Gaps in the Evidence on Population Interventions to Reduce Consumption of Sugars: A Review of Reviews.

There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews published in English from January 2005 to May 2017 and considering research on interventions to reduce sugar intake. Twelve systematic reviews that considered price changes, interventions to alter the food available within specific environments, and health promotion and education programs were examined. Each of the identified reviews focused on sugar-sweetened beverages (SSBs). The existing literature provides some promising indications in terms of the potential of interventions to reduce SSB consumption among populations. However, a common thread is the limited scope of available evidence, combined with the heterogeneity of methods and measures used in existing studies, which limits conclusions that can be reached regarding the effectiveness of interventions. Reviewed studies typically had limited follow-up periods, making it difficult to assess the sustainability of effects. Further, there is a lack of studies that address the complex context within which interventions are implemented and evaluated, and little is known about the cost-effectiveness of interventions. Identified gaps speak to the need for a more holistic approach to sources of sugars beyond SSBs, consensus on measures and methods, attention to the implementation of interventions in relation to context, and careful monitoring to identify intended and unintended consequences.

Total and Free Sugar Content of Pre-Packaged Foods and Non-Alcoholic Beverages in Slovenia.

Scientific evidence of the association between free sugar consumption and several adverse health effects has led many public health institutions to take measures to limit the intake of added or free sugar. Monitoring the efficiency of such policies and the amount of free sugar consumed requires precise knowledge of free sugar content in different food products. To meet this need, our cross-sectional study aimed at assessing free sugar content for 10,674 pre-packaged food items available from major Slovenian food stores during data collection in 2015. Together, 52.6% of all analyzed products contained free sugar, which accounted for an average of 57.5% of the total sugar content. Food categories with the highest median free sugar content were: honey and syrups (78.0 g/100 g), jellies (62.9 g/100 g), chocolate and sweets (44.6 g/100 g), jam and spreads (35.9 g/100 g), and cereal bars (23.8 g/100 g). Using year-round sales data provided by the retailers, the data showed that chocolate, sweets, and soft drinks alone accounted for more than 50% of all free sugar sold on the Slovenian market. The results of this study can be used to prepare more targeted interventions and efficient dietary recommendations.

Are Food Advertisements Promoting More Unhealthy Foods and Beverages over Time? Evidence from Three Swedish Food Magazines, 1995-2014.

Unhealthy food in advertising has been suggested as a mediator for the increase in diet-related illness. This study quantitatively investigates changes in food advertising between 1995 and 2014 in terms of food categories promoted, macronutrient content, and percentage of foods classified as heathy or unhealthy from a sample of 7,199 ads from three Swedish food magazines. With the exception of increased alcoholic beverage and decreased carbohydrate-rich-food promotion, no monotonic trends of increasingly unhealthy food advertisement are found. From these findings, it is argued that food magazine advertising is not a mediator of the adverse dietary trend.

Food, fibre, bile acids and the pelvic floor: An integrated low risk low cost approach to managing irritable bowel syndrome.

Patients presenting with abdominal pain and diarrhea are often labelled as suffering from irritable bowel syndrome, and medications may be used often without success. Advances in the understanding of the causes of the symptoms (including pelvic floor weakness and incontinence, bile salt malabsorption and food intolerance) mean that effective, safe and well tolerated treatments are now available.

Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome.

BACKGROUND: Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome (IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway. METHODS: Patients with IBS (n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model. RESULTS: The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up (P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up (P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36. CONCLUSIONS: The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care.

The least-cost low-carbohydrate diet is expensive.

This article describes the use of operations research methods to study the minimum possible cost of a low-carbohydrate diet. The study compares this cost to the minimum cost of a diet with no limitation on carbohydrate. The rationale for this study is the popularity of the low-carbohydrate diets and their perceived high cost. The method used was an operations research approach to find a set of least cost diets, varying the required carbohydrate. This method was chosen to avoid potential concerns with real diets that may be nutritionally deficient or could be had for a lower cost. The major finding is that the cheapest possible low-carbohydrate diet costs about triple the cost of the cheapest diet with no constraint on carbohydrate. Furthermore, the minimum cost of a diet low in both carbohydrate and fat is 5 to 10 times the cost of the cheapest diet, depending on the relative amounts of these nutrients. As carbohydrate and fat are constrained, cost increases dramatically and nonlinearly. The study identifies which nutrients had the greatest effect on cost for a low-carbohydrate and low-fat diet.