Changes in household food and drink purchases following restrictions on the advertisement of high fat, salt, and sugar products across the Transport for London network: A controlled interrupted time series analysis.

BACKGROUND: Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. METHODS AND FINDINGS: Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks. CONCLUSIONS: This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products.

Sugars, Salt, Saturated Fat and Fibre Purchased through Packaged Food and Soft Drinks in Europe 2015-2018: Are We Making Progress?

The availability, purchase and consumption of foods high in fat, sugars and salt and low in fibre are linked to the high health and economic burden of noncommunicable diseases, including cancer, in Europe. Therefore, assessing the quality of the food offer is key as feedback to decision makers, as well as to identify good practices and areas of the food supply still requiring urgent action. We combined detailed market share and sales data with nutrition composition data to evaluate the nutritional quality of 14 packaged food and soft drinks categories sold across 22 European countries over the 2015-2018 period. Our analysis shows great variability of the nutritional composition within and among packaged food and soft drinks categories across European countries. Our estimates of the market-share weighted mean, a measure that integrates possible changes in nutrient content with the amount of a product sold to consumers, as well as daily per capita nutrient sale estimates, suggest a small but statistically significant progress in certain food categories only. Overall, the amounts of sugars, saturated fat, salt and fibre being sold to European citizens through these products is not improving to an extent to meet public health objectives.

Substituting polyunsaturated fat for saturated fat: A health impact assessment of a fat tax in seven European countries.

There is evidence that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) lowers ischemic heart disease (IHD). In order to improve the population's diet, the World Health Organization has called for the taxation of foods that are high in SFA. We aimed to assess the potential health gains of a European fat tax by applying the SFA intake reduction that has been observed under the Danish fat tax to six other European countries. For each country, we created a fat tax scenario with a decreased SFA intake and a corresponding increase in PUFA. We compared this fat tax scenario to a reference scenario with no change in SFA intake, and to a guideline scenario with a population-wide SFA intake in line with dietary recommendations. We used DYNAMO-HIA to dynamically project the policy-attributable IHD cases of these three scenarios 10 years into the future. A fat tax would reduce prevalent IHD cases by a minimum of 500 and 300 among males and females in Denmark, respectively, up to a maximum of 5,600 and 4,000 among males and females in the UK. Thereby, the prevented IHD cases under a fat tax scenario would correspond to between 11.0% (in females in the Netherlands) and 29.5% (in females in Italy) of the prevented IHD cases under a guideline scenario, which represents the maximum preventable disease burden. Henceforth, our quantification of beneficial health impacts makes the case for the policy debate on fat taxes.

Application of winter mushroom powder as an alternative to phosphates in emulsion-type sausages.

This research evaluated the utilization of winter mushrooms as a replacement for phosphate in emulsion-type sausages. Winter mushroom powder (WMP) was added to the sausages at 0, 0.5, 1.0, 1.5, and 2.0% (w/w), and phosphate was added at 0.3% as a positive control. The WMP additions above 1.0% increased the pH of meat batter and efficiently inhibited the exudation of fat from the sausages (p < 0.05). Lipid oxidation of sausages was inhibited by the addition of WMP (p < 0.05). On the other hand, the addition of phosphate and WMP provided different instrumental texture properties. However, no adverse effects were observed with respect to the color and sensory properties of the sausages containing WMP, except for that containing 2.0% WMP. Therefore, this research indicates that WMP can effectively replace phosphate in meat products, and that the most effective addition level may be 1.0% WMP.

The effect of prices on nutrition: Comparing the impact of product- and nutrient-specific taxes.

This paper provides an analysis of the role of prices in determining food purchases and nutrition using very detailed transaction-level observations for a large, nationally-representative sample of US consumers over the period 2002-2007. Using product-specific nutritional information, we develop a new method of partitioning the product space into relevant nutritional clusters that define a set of nutritionally-bundled goods, which parsimoniously characterize consumer choice sets. We then estimate a large utility-derived demand system over this joint product-nutrient space that allows us to calculate price and expenditure elasticities. Using our structural demand estimates, we simulate the role of product taxes on soda, sugar-sweetened beverages, packaged meals, and snacks, and nutrient taxes on fat, salt, and sugar. We find that a 20% nutrient tax has a significantly larger impact on nutrition than an equivalent product tax, due to the fact that these are broader-based taxes. However, the costs of these taxes in terms of consumer utility are only about 70 cents per household per day. A sugar tax in particular is a powerful tool to induce healthier nutritive bundles among consumers.

The effects of the Danish saturated fat tax on food and nutrient intake and modelled health outcomes: an econometric and comparative risk assessment evaluation.

BACKGROUND/OBJECTIVE: The World Health Organisation recommends governments to consider the use of fiscal policies to promote healthy eating. However, there is very limited evidence of the effect of food taxation in a real-life setting, as most evidence is based on simulation studies. The objective of this study is to evaluate the effect of the Danish tax on saturated fat in terms of changes in nutritional quality of the diet, that is, changes in saturated fat consumption, as well as other non-targeted dietary measures, and to model the associated changes in mortality for different age groups and genders. SUBJECTS/METHODS: On the basis of household scanner data, we estimate the impact of the tax on consumption of saturated fat, unsaturated fat, salt, fruit, vegetables and fibre. The resultant changes in dietary quality are then used as inputs into a comparative risk assessment model (PRIME (Preventable Risk Integrated ModEl)) to estimate the effect of these changes on non-communicable diseases (NCDs) and mortality. RESULTS: The tax resulted in a 4.0% reduction in saturated fat intake. Vegetable consumption increased, and salt consumption increased for most individuals, except younger females. We find a modelled reduction in mortality with 123 lives saved annually, 76 of them below 75 years equal to 0.4% of all deaths from NCDs. CONCLUSIONS: Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive, but minor, contribution to public health in Denmark.

Fat composition of vegetable oil spreads and margarines in the USA in 2013: a national marketplace analysis.

Worldwide, the fat composition of spreads and margarines ("spreads") has significantly changed over the past decades. Data on fat composition of US spreads are limited and outdated. This paper compares the fat composition of spreads sold in 2013 to that sold in 2002 in the USA. The fat composition of 37 spreads representing >80% of the US market sales volume was determined by standard analytical methods. Sales volume weighted averages were calculated. In 2013, a 14 g serving of spread contained on average 7.1 g fat and 0.2 g trans-fatty acids and provided 22% and 15% of the daily amounts recommended for male adults in North America of omega-3 α-linolenic acid and omega-6 linoleic acid, respectively. Our analysis of the ingredient list on the food label showed that 86% of spreads did not contain partially hydrogenated vegetable oils (PHVO) in 2013. From 2002 to 2013, based on a 14 g serving, total fat and trans-fatty acid content of spreads decreased on average by 2.2 g and 1.5 g, respectively. In the same period, the overall fat composition improved as reflected by a decrease of solid fat (from 39% to 30% of total-fatty acids), and an increase of unsaturated fat (from 61% to 70% of total-fatty acids). The majority of US spreads no longer contains PHVO and can contribute to meeting dietary recommendations by providing unsaturated fat.

Mandatory labels, taxes and market forces: An empirical evaluation of fat policies.

The public-health community views mandatory Front-of-Pack (FOP) nutrition labels and nutritional taxes as promising tools to control the growth of food-related chronic diseases. This paper uses household scanner data to propose an ex-ante evaluation and comparison of these two policy options for the fromage blanc and dessert yogurt market. In most markets, labelling is voluntary and firms display fat labels only on the FOP of low-fat products to target consumers who do not want to eat fat. We here separately identify consumer preferences for fat and for FOP fat labels by exploiting an exogenous difference in legal labelling requirements between these two product categories. Estimates of demand curves are combined with a supply model of oligopolistic price competition to simulate policies. We find that a feasible ad valorem fat tax dominates a mandatory FOP-label policy from an economic perspective, but both are equally effective in reducing average fat purchases.

Guest Commentary: Fat and other taxes, lessons for the implementation of preventive policies.

Fat, sugar or sweetened beverage taxes are part of an overall public health nutrition approach to healthy eating. They are not approaches that on their own are likely to bring about change. Policy evidence from existing food tax implementation suggest that taxes need to be paralleled by subsidies and other interventions to encourage healthy eating. Such dual methods help not only contribute to nutrition outcomes but also ensure political support for food taxes. Politicians and policy makers are suspicious of taxes, using subsidies and revenue monies from taxes to support healthy eating is more likely to encourage both political and public support. Building support for policies is never just a matter of academic evidence. Public health advocates need to show more ambition by developing skills in implementing pricing policies to support healthy eating. Key opponents to taxes are the food industry who use a range of arguments to prevent taxation being implemented. Public health advocates are weak in tackling the issues of corporate power and providing evidence to maintain policy and political support. The public health movement needs to continue to develop the political will among politicians and the public for taxes on food. A new way of looking at policy formation is required and this includes addressing the power of corporate interests and the role of professionals in shaping or combating these influences.

The Danish fat tax-Effects on consumption patterns and risk of ischaemic heart disease.

OBJECTIVE: To examine the effects on consumption and risk of ischemic heart disease (IHD) of the Danish fat tax, effective from October 2011 to January 2013. METHODS: We used comprehensive retail outlet data on the sale of twelve foodstuff categories targeted by the fat tax. Data covered January 2010 to July 2013. IHD risk was assessed by modelling first the effect of changes in intake of monounsaturated, polyunsaturated and saturated fat and dietary cholesterol on serum cholesterol and subsequently modelling the resulting changes in risk of IHD using two different methods. RESULTS: The total sale of the included foodstuffs decreased by 0.9%. The fat tax was associated with marginal changes in population risk of IHD. One estimate suggests an increased population risk of IHD by 0.2% and the other estimate suggests that the risk of IHD decreased by 0.3%. CONCLUSIONS: The Danish fat tax had a marginal effect on population consumption of fat and risk of IHD. Fat taxes have to be carefully designed to prevent possible adverse effects from outweighing its beneficial effects on health outcomes. Policymakers must therefore be more ambitious in relation to food taxes, e.g. by implementing more comprehensive tax-subsidy schemes.

The rise and fall of the world's first fat tax.

In 2011, Denmark introduced the world's first tax on saturated fat, but only 15 months later the fat tax was abolished. The aim of this article is to investigate the political processes surrounding the implementation and rapid abolition of the fat tax. Our findings suggest that industry and trade associations were heavily involved in the political process of formulating the fat tax. Industry representatives used certain tactics to oppose the fat tax: threatening lawsuits, predicting welfare losses, casting doubt on evidence, diverting focus and requesting postponement. After the fat tax was implemented, the food industry continued their opposition through intensified lobbyism and juridical actions at EU level. However, other factors seem to have contributed to the fall of the fat tax. The tax received criticism for being poorly designed and gradually lost popularity among health professionals, politicians and the public. In the end, the fat tax was abolished for financial reasons. This study demonstrates how politicians considered the fat tax as a funding source rather than a public health initiative, which resulted in significant shortcomings. Furthermore, we demonstrate that the massive influence by industry stakeholders was not balanced with inputs from public health professionals, who should assume a more proactive role in policy-making.

Cost-effectiveness study of pediatric atopic dermatitis in Asia: atopiclair vs. regular emollient (AD-ATOP).

BACKGROUND: Atopic dermatitis (AD) is a highly prevalent, chronic relapsing condition in childhood with significant financial burden and impact on the quality of life of patients and caregivers. Proactive maintenance treatment with moisturizing agents is the mainstay AD therapy. OBJECTIVES: The aim of this study was to assess the cost-effectiveness of a non-steroidal barrier cream (Atopiclair), compared to regular emollient in pediatric patients with mild-to-moderate AD. METHODS: A Markov decision model was developed to evaluate the cost-effectiveness of Atopiclair versus regular emollient in 12 Asia-Pacific countries, grouped by income categories based on gross domestic product (GDP) per capita. Data was obtained from structured literature review, expert opinion, fee schedules, and findings from a 2012 survey of 12 Asia-Pacific countries. Analysis was performed a societal perspective. RESULTS: In the base case analysis, Atopiclair was cost-effective against regular emollient, with USD786, USD499, and USD289 in cost savings per year for high, middle, and low-income countries, respectively. Sensitivity analyses showed that Atopiclair remained cost-effective versus regular emollient. CONCLUSIONS: Modelling analysis showed that Atopiclair is a cost-effective treatment compared to regular emollient for mild-to-moderate pediatric AD in the countries included in the study.

Arachidonic acid production by Mortierella alpina using raw crop materials.

BACKGROUND: Arachidonic acid (ARA) is one of the three essential fatty acids, and it is important for human body to keep healthy and is widely used. At present, expensive materials such as glucose and yeast extract are generally reported to be optimal for ARA production. A new cost-effective fermentation process including cheaper material for ARA production is of great significance. METHODS: Feasibility of using corn meal and powdered soybean for fungal growth and lipid accumulation was evaluated by means of single factor test. N-hexadecane concentration was optimized, and the effect of temperature on biomass and ARA content was examined. RESULTS: Mortierella alpina made better use of the aforementioned material as carbon and nitrogen sources for both hyphae growth and ARA production compared with glucose and yeast extract. Maximal levels of 10.9 g/L ARA and 26.1 g/L total lipids were obtained when 66 g/L corn meal, 54 g/L soybean meal and 6% (v/v) n-hexadecane were supplemented. A temperature-shift strategy involved three steps, namely, 30°C (3 days) - 25°C (4 days) - 20°C (4 days), which further improved ARA production by 24.7%. CONCLUSIONS: Several factors such as carbon and nitrogen sources, temperature and dissolved oxygen had great influence on biomass and microbial oil production. Mortierella alpina preferred corn and soybean meal compared with glucose and yeast extract, which would surely alleviate the high cost of ARA production. Based on this study, the new process is both low cost and practicable.

Empirical evidence of the efficiency and efficacy of fat taxes and thin subsidies.

This study summarizes the empirical literature on fat taxes and thin subsidies to assess their efficiency and efficacy as instruments of public policy to control obesity. Three specific types of taxes are studied in the literature: food group taxes; nutrient taxes; and nutrient index taxes. Anumber of studies use food expenditure data to assess the impact of various taxes on obesity and therefore only indirectly measure the impacts of taxes and subsidies on obesity. These studies generally conclude that food group taxes, nutrient taxes and nutrient index taxes have a small impact on the purchases of food and the nutrients purchased. Other studies use the body mass index as the explanatory variable and thus measure the impacts of taxes on body mass index directly. Nutrient taxes are found to be more effective than food group taxes, although even for nutrient taxes, the effects are small. In general, thin subsidies seem to offer more effective control of obesity than obesity taxes. However, due to the small effects of both fat taxes and thin subsidies, they are not recommended as instruments of food and nutrition policy.

La transición alimentaria y la doble carga de malnutrición: cambios en los patrones alimentarios de 1961 a 2009 en el contexto socioeconómico mexicano

El propósito de este trabajo fue identificar si existieron cambios en la composición de los patrones alimentarios de 1961 a 2009, si el gasto en algunos alimentos por nivel de ingresos y el aumento en el precio de ciertos alimentos básicos de la dieta en el contexto socioeconómico mexicano, podrían explicar la transición alimentaria y la doble carga de malnutrición. Se llevó a cabo un estudio ecológico con la información de las Hojas de Balance de la FAO. Para conformar los patrones alimentarios se realizó análisis de conglomerados. Además, con los datos de la Encuesta Nacional de Ingresos y Gastos en los Hogares 2012 del Instituto Nacional de Estadística y Geografía se construyeron curvas de Engel para calcular la evolución del precio relativo de algunos alimentos. La dieta se definió en tres patrones alimentarios. La disponibilidad total de energía aumentó de 2316 kcal/persona/ día en 1961 a 3146 en 2009. Las modificaciones del patrón alimentario están en consonancia con la transición alimentaria y nutricional y con la doble carga de malnutrición. Se observó que la energía derivada de los cereales y la proveniente de las leguminosa (frijol) se redujo considerablemente, y de manera simultánea la energía procedente de azúcares, alimentos de origen animal y grasas vegetales tuvieron un aumento notable. El gasto en alimentos fue diferencial de acuerdo al nivel de ingresos. La malnutrición está mediada por la inequitativa distribución del ingreso, el bajo costo relativo de los alimentos ricos en energía, el encarecimiento de alimentos nutritivos y el escaso apoyo a la agricultura.

The nutrition transition and the double burden of malnutrition: changes in dietary patterns 1961-2009 in the Mexican socioeconomic context.. The purpose of this study was to identify whether there were changes in the composition of dietary patterns from 1961 to 2009, if food patterns by income level and the increase in the price of certainbasic foods of the diet in the socioeconomic Mexican context, could explain the nutrition transition and the double burden of malnutrition. We conducted an ecological study with data from FAO balance sheets. To construct eating patterns cluster analysis was performed. Engel curves were developed with data from the 2012 INEGI ENGH survey and evolution of therelative price of some foods was calculated. The diet was defined in three dietary patterns. The increase in the total availability of energy increased from 2316 kcal/person/day in 1961 to 3146 in 2009. Dietary pattern modifications are in line with the nutrition transition and the double burden of malnutrition. It was observed that the energy derived from cereals andfrom legume (common beans) was significantly reduced, and simultaneously, the energy from sugars, animal foods and vegetable fats had a dramatic increase. Spending on food was differential according to income level.Malnutritionis mediated by theunequal distribution of income, the relatively lowcost ofenergy-dense foods, the increased cost of nutritious foods, and limited support to agriculture.

The association between food prices and the blood glucose level of US adults with type 2 diabetes.

OBJECTIVES: We estimated the association between the price of healthy and less-healthy food groups and blood sugar among US adults with type 2 diabetes. METHODS: We linked 1999-2006 National Health and Nutrition Examination Survey health information to food prices contained in the Quarterly Food-at-Home Price Database. We regressed blood sugar levels on food prices from the previous calendar quarter, controlling for market region and a range of other covariates. We also examined whether the association between food prices and blood sugar varies among different income groups. RESULTS: The prices of produce and low-fat dairy foods were associated with blood sugar levels of people with type 2 diabetes. Specifically, higher prices for produce and low-fat dairy foods were associated with higher levels of glycated hemoglobin and fasting plasma glucose 3 months later. Food prices had a greater association with blood sugar for low-income people than for higher-income people, and in the expected direction. CONCLUSIONS: Higher prices of healthy foods were associated with increased blood sugar among people with type 2 diabetes. The association was especially pronounced among low-income people with type 2 diabetes.

[The nutrition transition and the double burden of malnutrition: changes in dietary patterns 1961-2009 in the Mexican socioeconomic context]. / La transición alimentaria y la doble carga de malnutrición: cambios en los patrones alimentarios de 1961 a 2009 en el contexto socioeconómico mexicano.

The purpose of this study was to identify whether there were changes in the composition of dietary patterns from 1961 to 2009, if food patterns by income level and the increase in the price of certain basic foods of the diet in the socioeconomic Mexican context, could explain the nutrition transition and the double burden of malnutrition. We conducted an ecological study with data from FAO balance sheets. To construct eating patterns cluster analysis was performed. Engel curves were developed with data from the 2012 INEGI ENGH survey and evolution of the relative price of some foods was calculated. The diet was defined in three dietary patterns. The increase in the total availability of energy increased from 2316 kcal/person/day in 1961 to 3146 in 2009. Dietary pattern modifications are in line with the nutrition transition and the double burden of malnutrition. It was observed that the energy derived from cereals and from legume (common beans) was significantly reduced, and simultaneously, the energy from sugars, animal foods and vegetable fats had a dramatic increase. Spending on food was differential according to income level. Malnutritionis mediated by the unequal distribution of income, the relatively low cost of energy-dense foods, the increased cost of nutritious foods, and limited support to agriculture.