Using Supermarket Loyalty Card Data to Provide Personalised Advice to Help Reduce Saturated Fat Intake among Patients with Hypercholesterolemia: A Qualitative Study of Participants' Experiences.

BACKGROUND: The 'Primary Care SHOPping Intervention for Cardiovascular Disease Prevention' (PCSHOP) trial tested the effectiveness and feasibility of a behavioural intervention to reduce saturated fat in food purchases. The intervention offered feedback from data collected through a supermarket loyalty card to supplement brief advice from a nurse. This qualitative study aimed to describe participants' experiences of receiving this intervention. METHODS: We conducted semi-structured, one-to-one, telephone interviews with participants from the PCSHOP trial. Interviews were audio-recorded and transcribed verbatim. We employed the one sheet of paper technique and a thematic analysis to develop high-level themes in NVivo software. RESULTS: Twenty-four participants were interviewed (mean age: 63 years (SD 12)). They reported that the brief advice did not provide any new information but they welcomed the sense of accountability the nurse provided. The personalised shopping feedback and healthier swap suggestions provided novel information that challenged previously held beliefs about the saturated fat content of food purchases and encouraged some positive dietary changes. However, the taste preferences of the participant or other household members were a barrier to changing food shopping behaviours. CONCLUSION: Harnessing loyalty card data is a novel and acceptable method to offering personalised dietary feedback. Yet, issues on the suitability of the healthier swap suggestions limited the extent of dietary change. TRIAL REGISTRATION: ISRCTN14279335. Registered 1 September 2017.

Supplemental Nutrition Assistance Program participation and current restricted food expenditures: implications for policy.

OBJECTIVE: National concerns over food insecurity and obesity have prompted legislation seeking to further restrict Supplemental Nutrition Assistance Program (SNAP) purchases. The objective of this study is to provide insight on the potential impact of proposed purchase restrictions by comparing SNAP participant and income-eligible non-participants' expenditures on current SNAP-restricted foods, that is, hot foods, prepared foods, alcohol, vitamins and meal supplements. DESIGN: Cross-sectional study. Bivariate analysis and multivariable regression analysis with an instrumental variables approach were employed to compare the probability of purchasing and expenditures on current SNAP-restricted foods among SNAP participants and income-eligible non-participants. SETTING: National Household Food Acquisition and Purchase Survey, 2012-2013. PARTICIPANTS: 2513 households, of which 1316 were SNAP participants and 1197 were income-eligible non-participants. RESULTS: Both the share of households purchasing and household expenditures on current SNAP-restricted foods were similar among SNAP participants and income-eligible non-participants. CONCLUSIONS: Results provide further empirical evidence that proposed SNAP purchase restrictions on sugar-sweetened beverages, snack foods and luxury foods are unlikely to have a meaningful effect on SNAP household food purchases.

Addressing the Fortification Quality Gap: A Proposed Way Forward.

Large-scale food fortification is an effective, sustainable, and scalable intervention to address vitamin and mineral deficiencies, however, pressing gaps exist globally around ensuring the quality of fortified foods. This paper summarizes the global challenges and gaps faced in monitoring the quality of fortified foods, the guidance produced in response to these challenges, where we are today in terms of effective implementation, and what approaches and opportunities may be usefully applied to enhance the quality of fortified foods moving forward.

Optimisation modelling to improve the diets of First Nations individuals.

We examined the feasibility of linear programming (LP) to develop diets that were economical, included traditional (cultural, non-market) foods and met the dietary reference intakes (DRI) in a Canadian Indigenous population. Diet optimisation using LP is a mathematical technique that can develop food-based dietary guidelines for healthy eating in Indigenous populations where food insecurity, availability and cost are important considerations. It is a means of developing nutritionally optimal food combinations that are based on economical and culture-specific foods. Observed food consumption data were derived using 24-h food recalls from the First Nations Food, Nutrition and Environment Study. The LP models were constructed to develop diets meeting DRI, cost and food constraints. Achieving the recommended food intake was not feasible in a model meeting all nutrient requirements. Models that met most nutrient requirements at reduced cost were designed for men and women, separately. In women, it was necessary to increase energy intake to meet most nutrient requirements. Nutrient requirements could not be met for fibre, linoleic and linolenic acids, vitamin D, Ca and K in both sexes, P in women, and Mg and vitamin A in men. Using LP to develop optimal diets for First Nations people, we found simultaneous achievement of all DRI was difficult, suggesting that supplementation might be necessary which goes against recommendations for individuals to meet their nutrient needs through healthy eating patterns. Additionally, to make diets feasible, programmes to reduce market food costs and to support First Nations people in traditional food harvesting are recommended.

The Role of Supportive Food Environments to Enable Healthier Choices When Eating Meals Prepared Outside the Home: Findings from Focus Groups of 18 to 30-Year-Olds.

Young adults are the highest consumers of food prepared outside home, which has been linked to weight gain. The aim of this qualitative research was to gather opinions from young adults about what influences their food choice when eating out and if they so desired, what might enable healthy choices. Thirty-one adults aged 18 to 30 years participated in four focus groups (females = 24). Predetermined questions were used to guide discussions which were audiotaped then transcribed. The content was organized into themes and sub-themes using NVivo software. Two broad groupings arose-personal behaviors and changes to physical and social food environments. For many, eating out was viewed as a special occasion so that healthy food was not a priority and despite understanding health consequences of poor diets this was not an immediate concern. Price discounts and menu-labelling were suggested and trust in credible organizations and peers' endorsement of meals and venues expressed. The role of smartphones in the modern food environment emerged as a tool to enable immediate access to many restaurants to order food and access reviews and social media as a source of persuasive food imagery. Current menu-labelling initiatives should continue, food pricing be explored and influence of smartphones on diet further researched. However, these findings may be limited by the high proportion of women and higher socioeconomic status and urban residence of many participants.

A Systematic Review of Mobile Produce Markets: Facilitators and Barriers to Use, and Associations with Reported Fruit and Vegetable Intake.

BACKGROUND: Diet-related chronic diseases are a major public health burden. There is growing awareness that disparities in healthful food access contribute to disparities in health. Mobile produce markets (MPMs) have emerged as a strategy to improve fruit and vegetable access and consumption, particularly among low-income, minority, and other vulnerable populations (eg, older adults and children) in food desert neighborhoods. OBJECTIVE: This review examined research on MPMs in the United States and specifically aimed to assess the relationship between MPM use and fruit and/or vegetable intake, and facilitators and barriers related to MPM use within a social ecological framework. METHODS: A systematic review of the literature consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. Articles published through December 2017 were identified using the following databases: Web of Science, PubMed, Agricola, and CAB Abstracts. MPM studies published in English and in peer-reviewed journals were eligible for inclusion if they were based on primary research of MPMs in the United States, included results, and if MPMs were analyzed separately from other market venues and sold predominantly fruits and/or vegetables. A total of 24 studies were identified for inclusion, which varied in study types as follows: quantitative (n=15), qualitative (n=3), and mixed methods (n=6). RESULTS: An association was found between MPM use and higher reported fruit and/or vegetable intake, although existing studies that measured fruit and vegetable intake were not rigorous in study design (eg, lack of control group, use of convenience sample, small sample size). MPM location was the most commonly cited facilitator of MPM use. Other institutional factors (eg, nutrition education), as well as policy factors (eg, food-assistance programs), community factors (eg, market site liaisons), interpersonal factors (eg, socializing at market), and intrapersonal factors (eg, awareness of the benefits of fruit and/or vegetable intake) were identified. CONCLUSIONS: MPMs offer a promising strategy to improve access to fruits and vegetables and may further support healthful-food purchasing and consumption through food-assistance incentives and enticements for consumers (eg, opportunities for social networking and nutrition education). Future research on MPMs would benefit from more rigorous experimental designs, such as including a control group, and examining multiple levels within a social ecological framework.

Vitamin A nutrition among East Timor refugee children.

BACKGROUND AND OBJECTIVES: Children age 6 to 72 months, living in refugee camps are at increased risk of developing vitamin A deficiency (VAD), resulting in increased morbidity and mortality. Due to poverty, often this population group has limited access to foods containing vitamin A from animal-based food sources and do not commonly consume available foods containing beta-carotene. To date, there is a paucity of data on vitamin A intake in young refugee children. To determine vitamin A intake in children ages 6 to 72 months at refugee camps in East Timor. METHODS AND STUDY DESIGN: A cross sectional study was carried out among children ages 6 to 72 months at refugee camps near Dili, East Timor. A detailed vitamin A intake questionnaire was ascertained from the primary caretaker, and the criteria and indicator cut off values suggested by World Health Organization (WHO) were used to classify the populations' vitamin A risk. RESULTS: Although animal sources of vitamin A were limited due to costs, all 89 children commonly consumed fruit containing vitamin A sources more than 3 times a week. Most children (69.7%) had been breast fed regularly, while 30.3% combined with bottle milk. 80.9% of children received vitamin A supplementation. CONCLUSION: Children in East Timor refugee camps have adequate vitamin A intake.

Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala.

The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low- and middle-income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low- and middle-income countries are not well understood. We conducted in-depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi-structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well-being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy-dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.

Overall Content of Salicylic Acid and Salicylates in Food Available on the European Market.

The study aimed to determine the salicylates content in 112 products available on the European market. Quantitative determination of free and conjugated forms of salicylic acid in food was performed using reversed-phase high-performance liquid chromatography with fluorescence detection. The salicylates contents ranged from 0 to 1675.79 (µg/100 g). The results of this study confirm the presence of salicylates in food products, as well as a broad content diversity of these compounds depending on the species, variety, and method of processing the food items. The results can be very helpful for nutritionists and dieticians in planning low-salicylates or high-salicylates diets.

POLITICS OF BIOPIRACY: AN ADVENTURE INTO HOODIA/XHOBA PATENTING IN SOUTHERN AFRICA.

BACKGROUND: Africa is being described as the wretched of the earth, despite this, the continent is endowed with natural resources, dynamic ecosystem, and different species of plants and animals, and species derivatives. This paper area of departure is to focus on Hoodia, a plant that is being a source of food, medicine and water for the San and Khoe indigenous peoples before the advent of Europeans into southern Africa. South African Council for Scientific and Industrial Research (CSIR) dubiously patented Hoodia without observing the basic indices of geographical indications (GIs), indigenous knowledge (IK), novelty, access sharing benefit (ASB), prior informed consent (PIC) and sustainability of ecosystem before the rights was sold to Phytopharm pharmaceutical company. MATERIALS AND METHODS: This article adopts neoliberal thesis with emphasis on complex interdependence theory of organic linkages between developing and developed countries. Secondary sources of information taken into account of qualitative and critical discuss content analyses dominate this paper. RESULT: The paper recommends a linkage between developed and developing states based on endowment theory and comparative advantage with the notion of adhering to the Convention on Biological Diversity (CBD) which has three objectives: the conservation of biodiversity; the sustainable utilisation of indigenous biological resources (IBR); and fair and equitable benefit sharing. CONCLUSION: The paper recommends that there is a need to follow CBD and other relevant international regimes that promote equal exchange in exploitation of Africa resources as against the present skewed arrangement that is in favour of multinational corporations (MNCs).

Wholesome Nutrition: an example for a sustainable diet.

'Wholesome Nutrition' is a concept of sustainable nutrition that was developed at the University of Giessen in the 1980s. In this concept, health and the ecologic, economic, social and cultural dimensions of nutrition are equally important. In 1992 at the UN-Conference on Environment and Development in Rio de Janeiro the definition of 'Sustainable Development' comprised the dimensions environment, economy and society. Additionally to these three 'classical' dimensions of sustainability, we included 'health' as the fourth dimension because nutrition has far reaching effects on human health. The fifth dimension, 'culture', became part of the sustainability dialogue since many years; the respective cultural background influences food habits. Presently, mankind has to cope with huge global challenges such as poverty and food insecurity in low-income countries as well as climate change. Therefore the objective is to identify prospects for actions to respond to these global challenges. The concept of 'Sustainable Nutrition' analyses the food supply chain at all stages from input-production and primary production to processing, distribution, preparation, consumption and waste disposal. The present analysis leads to the following seven principles: preference of plant-based foods, organic foods, regional and seasonal products, preference of minimally processed foods, Fair Trade products, resource-saving housekeeping and enjoyable eating culture. This concept is based on holistic thinking and has the potential to reduce the global challenges in the field of nutrition. Scientists, stakeholders, multipliers and consumers are asked to consider environmental, economic, social and cultural aspects in addition to the biological (health) aspects.

Development of a New Branded UK Food Composition Database for an Online Dietary Assessment Tool.

The current UK food composition tables are limited, containing ~3300 mostly generic food and drink items. To reflect the wide range of food products available to British consumers and to potentially improve accuracy of dietary assessment, a large UK specific electronic food composition database (FCDB) has been developed. A mapping exercise has been conducted that matched micronutrient data from generic food codes to "Back of Pack" data from branded food products using a semi-automated process. After cleaning and processing, version 1.0 of the new FCDB contains 40,274 generic and branded items with associated 120 macronutrient and micronutrient data and 5669 items with portion images. Over 50% of food and drink items were individually mapped to within 10% agreement with the generic food item for energy. Several quality checking procedures were applied after mapping including; identifying foods above and below the expected range for a particular nutrient within that food group and cross-checking the mapping of items such as concentrated and raw/dried products. The new electronic FCDB has substantially increased the size of the current, publically available, UK food tables. The FCDB has been incorporated into myfood24, a new fully automated online dietary assessment tool and, a smartphone application for weight loss.

Taxonomic Identity, Geographic Distribution, and Commercial Exploitation of the Culinary-Medicinal Mushroom Pleurotus nebrodensis (Basidiomycetes).

An updated overview of the outcome of studies conducted on the culinary-medicinal mushroom Pleurotus nebrodensis is presented by placing emphasis on the clarification of the taxonomic identity of P. nebrodensis and other related taxa possessing entirely white to cream basidiomes, which grow in association with different plants of the family Apiaceae. Cultivation techniques, quality of the product sold and sales price, as well as nutritional and medicinal aspects are discussed. Taking also into consideration the high economic importance of P. nebrodensis, it is essential to proceed with the verification of the commercial strains currently available in the international market under the name of "P. nebrodensis" since it is very probable that many (or most) of them do not represent the real P. nebrodensis. TO confirm this hypothesis, an in silico analysis was conducted on a large of number of ITS1-5.8S-ITS2 rRNA sequences deposited in the National Center for Biotechnology Information database under the name P. nebrodensis. Results demonstrated that all "P nebrodensis" material examined from China (plus several sequences of no reported origin) corresponded to P. eryngii subsp. tuoliensis, with only 2 exceptions, which were grouped within P. eryngii sensu stricto. The real P. nebrodensis biological material from Italy and Greece is certified and is available upon request by the authors at the University of Palermo and the Agricultural University of Athens.

From economic survival to recreation: contemporary uses of wild food and medicine in rural Sweden, Ukraine and NW Russia.

BACKGROUND: There are many ethnobotanical studies on the use of wild plants and mushrooms for food and medicinal treatment in Europe. However, there is a lack of comparative ethnobotanical research on the role of non-wood forest products (NWFPs) as wild food and medicine in local livelihoods in countries with different socio-economic conditions. The aim of this study was to compare the present use of wild food and medicine in three places representing different stages of socio-economic development in Europe. Specifically we explore which plant and fungi species people use for food and medicine in three selected rural regions of Sweden, Ukraine and the Russian Federation. METHODS: We studied the current use of NWFPs for food and medicine in three rural areas that represent a gradient in economic development (as indicated by the World Bank), i.e., Småland high plain (south Sweden), Roztochya (western Ukraine), and Kortkeros (Komi Republic in North West Russia). All areas were characterised by (a) predominating rural residency, (b) high forest coverage, and (c) free access to NWFPs. A total of 205 in-depth semi-structured interviews were conducted with local residents in the three study areas. The collected NWFPs data included (1) the species that are used; (2) the amount harvested, (3) uses and practices (4) changes over time, (5) sources of knowledge regarding the use of NWFPs as wild food and medicine and (6) traditional recipes. RESULTS: In Sweden 11 species of wild plant and fungi species were used as food, and no plant species were used for medicinal purposes. In Ukraine the present use of NWFPs included 26 wild foods and 60 medicinal species, while in Russia 36 food and 44 medicinal species were reported. CONCLUSIONS: In the economically less developed rural areas of Ukraine and Russia, the use of NWFPs continues to be an important part of livelihoods, both as a source of income and for domestic use as food and medicine. In Sweden the collection of wild food has become mainly a recreational activity and the use of medicinal plants is no longer prevalent among our respondents. This leads us to suggest that the consumption of wild food and medicine is influenced by the socio-economic situation in a country.

Microbiological impact of three commercial laying hen housing systems.

Hen housing for commercial egg production continues to be a societal and regulatory concern. Controlled studies have examined various aspects of egg safety, but a comprehensive assessment of commercial hen housing systems in the US has not been conducted. The current study is part of a holistic, multidisciplinary comparison of the diverse aspects of commercial conventional cage, enriched colony cage, and cage-free aviary housing systems and focuses on environmental and egg microbiology. Environmental swabs and eggshell pools were collected from all housing systems during 4 production periods. Total aerobes and coliforms were enumerated, and the prevalence of Salmonella and Campylobacter spp. was determined. Environmental aerobic and coliform counts were highest for aviary drag swabs (7.5 and 4.0 log cfu/mL, respectively) and enriched colony cage scratch pad swabs (6.8 and 3.8 log cfu/mL, respectively). Aviary floor and system wire shell pools had the greatest levels of aerobic contamination for all eggshell pools (4.9 and 4.1 log cfu/mL, respectively). Hens from all housing systems were shedding Salmonella spp. (89-100% of manure belt scraper blade swabs). The dry belt litter removal processes for all housing systems appear to affect Campylobacter spp. detection (0-41% of manure belt scraper blade swabs) considering detection of Campylobacter spp. was much higher for other environmental samples. Aviary forage area drag swabs were 100% contaminated with Campylobacter spp., whereas enriched colony cage scratch pads had a 93% positive rate. There were no differences in pathogen detection in the shell pools from the 3 housing systems. Results indicate egg safety is enhanced when hens in alternative housing systems use nest boxes. Additionally, current outcomes indicate the use of scratch pads in hen housing systems needs to be more thoroughly investigated for effects on hen health and egg safety.

The relation of potassium and sodium intakes to diet cost among U.S. adults.

The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.

Effect of sociodemographic variables and time on food group contribution to total food availability in Portuguese elderly households.

OBJECTIVE: To analyze the simultaneous effects of sociodemographic variables and time on each food group contribution to total Portuguese elderly household food availability. DESIGN: Four cross sectional Portuguese Household Budget Surveys were used. A multivariate analysis of variance (MANOVA), using a general linear model (GLM), was applied to analyze the simultaneous effects of sociodemographic variables and time. SETTING: Portuguese population. SUBJECTS: Nationally representative samples of households with members aged ≥ 65 years were selected and categorized as solitary elderly female, solitary elderly male, or couple (one elderly female and one elderly male). Samples included 1,967 households in 1989-1990, 2,219 households in 1994-1995, 2,533 households in 2000-2001 and 2,441 households in 2005-2006. RESULTS: The simultaneous effects of sociodemographic variables and time were significant for all food groups (P<0.001). The highest contribution for the total household food availability was found for cereals, potatoes, alcoholic beverages, non-alcoholic beverages and fruits. The effects were large for "household food availability" and medium for "elderly household type", "urbanization degree", "income", "food expenses" and "eating out expenses". Solitary elderly male households had the highest proportion of cereals and alcoholic beverages, whilst solitary elderly female households had higher availability of milk/milk products and fruits. Households located in urban areas had higher contribution of milk/milk products while rural, had higher contribution of potatoes. CONCLUSIONS: The simultaneous effect of the studied variables on food group contribution to total household food availability can be considered when addressing dietary recommendation for providing an insight into the motivations associated with food purchases.

Comparison of the effects of conditional food and cash transfers of the Ethiopian Productive Safety Net Program on household food security and dietary diversity in the face of rising food prices: ways forward for a more nutrition-sensitive program.

BACKGROUND: In light of the continuing rise in food prices during and after the 2008 world food crisis, whether food and cash transfers are equally effective in improving food security and diet quality is debatable. OBJECTIVE: To compare the effects of conditional food and cash transfers of the Ethiopian Productive Safety Net Program (PSNP) on household food security and dietary diversity. METHODS: Data on household dietary diversity, child anthropometry, food security, and preference of transfer modalities (food, cash, or mixed) were generated from a cross-sectional survey of 195 PSNP beneficiary households (67 receiving food and 128 receiving cash) in Hawella Tulla District, Sidama, southern Ethiopia. RESULTS: Most beneficiaries (96%) reported food shortages, and 47% reported food shortages that exceeded 3 months. Households receiving cash had better household dietary diversity scores (p = .02) and higher consumption of oils and fats (p = .003) and vitamin A-rich foods (p = .002). Compared with households receiving food, households receiving cash were more affected by increases in food prices that forced them to reduce their number of daily meals (p < .001) and spend less on nonstaples (p < .001). While most households receiving food (82%) preferred to continue receiving food, households receiving cash (56%) preferred a mix of food and cash. CONCLUSIONS: Households receiving cash had better household dietary diversity than households receiving food, a result suggesting that cash transfers may be more effective. However, the continuing rise infood prices may offset these benefits unless cash transfers are index-linked to food price fluctuations.

Palm oil taxes and cardiovascular disease mortality in India: economic-epidemiologic model.

OBJECTIVE: To examine the potential effect of a tax on palm oil on hyperlipidemia and on mortality due to cardiovascular disease in India. DESIGN: Economic-epidemiologic model. MODELING METHODS: A microsimulation model of mortality due to myocardial infarction and stroke among Indian populations was constructed, incorporating nationally representative data on systolic blood pressure, total cholesterol, tobacco smoking, diabetes, and cardiovascular event history, and stratified by age, sex, and urban/rural residence. Household expenditure data were used to estimate the change in consumption of palm oil following changes in oil price and the potential substitution of alternative oils that might occur after imposition of a tax. A 20% excise tax on palm oil purchases was simulated over the period 2014-23. MAIN OUTCOME MEASURES: The model was used to project future mortality due to myocardial infarction and stroke, as well as the potential effect of a tax on food insecurity, accounting for the effect of increased food prices. RESULTS: A 20% tax on palm oil purchases would be expected to avert approximately 363,000 (95% confidence interval 247,000 to 479,000) deaths from myocardial infarctions and strokes over the period 2014-23 in India (1.3% reduction in cardiovascular deaths) if people do not substitute other oils for reduced palm oil consumption. Given estimates of substitution of palm oil with other oils following a 20% price increase for palm oil, the beneficial effects of increased polyunsaturated fat consumption would be expected to enhance the projected reduction in deaths to as much as 421,000 (256,000 to 586,000). The tax would be expected to benefit men more than women and urban populations more than rural populations, given differential consumption and cardiovascular risk. In a scenario incorporating the effect of taxation on overall food expenditures, the tax may increase food insecurity by <1%, resulting in 16,000 (95% confidence interval 12,000 to 22,000) deaths. CONCLUSIONS: Curtailing palm oil intake through taxation may modestly reduce hyperlipidemia and cardiovascular mortality, but with potential distributional consequences differentially benefiting male and urban populations, as well as affecting food security.