chronic pain) was made by 25% (95% CI, 9%-41%) more brands in policy-exposed states than adjacent states (P = .002). Conclusions and Relevance: In this study, state-level policies designating OUD as a qualifying condition for medical cannabis were associated with more dispensaries claiming cannabis can treat OUD. In the current policy environment, in which medical claims by cannabis dispensaries are largely unregulated, these advertisements could harm patients. Future research linking these policies to patient outcomes is warranted.

Internet Marketing of Cardioprotective Dietary Supplements.

Objectives: Considering high prevalence of use of dietary supplements and their easy access on the internet, the aim of this research was to examine and assess the prevalence of the internet marketing of heart-protective supplements as the most popular supplements of today, and to investigate the quality and quantity of information that are available to consumers on the sale websites. Design: Three major search engines (Google, Yahoo, and Bing) and keywords "cardiovascular supportive supplements online buy" were used to identify websites that sell cardioprotective dietary supplements. Content of first 50 listed websites in each engine was evaluated for its compliance with regulatory acts while information about supplements' efficacy and safety was compared with the results of the latest scientific research. Results: Of a total of 150 listed websites, 89 selling supplements for the specific indication underwent further analysis. The most commonly registered cardioprotective dietary supplements on the internet were supplements based on omega-3 fatty acids (omega-3) (57 websites, 64.05%). Related to the websites selling omega-3 supplements, risk reduction claims were presented at 23 (40.35%), whereas structure or function claims were present at 50 (87.72%) analyzed websites, but followed with Food and Drug Administration disclaimer only on 68.00% of them. Information about adverse effects were rarely pointed out (1 website, 1.75%) unlike warnings, which were significantly more available to consumers (38, 66.67%). Conclusions: According to obtained results, most of the analyzed websites that sell omega-3 supplements did not contain all important medical information required by Dietary Supplement Health and Education Act. Since use of internet marketing is in expansion and since consumers have no access to relevant medical information about dietary supplements on the selling websites, there is a clear need for better quality control of websites and greater public awareness of these widely used products.

Assessing Vitamins, Minerals and Supplements Marketed to Children in Canada.

Given the growth of supplements specifically designed for children in Canada, this study examines the nutrient levels of these products, and evaluates them in light of the US Health and Medical Division (HMD)-formerly the Institute of Medicine-and Health Canada's recommendations. Content analysis was used to document the nutrient levels of child-targeted vitamins, minerals and fish oils/omega-3s (n = 80) in Calgary, Alberta, Canada. Products were assessed according to HMD and Health Canada dosage recommendations for children, and the percentage of Estimate Average Requirements (EAR), Adequate Intakes (AI), and Tolerable Upper Intakes Level (UL) calculated. Median EAR/AI/UL percentages and quartiles were calculated for each nutrient, and estimates for the adequate intake recommendations plotted with box plots. Sixty five percent of the products assessed were multivitamins; the median dose was higher than AI recommendations for vitamins A, B6, B12, and C, as well as thiamin, riboflavin, pantothenic acid, and biotin. Substantial variation in vitamin, mineral, or fish oil dosage was found between similar supplements-with nutrients such as vitamin B12 ranging from 83% to 5557% of AI. Such findings matter because the very existence of these products suggests that children should be taking them, yet more research is needed on their potential (adverse) effects over both the short and long term. The substantial variation in dosages between products also raises questions about the (perhaps unnecessary) fortification of our children, as well as the expectations that parents know-or are even aware of-appropriate nutrient levels for their kids.

Inter-brand competition in the convenience store industry, store density and healthcare utilization.

We investigate the impact of access to convenience stores and competition between convenience store chains on the use of medical care in Taiwan. Using insurance claims from 0.85 million individuals and administrative data on store sales, we find that greater store density and more inter-brand competition reduced expenditures on outpatient medical services and prescription drugs. In support of these findings, we demonstrate that convenience store competition was associated with greater consumption of healthy foods and lower obesity rates. Our estimates suggest that the rise in convenience store competition from 2002 to 2012 reduced outpatient expenditures in Taiwan by 0.44 percent and prescription drug expenditures by 0.85 percent.

An examination of the nutrient content and on-package marketing of novel beverages.

Changing regulatory approaches to fortification in Canada have enabled the expansion of the novel beverage market, but the nutritional implications of these new products are poorly understood. This study assessed the micronutrient composition of energy drinks, vitamin waters, and novel juices sold in Canadian supermarkets, and critically examined their on-package marketing at 2 time points: 2010-2011, when they were regulated as Natural Health Products, and 2014, when they fell under food regulations. We examined changes in micronutrient composition and on-package marketing among a sample of novel beverages (n = 46) over time, compared micronutrient content with Dietary Reference Intakes and the results of the 2004 Canadian Community Health Survey to assess potential benefits, and conducted a content analysis of product labels. The median number of nutrients per product was 4.5, with vitamins B6, B12, C, and niacin most commonly added. Almost every beverage provided at least 1 nutrient in excess of requirements, and most contained 3 or more nutrients at such levels. With the exception of vitamin C, there was no discernible prevalence of inadequacy among young Canadian adults for the nutrients. Product labels promoted performance and emotional benefits related to nutrient formulations that go beyond conventional nutritional science. Label graphics continued to communicate these attributes even after reformatting to comply with food regulations. In contrast with the on-package marketing of novel beverages, there is little evidence that consumers stand to benefit from the micronutrients most commonly found in these products.

China and the global uranium market: prospects for peaceful coexistence.

China's recent reemergence has resulted in a significant increase in the global demand of commodities and is already having major impacts on the dynamics of global commodity markets. In the case of the global uranium market, we stand at the very beginning of a period of change. However, interesting trends are already emerging. Whereas China has had many policy reversals, and some difficulties in taking control of its procurement strategy in other commodity markets, it is seemingly more successful in managing its uranium procurement strategy. Why? The argument presented here is that a mixture of domestic and international level variables has allowed China more room for maneuver in fulfilling its uranium procurement strategy. On the domestic level, a centralized industry, and, on the international level, a geographically dispersed and uncoordinated market have allowed China to forge ahead with an ambitious civilian nuclear power plan and triple its total uranium imports, all within the span of a few years. Many challenges remain, not the least that of negative public opinion, which has surged since the Fukushima disaster in 2011. Nevertheless, should uranium demand continue to grow, this paper will consider the potential for continued peaceful coexistence among uranium market participants worldwide.

Plant food supplement (PFS) market structure in EC Member States, methods and techniques for the assessment of individual PFS intake.

The popularity of herbal products, especially plant food supplements (PFS) and herbal medicine is on the rise in Europe and other parts of the world, with increased use in the general population as well as among specific subgroups encompassing children, women or those suffering from diseases such as cancer. The aim of this paper is to examine the PFS market structures in European Community (EC) Member States as well as to examine issues addressing methodologies and consumption data relating to PFS use in Europe. A revision of recent reports on market data, trends and main distribution channels, in addition an example of the consumption of PFS in Spain, is presented. An overview of the methods and administration techniques used to assess individual food consumption as a starting point, including their uses and limitations, as well as some examples of studies that collect Food Supplement (FS) information, including herbal/botanical/plant-derived products are also discussed. Additionally, the intake estimation process of food nutrients is described and used to propose the PFS ingredients intake estimation process. Nationally representative PFS consumption data is scarce in Europe. The majority of studies have been conducted in Scandinavia and the UK. However the heterogeneity of definitions, study design and objectives make it difficult to compare results and extrapolate conclusions.

Nutrition marketing on food labels.

OBJECTIVE: This research sought to determine how often nutrition marketing is used on labels of foods that are high in saturated fat, sodium, and/or sugar. DESIGN AND SETTING: All items packaged with food labels (N = 56,900) in all 6 grocery stores in Grand Forks, ND were surveyed. MAIN OUTCOME MEASURE(S): Marketing strategy, nutrient label information, if the product was fruit/or milk based, and target age. ANALYSIS: Frequency distributions were computed. RESULTS: Forty-nine percent of all products contained nutrition marketing and of those, 48% had both nutrition marketing and were high in saturated fat, sodium and/or sugar (11%, 17%, and 31% respectively). Seventy-one percent of products marketed to children had nutrition marketing. Of those, 59% were high in saturated fat, sodium and/or sugar content, with more than half being high in sugar. The most commonly used nutrition marketing statements were "good source of calcium", "reduced/low/fat free", and "food company's health symbol". CONCLUSIONS AND IMPLICATIONS: Nutrition marketing is commonly used on products high in saturated fat, sodium and/or sugar and is more often used on products marketed toward children than products marketed toward adults. Current food industry symbols may not be helping consumers select foods low in saturated fat, sodium or sugar.

Arrhythmogenicity of weight-loss supplements marketed on the Internet.

BACKGROUND: We examined nonprescription weight-loss supplements marketed on the Internet for ingredients with potential arrhythmogenic and life-threatening cardiac adverse effects. OBJECTIVE: We aimed to define the risks of life-threatening cardiac adverse effects that are associated with weight-loss supplements marketed on the Internet. METHODS: We entered the key words "weight-loss supplements" and "diet pills" into three popular Internet search engines. The top four nonoverlapping hits from each search engine were purchased. After receipt, the products and their ingredient lists were inspected, and Medline and the Natural Medicines Comprehensive Database were searched for reports of significant associations between each ingredient and various key words for life-threatening cardiac adverse effects. RESULTS: All supplements had the list of ingredients on the label. We identified 60 different ingredients (7.25 +/- 4.66 per supplement; range 1-21). Eleven ingredients representing eight different substances (because multiple names were used for some substances) were each associated with two or more reports of life-threatening cardiac complications or death. Eight of the 12 products contained one or more such ingredients, but none of these eight products had warnings about life-threatening cardiac adverse effects on the Web pages, on the labels, or in the package inserts. One product contained ma huang (Chinese ephedra), even though the marketing of ephedra-containing products is banned in the United States. CONCLUSIONS: The Internet provides easy access to weight-loss supplements, several of which contain ingredients with potentially life-threatening adverse effects. There is a need for increased public education and awareness regarding such weight-loss products.

Comercialización de productos elaborados a partir de plantas aromáticas y medicinales de cultivo ecológico en Cataluña / Marketing of products made from or ganically grown medicinal and aromatic plants in Catalonia

El sector de la transformación y distribución de productos ecológicos elaborados a partir de plantas aromáticas y medicinales (PAM) es muy pequeño y existen pocos datos sobre su mercado. Después de realizar una encuesta a 26 de las empresas catalanas que trabajan con productos de PAM ecológicas (condimentos, complementos alimentarios, cosméticos, etc.) se detecta un bajo Consumo de estos productos, poca información sobre el mercado y debilidades en las estrategias de comercialización (AU)

Processing and distribution sector of products made from or ganically grown medicinal and aromatic plants (MAP) is small and there only few market data. After an enquiry to 26 Catalan companies That work with organic MAP products (seasoning, food complements, cosmetics,...) we have detected a small consumption of these products, few market information and weak marketing strategies (AU)

Evaluation of internet websites marketing herbal weight-loss supplements to consumers.

OBJECTIVE: The aim of this study was to evaluate the quality and quantity of drug information available to consumers on Internet websites marketing herbal weight-loss dietary supplements in the United States. METHODS: We conducted an Internet search using the search engines Yahoo and Google and the keywords "herbal weight loss." Website content was evaluated for the presence of active/inactive ingredient names and strengths and other Food and Drug Administration (FDA) labeling requirements. Information related to drug safety for the most common herbal ingredients in the products evaluated was compared against standard herbal drug information references. RESULTS: Thirty-two (32) websites were evaluated for labeling requirements and safety information. All sites listed an FDA disclaimer statement and most sites (84.4%) listed active ingredients, although few listed strengths or inactive ingredients. Based on the drug information for the most common ingredients found in the weight-loss dietary supplements evaluated, potential contraindications for cardiovascular conditions, pregnancy/nursing, and high blood pressure were listed most frequently (73%, 65.5%, and 37%, respectively), whereas few websites listed potential drug interactions or adverse reactions. CONCLUSIONS: Potential hazards posed by dietary supplements may not be accurately, if at all, represented on Internet websites selling these products. Since consumers may not approach their physicians or pharmacists for information regarding use of dietary supplements in weight loss, it becomes necessary for health care providers to actively engage their patients in open discussion regarding the use, benefits, and hazards of dietary supplements.

[Quality of the various vegetable oils available on the Polish market]. / Jakosc wybranych olejów roslinnych dostepnych na polskim rynku.

The aim of this work was the examination of the quality of 17 different vegetable oils (13 refined and 4 extra virgin olive oils) available on the domestic market. The quality of oils was expressed by the following factors: conformity of fatty acid composition that as declared by manufacturer, content of oxidation products (PV, AnV, Totox), content of free fatty acids (LK) and oxidative stability. It was found that 40% of oils did not comply with the requirements concerning oxidative stability. The fatty acid composition of only 1 oil out of 17 investigated did not comply with the declaration by manufacturer. The oxidative stabilities of extra vergin olive oils: 6.44-8.24 hrs., were considerably higher that of other refined oils 2.34 to 8.24 hrs.

[Quality of shortenings available on the home market]. / Jakosc wybranych tluszczów piekarskich na rynku krajowym.

The aim of this work was to examine the quality of shortenings available on Polish market, produced home or imported. The quality of twelve 100% vegetable fats and lard was estimated. Both chemical (fatty acids composition, especially trans isomers content, acid value, peroxide value, anisidine value, Totox, iodine value and oxidative stability--Rancimat test) and physical (melting point, solid fat content--at temperatures from 5 to 50 degrees C) properties were measured. The fats were subject to sensoric examination. The parameters defining the freshness of examined fats and their shelf life for all examined samples were good and proved the good quality. Induction time (150 degrees C) for examined fats varied from 1,79 to 4,29h. Examined fats differed significantly in saturated fatty acids content (from 14,0 do 60,2%) and trans isomers (from 0,1 to 56,6%). Fats produced from palm oil are also present and there are fats with smaller trans fat acids content. Examined shortenings contained very small content of essential fatty acids (from 0,5 to 10,4), and they showed very different melting points (from 19,6 to 42,1 degrees C) and solid phase contents. In general the examined fats were of good sensoric value. Summing up the received results, it should be underlined that large disparity in the content of trans isomers in analysed samples was observed and definitely TFA content should be lowered.

[Salvia divinorum--representation of a new drug in the Internet]. / Salvia divinorum--Präsenz einer neuen Droge im Internet.

AIM OF THE STUDY: The German pages of the Internet were searched for the presence of the hallucinogenic herbal drug Salvia divinorum, which is not dealt with in current addiction medicine or psychiatric text books. The investigation is part of the EU sponsored project "Psychonaut" as preparatory work for the development of an Internet-based early warning system. METHODS: The first 100 websites of the search using "Salvia divinorum" were compared with the search results for "cannabis" and "LSD". The following aspects of the sites were especially analyzed: the originator, marketing of drugs, and the attitude towards drug use. RESULTS: Salvia was offered for sale on approximately a third of the sites (29%); cannabis and LSD were not marketed on any sites. Official websites such as those from governmental organizations or universities were seldom found when searching for "Salvia divinorum", and then only under the last hits. The percentage of institutional sites (e. g. public organizations) were 12% with Salvia, 21% with cannabis, and 38% with LSD. A drug-friendly attitude was found at 64 % of the sites with regard to Salvia, 58% for cannabis, and 24% for LSD. CONCLUSION: The drug help system must be aware of that the Internet is a source of drug-related information, and of drug trade. As this investigation shows, sites often have a drug-friendly attitude. The low availability of official information on Salvia divinorum (also outside the Internet) relative to the presence of drug-friendly or drug trading sites is an indication that new trends of drug consumption can be tracked in the Internet before they will be found in official literature.

The relation between sale of antimicrobial drugs and antibiotic resistance in uropathogens in general practice.

BACKGROUND: Overuse of antimicrobial drugs has resulted in an alarming increase in bacterial resistance in most countries. The relevance for general practice is unknown. OBJECTIVE: To evaluate the impact of the sale of antimicrobial drugs on bacterial resistance as found in uropathogens from general practice. SETTING: General practice in Belgium and Norway. METHODS: Observational study. RESULTS: The sale of antimicrobial drugs indicated for use in the treatment of urinary tract infection was four times higher in Belgium than in Norway (18.5 vs 4.4 DDD/1000 inhabitants/day). The antibiotic resistance reported by microbiological laboratories as valid for general practice was significant higher in Belgium than in Norway (ampicillins (44% vs 27%), co-trimoxazole (28% vs 17%), fluoroquinolones (12% vs 2%) and nitrofurantoin (16% vs 11%, p < 0.0001 for all). However, the antibiotic resistance found in urine samples from dysuric women in general practice was similar (trimethoprim 14% vs 12%, co-trimoxazole 14% vs 11%, nitrofurantoin 7% vs 3%), except in the case of ampicillins (30% vs 19%, p < 0.05). CONCLUSION: The impact of the antimicrobial sale on resistance in uropathogens seems less than expected at the general practice level, even though local microbiological reports mention fairly high antibiotic resistance data. Adapted methods for following-up bacterial resistance evolution in general practice are needed.