[An exploratory study of vegetarianism in catering establishment]. / Estudio exploratorio del vegetarianismo en restauración colectiva.

INTRODUCTION: Introduction: interest in vegetarian diets is rising, however, it remains a very controversial topic, and with many reservations regarding it. Questions like their conceivable nutritional deficiencies, or if they are adequate or healthy, might be widely unknown. Objectives: exploring vegetarian diets, examining the current level of knowledge about them, and analyzing and improving, from a nutritional standpoint, the vegetarian menus of a restaurant with vegetarian options. Methods: this study was designed as an exploratory, crossover, descriptive study. Surveys with 17 items and a food frequency questionnaire were given among the customers of the restaurant. A total of 155 people, aged between 18 and 62, took part in it. A total of 30 menus were analyzed, and some suggestions were made in order to improve them. Results: out of the total sample, 138 people were omnivores, 12 people were vegetarians and two were vegans. More than half of the vegetarians did not know vitamin B12 is the only required supplement by default, and almost 60% of them stated never taking B12 supplements. The vegetarian menus which were analyzed provided a mean of 1,195 kcal, and covered 89% of the requirements of fiber, 212% of vitamin C, ≈30% of both calcium and zinc, 86% of iron, and 38% of B12. Conclusion: a great lack of knowledge regarding several aspects of vegetarian diets was found, even among vegetarian themselves. Informing the general public is essential for both avoiding dangerous nutritional deficiencies (like B12), and attracting more people towards this kind of diets, with all the benefits this would provide. In the vegetarian menus of Foodtopía, adequate levels of nutrients were observed. The main suggestions to improve the menus were: reducing the total calories and the amount of sunflower oil, and increasing the amount of legumes, nuts and seeds.

INTRODUCCIÓN: Introducción: el interés por las dietas vegetarianas está en auge, pero siguen existiendo muchas dudas y controversia al respecto. Temas como sus posibles deficiencias nutricionales, o si son adecuadas o saludables, podrían no ser ampliamente conocidos. Objetivos: explorar estas dietas, ver el nivel de conocimiento que existe sobre ellas y analizar y mejorar nutricionalmente los menús vegetarianos de un restaurante con opciones vegetarianas. Métodos: el diseño del estudio fue de tipo descriptivo, transversal y exploratorio. Se entregaron cuestionarios con 17 preguntas y un cuestionario de frecuencia de consumo de alimentos entre los clientes del restaurante. Participaron un total de 155 personas, con un rango de edad de 18-62 años. Se analizaron un total de 30 menús y se hicieron sugerencias para mejorarlos. Resultados: de la muestra total, 138 personas eran omnívoras, 12 eran vegetarianas y dos, veganas. Más de la mitad de los vegetarianos no sabían que la única suplementación necesaria por defecto es la B12 y el ≈60% de ellos dijo no suplementarse nunca con ella. Los menús vegetarianos analizados aportaban de media 1.195 kcal y cubrían el 89% de la ingesta recomendada de fibra, el 212% de vitamina C, ≈30% de calcio y zinc, el 86% de hierro y el 38% de B12. Se observaron niveles insuficientes de vitamina D. Conclusiones: existe un gran desconocimiento sobre muchos aspectos de las dietas vegetarianas, incluso entre los propios vegetarianos. Informar al público es primordial, tanto para evitar deficiencias nutricionales potencialmente peligrosas (B12), como para atraer a más personas hacia este tipo de dietas, con los beneficios que esto acarrearía. Se observaron niveles muy adecuados de nutrientes en los menús vegetarianos de Foodtopía. Las principales sugerencias de mejora fueron: reducir las calorías totales y la cantidad de aceite de girasol y aumentar la cantidad de legumbres, frutos secos y semillas.

Effects of an icon-based menu labelling initiative on consumer food choice.

AIMS: The purpose of this study was to examine the impact of an icon-based menu labelling initiative on consumer buying behaviour. METHODS: This quasi-experimental study recruited a convenience sample of eight food service establishments, all with at least one menu item meeting the heart healthy criteria. Data from sales of all menu items sold over an 8-week period were collated 4 weeks prior to and 4 weeks during the display of information icons related to healthy food choices on menus. RESULTS: The absolute change in menu item sales showed a non-significant trend towards an increase in healthier menu item selections. Furthermore, there was no association between the type of food service establishment and the percentage change in labelled menu item sales. CONCLUSION: The study did not find a statistically significant influence of the icon-based menu labels on consumer food choice. Given the limited amount of research that examines alternative menu labelling formats in real-world settings, more studies are necessary to confirm these results. Further research is needed to identify the optimal format, content and impact of menu labels on consumer behaviour.

A Statistical Analysis of a Traffic-Light Food Rating System to Promote Healthy Nutrition and Body Weight.

BACKGROUND: Restaurant eating while optimizing nutrition and maintaining a healthy weight is challenging. Even when nutritional information is available, consumers often consider only calories. A quick and easy method to rate both caloric density and nutrition is an unmet need. A food rating system created to address that need is assessed in this study. METHODS: The food rating system categorizes food items into 3 color-coded categories: most healthy (green), medium healthy (yellow), or least healthy (red) based on calorie density and general nutritional quality from national guidelines. Nutritional information was downloaded from 20 popular fast-food chains. Nutritional assessments and the 3 color coded categories were compared using the Wilcoxon and Median tests to demonstrate the significance of nutrition differences. RESULTS: Green foods were significantly lower than yellow foods, which in turn were significantly lower than red foods, for calories and calories from fat, in addition to content of total fat, saturated fat and carbohydrates per 100 g serving weight (all P < .02). The green foods had significantly lower cholesterol than the yellow (P = .0006) and red (P < .0001) foods. Yellow foods had less sugar than red foods (P < .0001). Yellow foods were significantly higher in dietary fiber than red foods (P = .001). CONCLUSION: The food rating color-coded system identifies food items with superior nutrition, and lower caloric density. The smartphone app, incorporating the system, has the potential to improve nutrition; reduce the risk of developing diabetes, hypertension, heart disease, and stroke; and improve public health.

Sodium, saturated fat, and trans fat content per 1,000 kilocalories: temporal trends in fast-food restaurants, United States, 2000-2013.

INTRODUCTION: Intakes of sodium, saturated fat, and trans fat remain high despite recommendations to limit these nutrients for cardiometabolic risk reduction. A major contributor to intake of these nutrients is foods prepared outside the home, particularly from fast-food restaurants. METHODS: We analyzed the nutrient content of frequently ordered items from 3 US national fast-food chains: fried potatoes (large French fries), cheeseburgers (2-oz and 4-oz), and a grilled chicken sandwich. We used an archival website to obtain data on sodium, saturated fat, and trans fat content for these items from 2000 through 2013. The amount of each nutrient per 1,000 kcal was calculated to determine whether there were trends in product reformulation. RESULTS: Sodium content per 1,000 kcal differed widely among the 3 chains by food item, precluding generalizations across chains. During the 14-year period, sodium content per 1,000 kcal for large French fries remained high for all 3 chains, although the range narrowed from 316-2,000 mg per 1,000 kcal in 2000 to 700-1,420 mg per 1,000 kcal in 2013. Among the items assessed, cheeseburgers were the main contributor of saturated fat, and there was little change in content per 1,000 kcal for this item during the 14-year period. In contrast, there was a sharp decline in saturated and trans fat content of large French fries per 1,000 kcal. Post-2009, the major contributor of trans fat per 1,000 kcal was cheeseburgers; trans fat content of this item remained stable during the 14-year period. CONCLUSION: With the exception of French fries, little evidence was found during the 14-year period of product reformulation by restaurants to become more consistent with dietary guidance to reduce intakes of sodium and saturated fat.

Temporal trends in fast-food restaurant energy, sodium, saturated fat, and trans fat content, United States, 1996-2013.

INTRODUCTION: Excess intakes of energy, sodium, saturated fat, and trans fat are associated with increased risk for cardiometabolic syndrome. Trends in fast-food restaurant portion sizes can inform policy decisions. We examined the variability of popular food items in 3 fast-food restaurants in the United States by portion size during the past 18 years. METHODS: Items from 3 national fast-food chains were selected: French fries, cheeseburgers, grilled chicken sandwich, and regular cola. Data on energy, sodium, saturated fat, and trans fat content were collated from 1996 through 2013 using an archival website. Time trends were assessed using simple linear regression models, using energy or a nutrient component as the dependent variable and the year as the independent variable. RESULTS: For most items, energy content per serving differed among chain restaurants for all menu items (P ≤ .04); energy content of 56% of items decreased (ß range, -0.1 to -5.8 kcal) and the content of 44% increased (ß range, 0.6-10.6 kcal). For sodium, the content of 18% of the items significantly decreased (ß range, -4.1 to -24.0 mg) and the content for 33% increased (ß range, 1.9-29.6 mg). Absolute differences were modest. The saturated and trans fat content, post-2009, was modest for French fries. In 2013, the energy content of a large-sized bundled meal (cheeseburger, French fries, and regular cola) represented 65% to 80% of a 2,000-calorie-per-day diet, and sodium content represented 63% to 91% of the 2,300-mg-per-day recommendation and 97% to 139% of the 1,500-mg-per-day recommendation. CONCLUSION: Findings suggest that efforts to promote reductions in energy, sodium, saturated fat, and trans fat intakes need to be shifted from emphasizing portion-size labels to additional factors such as total calories, frequency of eating, number of items ordered, menu choices, and energy-containing beverages.

Greater effectiveness of daily iron supplementation scheme in infants.

OBJECTIVE: To assess the effectiveness of weekly and daily schemes of preventive supplementation with supplementary iron to prevent iron deficiency anemia in non-anemic infants. METHODS: A prospective population study with a quantitative approach and preventive intervention was performed in the city of Viçosa, Southeastern Brazil, in 2007-8. A total of 103 non-anemic children, aged between six and 18 months of age, were selected, corresponding to 20.2% of the children registered with and cared for by Equipes de Saúde da Família (Family Health Teams). Children were divided into two supplementation groups: daily dosage recommended by the Sociedade Brasileira de Pediatria (Brazilian Society of Pediatrics) (group 1, n=34) and weekly dosage recommended by the Brazilian Ministry of Health (group 2, n=69). Assessments were made in the beginning of the study and after six months, with hemoglobin dosage (portable ss-Hemoglobin-meter) and anthropometric and dietary assessments being performed and socioeconomic questionnaire applied. Impact indicators used were prevalence of anemia, hemoglobin variation, adherence to and side effects of supplements. RESULTS: Groups were homogeneous in terms of socioeconomic, biological and before-intervention health variables. After six months of supplementation, higher means of hemoglobin were found in group 1 than in group 2 (11.66; SD=1.25 and 10.95; SD=1.41, respectively, p=0.015); in addition to lower prevalences of anemia (20.6% and 43.5%, respectively, p=0.04). Only 'supplementation time' influenced severe anemia (p=0.009). Statistically significant differences were not found for the 'adherence to supplementation' and 'side effects' variables. CONCLUSIONS: The daily dosage recommended by the Sociedade Brasileira de Pediatria was found to be more effective to prevent anemia in infants, when compared to the dosage used by the Ministry of Health. The weekly dosage recommended by the Brazilian government program needs to be reviewed to increase the effectiveness of prevention of anemia in infants cared for in public health services.

An integrated occupational hygiene consultation model for the catering industry.

Vegetable oil used in food processing, during high-temperature exposure, will generate particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs), which are carcinogenic chemical compounds, with the potential to cause lung disease for restaurant kitchen staff. This study's design includes a three-stage consultation process with eight major consultation items, in order to build an integrated consultation model for occupational hygiene. This model combines inspection and consultation, targeting Chinese restaurants in the catering industry. Characteristics of the integrated consultation model include cooperation between different government departments and collaboration with nongovernmental, professional consulting organizations. An additional benefit of the model is the building of a good partnership relationship with the Catering Trade Association. The consultation model helps Chinese restaurants attain improvements in their work environments with minimal investment. Postconsultation, results show a 63.35% and 61.98% (P < 0.001) decrease in the mean time-weighted concentration of exposure to PM and PAHs, respectively. The overall regulation compliance rate of Chinese restaurants significantly increased from 34.3% to 89.6%. These results show that the integrated consultation model for occupational hygiene not only helps small and medium enterprises reduce exposure concentrations in the workplace but also has specific potential for successful implementation in Taiwan.

What people buy from fast-food restaurants: caloric content and menu item selection, New York City 2007.

Fast-food restaurants provide a growing share of daily food intake, but little information is available in the public health literature about customer purchases. In order to establish baseline data on mean calorie intake, this study was completed in the Spring of 2007, before calorie labeling regulations went into effect in New York City. Receipts were collected from lunchtime customers, at randomly selected New York City fast-food chains. A supplementary survey was also administered to clarify receipt items. Calorie information was obtained through company websites and ascribed to purchases. Lunchtime purchases for 7,750 customers averaged 827 calories and were lowest for sandwich chains (734 calories); and highest for chicken chains (931 calories). Overall, one-third of purchases were over 1,000 calories, predominantly from hamburger chains (39%) and chicken chains (48%); sandwich chains were the lowest, with only 20% of purchases over 1,000 calories. "Combination meals" at hamburger chains accounted for 31% of all purchases and averaged over 1,200 calories; side orders accounted for almost one-third of these calories. Lunch meals at these fast-food chains are high in calorie content. Although calorie posting may help to raise awareness of the high calories in fast-food offerings, reducing portion sizes and changing popular combination meals to include lower calorie options could significantly reduce the average calorie content of purchases.

Portion sizes and obesity: responses of fast-food companies.

Because the sizes of food portions, especially of fast food, have increased in parallel with rising rates of overweight, health authorities have called on fast-food chains to decrease the sizes of menu items. From 2002 to 2006, we examined responses of fast-food chains to such calls by determining the current sizes of sodas, French fries, and hamburgers at three leading chains and comparing them to sizes observed in 1998 and 2002. Although McDonald's recently phased out its largest offerings, current items are similar to 1998 sizes and greatly exceed those offered when the company opened in 1955. Burger King and Wendy's have increased portion sizes, even while health authorities are calling for portion size reductions. Fast-food portions in the United States are larger than in Europe. These observations suggest that voluntary efforts by fast-food companies to reduce portion sizes are unlikely to be effective, and that policy approaches are needed to reduce energy intake from fast food.

Airway disease risk from environmental tobacco smoke among coffeehouse workers in Turkey.

OBJECTIVES: To examine the effect of ETS exposure on respiratory symptoms and pulmonary function and to compare workers in coffeehouses to those in other occupations in order to assess the risk of respiratory illness in this occupation. DESIGN: Cross sectional study. SETTING: The study area consisted of the three metropolitan districts of the city of Izmir, Turkey. 86 coffeehouses and 80 other small scale shops which had no known respiratory risk factor, located in the same area, were taken as the study group. SUBJECTS: 207 workers were assessed. MAIN OUTCOME MEASUREMENTS: Subjects answered a questionnaire about demographic and working characteristics, respiratory symptoms, and smoking behaviour. Physical examinations and spirometric measurements were carried out at the workplaces. RESULTS: There was a significant increase in respiratory symptoms in coffeehouse workers. Working in a coffeehouse showed a significant risk for chronic bronchitis (odds ratio (OR) 4.3). In coffeehouse workers, forced expiratory volume in one second (FEV(1)) decreased 5.1%, forced vital capacity (FVC) 3.4%, FEV(1)/FVC 1.6%, peak expiratory flow (PEF) 6.45%, and forced expiratory flow (FEF(25)) 7.2%, FEF(50) 10%, and FEF(25-75) 9.8%. Among workers who were described as having an "airway disease", coffeehouse workers were significantly greater in number. When age, body mass index, and smoking behaviour were controlled, working in a coffeehouse was strongly associated with "airway disease" compared to other workers (OR 5.35, 95% confidence interval 2.41 to 11.87). CONCLUSIONS: Workers in coffeehouses showed significant increases in respiratory symptoms and decreased pulmonary function. All workers need to gain an awareness of these occupational risks and working conditions should be improved immediately.

Fat content of chips, quality of frying fat and deep-frying practices in New Zealand fast food outlets.

OBJECTIVES: To collect baseline data on the fat content of hot chips, quality (degradation) of cooking fat, deep-frying practices and related attitudes in fast food outlets in New Zealand. To identify the key determinants of the fat content of chips and quality of cooking fat. METHODS: A nationally representative sample of fast food outlets (n=150, response rate 80%) was surveyed between September 1998 and March 1999. Data collected included a questionnaire, observation of cooking practices and analysis of cooked chips and frying fat. RESULTS: Only 8% of independent operators had formal training in deep frying practices compared with 93% of chain operators. There was a wide range of fat content of chips (5%-20%, mean 11.5%). The use of thinner chips, crinkle cut chips and lower fryer fat temperature were associated with higher chip fat content. Eighty-nine per cent of chain outlets used 6-10 mm chips compared with 83% of independent outlets that used chips > or = 12 mm. A wide range of frying temperatures was recorded (136-233 degrees C) with 58% of outlets frying outside the reference range (175-190 degrees C). As indices of fat degradation, fat acid and polar compound values above the recommended levels occurred in 54% and 5% of outlets respectively. Operators seemed willing to learn more about best practice techniques, with lack of knowledge being the main barrier to change. CONCLUSIONS AND IMPLICATIONS: Deep frying practices could be improved through operator training and certification options. Even a small decrease in the mean fat content of chips would reduce the obesogenic impact of this popular food.