Prospective association between organic food consumption and the risk of type 2 diabetes: findings from the NutriNet-Santé cohort study.

BACKGROUND: Organic food (OF) consumption has substantially increased in high income countries, mostly driven by environmental concerns and health beliefs. Lower exposure to synthetic pesticides has been systematically documented among consumers of organic products compared to non-consumers. While experimental studies suggest that pesticides currently used in food production may be associated with type 2 diabetes (T2D), no well-conducted prospective studies have investigated the potential association between consumption of organic products and the risk of T2D, controlling for potential confounding factors. The objective of this prospective study was to estimate the association between OF consumption and the risk of T2D. METHODS: A total of 33,256 participants (76% women, mean (SD) age: 53 years (14)) of the French NutriNet-Santé prospective cohort study who completed the organic food frequency questionnaire were included (2014-2019). The proportion of OF in the diet (as weight without drinking water) was computed. The associations between the proportion of OF in the diet (as 5% increment and as quintiles) and the risk of T2D were estimated using multivariable Hazard Ratio (HR) and 95% confidence interval (95% CI) derived from proportional hazards models adjusted for confounders (sociodemographic, anthropometric, lifestyle, medical and nutritional factors). RESULTS: During follow-up (mean = 4.05 y, SD = 1.03 y, 134,990 person-years), 293 incident cases of T2D were identified. After adjustment for confounders including lifestyle (physical activity, smoking status, alcohol consumption) and nutritional quality of the diet assessed by the adherence to the French food-based dietary guidelines, OF consumption was associated with a lower risk of T2D. Participants with the highest quintile of OF consumption, compared with those with the lowest quintile, had 35% lower risk of T2D (95% CI = 0.43-0.97). Each increment of 5% in the proportion of OF in the diet was associated with 3% lower risk of T2D (HR 0.97, 95% CI = 0.95-0.99). CONCLUSIONS: In this large prospective cohort study, OF consumption was inversely associated with the risk of T2D. Further experimental and prospective studies should be conducted to confirm these observations. CLINICAL TRIAL REGISTRY: The study was registered at ClinicalTrials.gov ( NCT03335644 ).

Prospective associations between sustainable dietary pattern assessed with the Sustainable Diet Index (SDI) and risk of cancer and cardiovascular diseases in the French NutriNet-Santé cohort.

To ensure a sustainable development, it is essential to better characterize the relationships between diet sustainability and health. We investigated the associations between sustainable dietary patterns, assessed using the Sustainable Diet Index (SDI) and the risk of cancer and cardiovascular diseases in a large prospective cohort of French volunteers. We computed the SDI among 25,592 participants of the NutriNet-Santé cohort using a database developed within the BioNutriNet project comprising nutritional, behavioral, environmental and economic data. Health status of each participant was collected from 2014 to 2018 and validated by physicians. Associations between the SDI and risk of chronic diseases (cancer and cardiovascular diseases) were assessed using multivariable Cox models. 640 incident chronic diseases occurred during the 3.8-year follow-up (483 cancer cases and 158 cardiovascular disease cases). A higher SDI was associated with a lower risk of overall chronic diseases after adjustment for potential confounding factors. Participants in the fourth quartile, reflecting the highest sustainable dietary patterns, exhibited a significant decrease in risk of cancers or cardiovascular diseases (HRQ4 vs. Q1 = 0.61 (95% CI 0.47-0.80), P-trend = 0.0002). More specifically, this association was observed for cancers in the fully adjusted model but was not statistically significant for cardiovascular diseases. Although these results need to be confirmed by other observational studies, they support the fact that a wide adoption of sustainable dietary patterns may contribute to improving global health in France and argue for existing dietary patterns exhibiting cobenefits for human health and the environment.

Organic food and health.

The popularity of organic foods grows systematically. In the last decade, several critical reviews and meta-analysis concerning organic food consumption and their effect on some chosen health problems have been published. The aim of the work was to present the current state of knowledge regarding the influence of organic food consumption on human health. On average, organic food of plant origin is characterized by a trace presence of pesticides, a lower content of nitrates and an increased content of polyphenols and vitamin C. Organic products of animal origin contain more beneficial for health unsaturated fatty acid. Organic dairy products, in contrast to meat products, are characterized by a higher content of protein and saturated fatty acids, however, the differences more result from the length of the grazing period and access to fresh forage than to the production system. Although generally, the consumption of organic food does not provide a significant nutritional advantage compared to a conventional diet, regular and frequent consumption of organic products generally reduces the risk of overweight and obesity, both for women and men, as well as non-Hodgkin lymphoma in case of women. Besides those, consumption of organic fruits and vegetables, as well as dairy products significantly reduces the risk of pre-eclampsia in pregnancy and eczema in infants, respectively. Positive effect on selected health problems probably results from a reduced amount of pesticide residues and an increased secondary plant metabolites intake which characterize organic food. This review showed that there is a need for further, especially, large cohort studies concerning the effect of organic food consumption on specific diseases development.

Association between time perspective and organic food consumption in a large sample of adults.

BACKGROUND: Organic food intake has risen in many countries during the past decades. Even though motivations associated with such choice have been studied, psychological traits preceding these motivations have rarely been explored. Consideration of future consequences (CFC) represents the extent to which individuals consider future versus immediate consequences of their current behaviors. Consequently, a future oriented personality may be an important characteristic of organic food consumers. The objective was to analyze the association between CFC and organic food consumption in a large sample of the adult general population. METHODS: In 2014, a sample of 27,634 participants from the NutriNet-Santé cohort study completed the CFC questionnaire and an Organic-Food Frequency questionnaire. For each food group (17 groups), non-organic food consumers were compared to organic food consumers across quartiles of the CFC using multiple logistic regressions. Moreover, adjusted means of proportions of organic food intakes out of total food intakes were compared between quartiles of the CFC. Analyses were adjusted for socio-demographic, lifestyle and dietary characteristics. RESULTS: Participants with higher CFC were more likely to consume organic food (OR quartile 4 (Q4) vs. Q1 = 1.88, 95% CI: 1.62, 2.20). Overall, future oriented participants were more likely to consume 14 food groups. The strongest associations were observed for starchy refined foods (OR = 1.78, 95% CI: 1.63, 1.94), and fruits and vegetables (OR = 1.74, 95% CI: 1.58, 1.92). The contribution of organic food intake out of total food intake was 33% higher in the Q4 compared to Q1. More precisely, the contribution of organic food consumed was higher in the Q4 for 16 food groups. The highest relative differences between Q4 and Q1 were observed for starchy refined foods (22%) and non-alcoholic beverages (21%). Seafood was the only food group without a significant difference. CONCLUSIONS: This study provides information on the personality of organic food consumers in a large sample of adult participants. Consideration of future consequences could represent a significant psychological determinant of organic food consumption.

Gardening for Health: Patterns of Gardening and Fruit and Vegetable Consumption Among the Navajo.

American Indians, including Navajo, are disproportionately affected by obesity and diabetes, in part due to diet-related health behaviors. The purpose of this study was to assess the patterns of gardening and fruit and vegetable (FV) consumption among residents in two communities on the Navajo Nation in order to inform a community gardening intervention. We analyzed survey data collected from participants in the Yéego Gardening study conducted in two communities in the Navajo Nation (N = 169). We found that 51% of the sample gardened, and on average participants gardened 8.9 times per month. Lack of time (53%) and financial barriers, such as gas for transportation or irrigation (51 and 49%, respectively), were reported as barriers to gardening. Most participants reported low levels of self-efficacy (80%) and behavioral capability (82%) related to gardening. Those with higher levels of gardening self-efficacy and behavioral capability reported more frequent gardening. Average daily FV consumption was 2.5 servings. Most participants reported high levels of self-efficacy to eat FV daily (64%) and high behavioral capability to prepare FV (66%). There was a positive association between FV consumption and gardening, with those gardening more than 4 times per month eating about 1 more serving of FV per day than those gardening 4 or fewer times per month. Further research is needed to better understand how gardening can increase fruit and vegetable availability and consumption among residents of the Navajo Nation.

Dietary intakes and diet quality according to levels of organic food consumption by French adults: cross-sectional findings from the NutriNet-Santé Cohort Study.

OBJECTIVE: We aimed to assess dietary profiles of adults from the NutriNet-Santé cohort according to different levels of organic food consumption using detailed self-reported data on organic food intakes. DESIGN: Food intakes were obtained using an organic food frequency questionnaire (Org-FFQ). The participants were ranked into five groups (quintiles, Q) according to the proportion of organic foods in their diet. To determine diet quality, two scores were computed reflecting adherence to food-based recommendations (mPNNS-GS) and the probability of adequate nutrient intake (PANDiet). Relationships between levels of organic food consumption and dietary characteristics were assessed using multivariable-adjusted ANCOVA models. SETTING: The NutriNet-Santé Study. SUBJECTS: French adults from the NutriNet-Santé Study (n 28 245). RESULTS: Intakes of foods of plant origin increased along with the contribution of organic foods to the diet while a reverse trend was identified for dairy products, cookies and soda (P-trend<0·0001). The diet quality scores increased from Q1 (mPNNS-GS, 7·89 (se 0·02); PANDiet: 63·04 (se 0·11)) to Q5 (mPNNS-GS, 8·78 (se 0·02); PANDiet, 69·37 (se 0·10)). Overall, high organic food consumers exhibited better diet quality, although intermediate organic food consumers showed better adherence to specific nutritional recommendations related to animal products. CONCLUSIONS: The study provides new insights into the understanding of organic food consumption as a part of a healthy diet and sheds some light on the dietary profiles of different categories of organic food consumers. These results underline strong dietary behaviour correlates associated with organic food consumption that should be controlled for in future aetiological studies on organic foods and health.

Typology of eaters based on conventional and organic food consumption: results from the NutriNet-Santé cohort study.

Limited information is available on large-scale populations regarding the socio-demographic and nutrient profiles and eating behaviour of consumers, taking into account both organic and conventional foods. The aims of this study were to draw up a typology of consumers according to their eating habits, based both on their dietary patterns and the mode of food production, and to outline their socio-demographic, behavioural and nutritional characteristics. Data were collected from 28 245 participants of the NutriNet-Santé study. Dietary information was obtained using a 264-item, semi-quantitative, organic FFQ. To identify clusters of consumers, principal component analysis was applied on sixteen conventional and sixteen organic food groups followed by a clustering procedure. The following five clusters of consumers were identified: (1) a cluster characterised by low energy intake, low consumption of organic food and high prevalence of inadequate nutrient intakes; (2) a cluster of big eaters of conventional foods with high intakes of SFA and cholesterol; (3) a cluster with high consumption of organic food and relatively adequate nutritional diet quality; (4) a group with a high percentage of organic food consumers, 14 % of which were either vegetarians or vegans, who exhibited a high nutritional diet quality and a low prevalence of inadequate intakes of most vitamins except B12; and (5) a group of moderate organic food consumers with a particularly high intake of proteins and alcohol and a poor nutritional diet quality. These findings may have implications for future aetiological studies investigating the potential impact of organic food consumption.

The effectiveness of the Danish Organic Action Plan 2020 to increase the level of organic public procurement in Danish public kitchens.

OBJECTIVE: To measure the effect of organic food conversion projects on the percentage of organic food used in Danish public kitchens participating in the Danish Organic Action Plan 2020. DESIGN: The current longitudinal study was based on measurements of organic food percentages in Danish public kitchens before and after kitchen employees participated in conversion projects. SETTING: Public kitchens participating in the nine organic food conversion projects under the Danish Organic Action Plan 2020, initiated during autumn 2012 and spring 2013 and completed in summer 2015. SUBJECTS: A total of 622 public kitchens. RESULTS: The average (median) increase in organic food percentage from baseline to follow-up was 24 percentage points (P<0·001) during an overall median follow-up period of 1·5 years. When analysing data according to public kitchen type, the increase remained significant for seven out of eight kitchens. Furthermore, the proportion of public kitchens eligible for the Organic Cuisine Label in either silver (60-90 % organic food procurement) or gold (90-100 % organic food procurement) level doubled from 31 % to 62 %, respectively, during the conversion period. Conversion project curriculum mostly included elements of 'theory', 'menu planning', 'network' and 'Organic Cuisine Label method' to ensure successful implementation. CONCLUSIONS: The study reports significant increases in the level of organic food procurement among public kitchens participating in the Danish Organic Action Plan 2020. Recommendations for future organic conversion projects include adding key curriculum components to the project's educational content and measuring changes in organic food percentage to increase the chances of successful implementation.

Organic food consumption and the incidence of cancer in a large prospective study of women in the United Kingdom.

BACKGROUND: Organically produced foods are less likely than conventionally produced foods to contain pesticide residues. METHODS: We examined the hypothesis that eating organic food may reduce the risk of soft tissue sarcoma, breast cancer, non-Hodgkin lymphoma and other common cancers in a large prospective study of 623 080 middle-aged UK women. Women reported their consumption of organic food and were followed for cancer incidence over the next 9.3 years. Cox regression models were used to estimate adjusted relative risks for cancer incidence by the reported frequency of consumption of organic foods. RESULTS: At baseline, 30%, 63% and 7% of women reported never, sometimes, or usually/always eating organic food, respectively. Consumption of organic food was not associated with a reduction in the incidence of all cancer (n=53 769 cases in total) (RR for usually/always vs never=1.03, 95% confidence interval (CI): 0.99-1.07), soft tissue sarcoma (RR=1.37, 95% CI: 0.82-2.27), or breast cancer (RR=1.09, 95% CI: 1.02-1.15), but was associated for non-Hodgkin lymphoma (RR=0.79, 95% CI: 0.65-0.96). CONCLUSIONS: In this large prospective study there was little or no decrease in the incidence of cancer associated with consumption of organic food, except possibly for non-Hodgkin lymphoma.

Measuring the healthfulness of food retail stores: variations by store type and neighbourhood deprivation.

BACKGROUND: The consumer nutrition environment has been conceptualised as in-store environmental factors that influence food shopping habits. More healthful in-store environments could be characterised as those which promote healthful food choices such as selling good quality healthy foods or placing them in prominent locations to prompt purchasing. Research measuring the full-range of in-store environmental factors concurrently is limited. PURPOSE: To develop a summary score of 'healthfulness' composed of nine in-store factors that influence food shopping behaviour, and to assess this score by store type and neighbourhood deprivation. METHODS: A cross-sectional survey of 601 retail food stores, including supermarkets, grocery stores and convenience stores, was completed in Hampshire, United Kingdom between July 2010 and June 2011. The survey measured nine variables (variety, price, quality, promotions, shelf placement, store placement, nutrition information, healthier alternatives and single fruit sale) to assess the healthfulness of retail food stores on seven healthy and five less healthy foods that are markers of diet quality. Four steps were completed to create nine individual variable scores and another three to create an overall score of healthfulness for each store. RESULTS: Analysis of variance showed strong evidence of a difference in overall healthfulness by store type (p < 0.001). Large and premium supermarkets offered the most healthful shopping environments for consumers. Discount supermarkets, 'world', convenience and petrol stores offered less healthful environments to consumers however there was variation across the healthfulness spectrum. No relationship between overall healthfulness and neighbourhood deprivation was observed (p = 0.1). CONCLUSIONS: A new composite measure of nine variables that can influence food choices was developed to provide an overall assessment of the healthfulness of retail food stores. This composite score could be useful in future research to measure the relationship between main food store and quality of diet, and to evaluate the effects of multi-component food environment interventions.

Trading between healthy food, alcohol and physical activity behaviours.

BACKGROUND: While recent lifestyle studies have explored the role that food, alcohol or physical activity have on health and wellbeing, few have explored the interplay between these behaviours and the impact this has on a healthy lifestyle. Given the long term health advantages associated with leading healthier lifestyles, this study seeks to: 1) explore the interplay between the food, alcohol and physical activity behaviours of young adults (aged 19-26 years) in the North East of England; 2) explore the trade-offs young adults make between their food, alcohol and physical activity behaviours; and 3) recognise the positive and negative associations between the three behaviours. METHODS: Qualitative self-reported lifestyle diaries and in-depth interviews were conducted with 50 young adults from the North East of England between February and June 2008. Qualitative thematic analysis was undertaken using Nvivo QSR software, and diary coding using Windiets software. RESULTS: Young adults who attempt to achieve a 'healthy lifestyle' make trade-offs between the food and alcohol they consume, and the amounts of physical activity they undertake. There are negative reasons and positive consequences associated with these trade-offs. Young adults recognise the consequences of their behaviours and as a result are prepared to undertake healthy behaviours to compensate for unhealthy behaviours. They prefer certain strategies to promote healthier behaviours over others, in particular those that relate to personalised advice and support, more affordable ways to be healthier and easily-accessed advice from a range of media sources. CONCLUSIONS: Young adults seek to compensate unhealthy behaviours (e.g. binge drinking) with healthy behaviours (e.g. physical activity). Creative solutions may be required to tackle these trade-offs and promote a balance across the food, alcohol and physical activity behaviours of this age group. Solutions that may be effective with this age group include environmental changes (e.g. green spaces and increasing the price of alcohol) designed to encourage and facilitate young people making healthier choices and improving their access to, and lowering the price of, healthy food products. Solutions must recognise these trade-offs and in particular, the strong reluctance of young adults to alter their higher-than-recommended levels of alcohol consumption.

Assessment of the dining environment on and near the campuses of fifteen post-secondary institutions.

OBJECTIVE: The present study evaluated the restaurant and dining venues on and near post-secondary campuses varying in institution size. DESIGN: The Nutrition Environment Measures Survey for Restaurants (NEMS-R) was modified to evaluate restaurants as fast food, sit down and fast casual; and campus dining venues as dining halls, student unions and snack bar/cafe´s. ANOVA with post hoc Tukey's B and T tests were used to distinguish differences between dining venues and associated institutions by size. SETTING: The study was conducted at fifteen US post-secondary institutions, 2009­2011. SUBJECTS: Data presented are from a sample of 175 restaurants and sixty-eight on-campus dining venues. RESULTS: There were minimal differences in dining halls by institution size, although medium-sized institutions as compared with small-sized institutions offered significantly more healthful side dish/salad bar items. Dining halls scored significantly higher than student unions or snack bar/cafe´s on healthful entre´es, side dish/salad bar and beverages offerings, but they also had the most barriers to healthful dietary habits (i.e. all-you-can-eat). No differences were found by restaurant type for NEMS-R scores for total restaurant dining environment or healthful entre´es and barriers. Snack bars had more healthful side dishes (P50?002) and fast-food restaurants had the highest level of facilitators (i.e. nutrition information; P50?002). CONCLUSIONS: Based on this evaluation in fifteen institutions, the full campus dining environment provides limited support for healthy eating and obesity prevention. The quality of campus dining environments can be improved via healthful offerings, providing nutrition information and other supports to facilitate healthy eating and prevent unwanted weight gain.

Food purchasing sites. Repercussions for healthy eating.

Changes in the food system are associated with the increase in consumption of foods with low nutritional value in recent decades. Data on food purchasing for household consumption, collected from the Instituto Brasileiro de Geografia e Estatística (IBGE--Brazilian Institute of Geography and Statistics) Household Budget Survey (HBS) in 2002-3, were used to describe the contribution of food purchasing sites (FPS) to the diet of Brazilian families. All the 241 distinct FPS mentioned in the HBS were grouped into ten categories, according to the nature of the products available. Food acquisitions were organized into seven groups. Supermarkets and hypermarkets accounted for 49% of the acquisitions and were the main source of six out of the seven food groups. Street markets and greengroceries stood out in the acquisitions of fruits and vegetables, accounting for 39% of this market. The large contribution of supermarkets and hypermarkets to the diet shows the need for healthy eating promotion policies aiming at these locations. Street markets and greengroceries represent important allies for healthy eating.

Healthy bodegas: increasing and promoting healthy foods at corner stores in New York City.

OBJECTIVES: We assessed the effectiveness of an initiative to increase the stock and promotion of healthy foods in 55 corner stores in underserved neighborhoods. METHODS: We evaluated the intervention through in-store observations and preintervention and postintervention surveys of all 55 store owners as well as surveys with customers at a subset of stores. RESULTS: We observed an average of 4 changes on a 15-point criteria scale. The most common were placing refrigerated water at eye level, stocking canned fruit with no sugar added, offering a healthy sandwich, and identifying healthier items. Forty-six (84%) store owners completed both surveys. Owners reported increased sales of healthier items, but identified barriers including consumer demand and lack of space and refrigeration. The percentage of customers surveyed who purchased items for which we promoted a healthier option (low-sodium canned goods, low-fat milk, whole-grain bread, healthier snacks and sandwiches) increased from 5% to 16%. CONCLUSIONS: Corner stores are important vehicles for access to healthy foods. The approach described here achieved improvements in participating corner stores and in some consumer purchases and may be a useful model for other locales.

Food patterns and dietary quality associated with organic food consumption during pregnancy; data from a large cohort of pregnant women in Norway.

BACKGROUND: Little is known about the consumption of organic food during pregnancy. The aim of this study was to describe dietary characteristics associated with frequent consumption of organic food among pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa). METHODS: The present study includes 63 808 women who during the years 2002-2007 answered two questionnaires, a general health questionnaire at gestational weeks 15 and a food frequency questionnaire at weeks 17-22. The exploration of food patterns by Principal component analyses (PCA) was followed by ANOVA analyses investigating how these food patterns as well as intake of selected food groups were associated with consumption of organic food. RESULTS: The first principal component (PC1) identified by PCA, accounting for 12% of the variation, was interpreted as a 'health and sustainability component', with high positive loadings for vegetables, fruit and berries, cooking oil, whole grain bread and cereal products and negative loadings for meat, including processed meat, white bread, and cakes and sweets. Frequent consumption of organic food, which was reported among 9.1% of participants (n = 5786), was associated with increased scores on the 'health and sustainability component' (p < 0.001). The increase in score represented approximately 1/10 of the total variation and was independent of sociodemographic and lifestyle characteristics. Participants with frequent consumption of organic food had a diet with higher density of fiber and most nutrients such as folate, beta-carotene and vitamin C, and lower density of sodium compared to participants with no or low organic consumption. CONCLUSION: The present study showed that pregnant Norwegian women reporting frequent consumption of organically produced food had dietary pattern and quality more in line with public advice for healthy and sustainable diets. A methodological implication is that the overall diet needs to be included in future studies of potential health outcomes related to consumption of organic food during pregnancy.

Effects of an osteoarthritis self-management programme.

AIM: The aim of this study was to assess the effectiveness of a self-management programme among osteoarthritis knee sufferers. BACKGROUND: Osteoarthritis of the knee is a major cause of loss of function and is common in the older people. A self-management programme is an effective way to increase arthritis self-efficacy, and helps with mastering self-management practices. METHOD: This study was carried out from January 2008 to December 2008 and included 205 participants, with 114 in the intervention group and 91 in the control group. The 4-week trial was followed by an 8-week follow-up assessment. The outcome measures included assessments of arthritis self-efficacy, pain beliefs, unplanned medical consultations, pain days and disability days using the Mann-Whitney U-test and Friedman test. FINDINGS: At post-intervention, significant differences were found in pain beliefs (P<0·001) and pain days (P<0·004). At 8-week follow-up, there was a significant improvement in arthritis self-efficacy: pain and other symptoms subscales (P<0·001 and 0·049, respectively), pain beliefs (P<0·001) and number of unplanned medical consultations (P<0·010). CONCLUSION: The study supports the hypothesis that a self-management programme enhances arthritis-related self-efficacy and pain beliefs. A decrease in the number of unplanned medical consultations, pain days and disability days suggests that the programme might help reduce healthcare costs. This programme has introduced a significant result about self-efficacy and self-management to a chronic disease population in Taiwan. In short, there were great beneficial effects on self-management among persons who are affected by knee osteoarthritis.

Packaged Foods Labeled as Organic Have a More Healthful Profile Than Their Conventional Counterparts, According to Analysis of Products Sold in the U.S. in 2019-2020.

The organic food market's recent rapid global growth reflects the public's interest in buying certified organic foods, including packaged products. Our analysis shows that packaged foods containing fewer ingredients associated with negative public health outcomes are more likely to be labeled organic. Previous studies comparing organic and conventional foods focused primarily on nutrient composition. We expanded this research by additionally examining ingredient characteristics, including processing and functional use. Our dataset included nutrition and ingredient data for 8240 organic and 72,205 conventional food products sold in the U.S. from 2019 to 2020. Compared to conventional foods, organic foods in this dataset had lower total sugar, added sugar, saturated fat and sodium content. Using a mixed effects logistic regression, we found that likelihood of classification as organic increased as sodium content, added sugar content and the number of ultra-processed ingredients and cosmetic additives on the product label decreased. Products containing no trans-fat ingredients were more likely to be labeled organic. A product was more likely to be classified "organic" the more potassium it contained. These features of organic foods sold in the U.S. are significant because lower dietary ingestion of ultra-processed foods, added sugar, sodium and trans-fats is associated with improved public health outcomes.

Recommendations of community pharmacists and health food store employees regarding undiagnosed symptoms of diabetes.

BACKGROUND: Consumers may seek health advice from health food store employees (HFSEs) and pharmacists. Delays in the diagnosis of time-critical illnesses may increase the likelihood of morbidity, mortality and healthcare expenditures. OBJECTIVE: To describe the information provided by HFSEs and pharmacists for symptoms of undiagnosed Type 1 diabetes. DESIGN: A standardized actor portrayed a consumer with symptoms of Type 1 diabetes at eight community pharmacies and 12 health food stores (HFSs) in Pittsburgh, Pennsylvania, and Chapel Hill and Durham, North Carolina. He inquired about potential diagnoses, the need to see a physician, and product recommendations. SUBJECTS: The subjects included twelve HFSEs and eight licensed pharmacists. RESULTS: Four of eight (50%) pharmacists and two of 12 (17%) HFSEs mentioned diabetes as a potential diagnosis. Although six pharmacists recommended urgent physician follow-up, only two HFSEs did so; two HFSEs explicitly advised against a physician visit. One pharmacist recommended a product. Nine HFSEs recommended at least one product (monthly costs, range: $24.70-$209.96). CONCLUSIONS: Even when presented with classic symptoms of Type 1 diabetes, under-recognition of diabetes was common among HFSEs and community pharmacists. Delays in treatment present a health risk to consumers. Further research could confirm these results and inform educational interventions to improve diabetes recognition by both groups.

Mapping the availability and accessibility of healthy food in rural and urban New Zealand--Te Wai o Rona: Diabetes Prevention Strategy.

OBJECTIVE: Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand. DESIGN: We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread). RESULTS: Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29.1% more expensive than the 'regular' basket ($NZ 176.72 v. $NZ 136.84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49.18) than rural areas ($NZ 36.27) in adjusted analysis. CONCLUSIONS: 'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.

Texas nutrition environment assessment of retail food stores (TxNEA-S): development and evaluation.

OBJECTIVE: Current nutrition environment instruments are typically designed to measure a small number of healthy foods based on national trends. They lack the depth to accurately measure the unique dietary choices of subpopulations, such as Texas consumers whose food preferences are influenced by Hispanic/Latino culture. Thus the purposes of the present study were to: (i) develop a comprehensive observational tool to measure the availability of healthy foods from retail stores in Texas; and (ii) conduct a pilot test to examine the tool's reliability, as well as differences in the availability of healthy foods in stores between high- and low-income neighbourhoods. DESIGN: Grocery and convenience stores were assessed for availability of healthy foods. Reliability was calculated using percentage agreement, and differences in availability were examined using 2 (store type) × 2 (neighbourhood income) ANOVA. SETTING: One high-income and one low-income neighbourhood in Austin, Texas. SUBJECTS: A sample of thirty-eight stores comprising twenty-five convenience stores and thirteen grocery stores. RESULTS: The low-income neighbourhood had 324 % more convenience stores and 56 % fewer grocery stores than the high-income neighbourhood. High inter-rater (mean = 0·95) and test-retest reliability (mean = 0·92) and a significant interaction (P = 0·028) between store type and neighbourhood income were found. CONCLUSIONS: The TxNEA-S tool includes 106 healthy food items, such as fruits, vegetables, dairy, proteins and grains. The tool is reliable and face validity is affirmed by the Texas Department of Health. Grocery stores have more healthy foods than convenience stores, and high-income grocery stores offer more healthy foods than low-income grocery stores.