The Contribution of Major Food Categories and Companies to Household Purchases of Added Sugar in Australia.

BACKGROUND: The Australian Government will soon be releasing a series of sugar reformulation targets for packaged foods. OBJECTIVE: To estimate the amount of added sugar purchased from packaged food and beverages and the relative contribution that food categories and food companies made to these purchases in 2018. The secondary objective was to examine differences in purchases of added sugar across income levels. DESIGN: Cross-sectional study. PARTICIPANTS/SETTING: We used 1 year of grocery purchase data from a nationally representative panel of Australian households (the NielsenIQ Homescan panel), combined with a packaged food and beverage database (FoodSwitch). MAIN OUTCOME MEASURES: Added sugar purchases (grams per day per capita), purchase-weighted added sugar content (grams per 100 g) and total weight of products (with added sugar) purchased (grams per day per capita). STATISTICAL ANALYSES PERFORMED: Food categories and food companies were ranked according to their contribution to added sugar purchases. Differences in added sugar purchases by income levels were assessed by 1-factor analysis of variance. RESULTS: Added sugar information was available from 7188 households and across 26,291 unique foods and beverages. On average, the amount of added sugar acquired from packaged foods and beverages was (mean ± SE) 35.9 ± 0.01 g/d per capita. Low-income households purchased 11.0 g/d (95% CI: 10.9-11.0 g/d, P < .001) more added sugar from packaged products than high-income households per capita. The top 10 food categories accounted for 82.2% of added sugar purchased, largely due to purchases of chocolate and sweets, soft drinks, and ice cream and edible ices. Out of 994 food companies, the top 10 companies contributed to 62.1% of added sugar purchases. CONCLUSIONS: The Australian Government can strengthen their proposed sugar reduction program by adding further category-specific targets, prioritizing engagement with key food companies and considering a broader range of policies to reduce added sugar intakes across the Australian population.

Comparison of Healthiness, Labelling, and Price between Private and Branded Label Packaged Foods in New Zealand (2015-2019).

We aimed to compare New Zealand private label (PL) and branded label (BL) packaged food products in relation to their current (2019) healthiness (sodium and sugar contents, and estimated Health Star Rating (HSR) score), display of the voluntary HSR nutrition label on the package, and price. Healthiness and HSR display of products were also explored over time (2015 to 2019). Data were obtained from Nutritrack, a brand-specific food composition database. Means and proportions were compared using Student t-tests and Pearson chi-square tests, respectively. Changes over time were assessed using linear regression and chi-square tests for trends (Mantel-Haenzel tests). Altogether, 4266 PL and 19,318 BL products across 21 food categories were included. Overall, PL products in 2019 had a significantly lower mean sodium content and price, a higher proportion of products with estimated HSR ≥ 3.5/5 (48.9% vs. 38.5%) and were more likely to display the HSR on the pack compared with BL products (92.4% vs. 17.2%, respectively). However, for most food categories, no significant difference was found in mean sodium or sugar content between PL and BL products. In the period 2015-2019, there were no consistent changes in estimated HSR score, sodium or sugar contents of PL or BL products, but there was an increase in the proportion of both PL and BL products displaying HSR labels. In most food categories, there were PL options available which were similar in nutritional composition, more likely to be labelled with the HSR, and lower in cost than their branded counterparts.

The Level of Processing, Nutritional Composition and Prices of Canadian Packaged Foods and Beverages with and without Gluten-Free Claims.

Little is known about the healthfulness and cost of gluten-free (GF) foods, relative to non-GF alternatives, in Canada. This study compared the extent of processing, nutritional composition and prices of Canadian products with and without GF claims. Data were sourced from the University of Toronto Food Label Information Program (FLIP) 2013 (n = 15,285) and 2017 (n = 17,337) databases. Logistic regression models examined the association of NOVA processing category with GF claims. Calorie/nutrient contents per 100 g (or mL) were compared between GF and non-GF products. Generalized linear models compared adjusted mean prices per 100 g (or mL) of products with and without GF claims. The prevalence of GF claims increased from 7.1% in 2013 to 15.0% in 2017. GF claims appeared on 17.0% of ultra-processed foods, which were more likely to bear GF claims products than less-processed categories. Median calories and sodium were significantly higher in GF products; no significant differences were observed for saturated fat or sugars. Compared to non-GF products, adjusted mean prices of GF products were higher for 10 food categories, lower for six categories and not significantly different for six categories. Overall, GF claims are becoming increasingly prevalent in Canada; however, they are often less healthful and more expensive than non-GF alternatives, disadvantaging consumers following GF diets.

Use of advertising strategies to target children in sugar-sweetened beverages packaging in Mexico and the nutritional quality of those beverages.

BACKGROUND: A product package can be a powerful marketing tool to persuade and attract consumers at the point-of-sale. Evidence shows that most advertised products have low nutritional quality. Currently, Mexico has incorporated advertising regulations on food and beverage packaging. OBJECTIVES: To analyze the advertising strategies used to target children on packaging and to assess the nutritional quality of sugar-sweetened beverages available in the Mexican market. METHODS: Photographs of 2380 beverages available in retail stores in Mexico City from January to March 2017 were analyzed. Beverages were classified as displaying child-directed strategies or nondirected strategies. Nutrition quality was evaluated using the Pan American Health Organization nutrient profile model. RESULTS: The use of characters was the most frequent strategy among beverages with child-directed strategies (82.0%). The evaluation of nutrition quality found that 88.0% (P < .001) of sugar-sweetened beverages with child-directed strategies were excessive in free sugars and 56.9% (P < .001) contained other sweeteners. Beverages with more than two advertising strategies have the highest proportion of excessive free sugars (93.4%, 95% CI 82.8-98.6). CONCLUSIONS: The use of characters and other visual strategies were frequently used in the packaging of sugar-sweetened beverages with child-directed strategies. In addition, these beverages are excessive in free sugars and contain a large number of products with other sweeteners.

Nutritional Aspects of Commercially Available Complementary Foods in New Zealand Supermarkets.

Optimal nutrition in early childhood fosters growth and development whilst preventing morbidity and mortality in later life. There is little research in New Zealand on commercially available complementary foods (CACFs). This cross-sectional study of the nutritional aspects and packaging of CACFs used data collected in four major supermarket chains in New Zealand in 2019 (Nutritrack). Of the 197 CACFs analysed, 43 (21.8%) were inappropriately recommended for consumption by children four months of age or older, 10 (5.1%) had added salt, and 67 (34.0%) contained free sugars. The majority (n = 136, 69.0%) contained ingredients with a sweet flavour. Relatively sweet vegetables like carrot and sweetcorn were used more often than bitter vegetables such as broccoli and spinach. The described texture of most (n = 145, 62.1%) wet 'spoonable' products was of the lowest complexity (smooth, puréed, custard). CACFs would adequately expose children to cow's milk and wheat but not to other common food allergens (cooked hen's egg, soy, fish, crustacean shellfish, peanut, and tree-nuts). If children's diets include CACFs, non-commercial meals must be offered as well in order to meet nutritional guidelines related to the introduction of common food allergens, diversity of flavours, and complex textures for infants and toddlers.

Who Reads Food Labels? Selected Predictors of Consumer Interest in Front-of-Package and Back-of-Package Labels during and after the Purchase.

The paper aims to identify selected predictors of food label use to extend our knowledge about consumer behavior related to food purchases. Two types of information were examined: front-of-package (FOP) and back-of-package (BOP), and two contexts of reading labels were distinguished: during shopping and at home. Various types of potential predictors were tested, including demographic (e.g., age, gender, household size, place of living), socioeconomic (e.g., education, professional activity, income), behavioral (e.g., purchasing certain types of products), and psychographic (e.g., importance attached to various types of information) criteria. The survey was conducted with the use of the CAWI (Computer-Assisted Web Interviews) methodology in a sample of 1051 Polish consumers. Quota sampling was applied based on sex, age, education, place of living (urban vs. rural), and region. Descriptive statistics, t-tests, ANOVAs, Pearson correlation coefficients, and multiple and retrograde step regressions were applied. In retrograde step regression models, only one predictor (self-rated knowledge about nutrition healthiness) turned out to be significant for all four measures of label reading. The remaining predictors were specific to selected measures of reading labels. The importance of the information about the content of fat and that about the health effects of consuming a food product were significant predictors of three types of food label use. This study confirms the necessity to investigate reading labels in fine-grained models, adapted to different types of labels and different contexts of reading. Our results show that demographic or socioeconomic variables are not significant predictors of reading food labels for a large group of Polish consumers.

Impact of bottle size on in-home consumption of wine: a randomized controlled cross-over trial.

AIM: To assess the impact of purchasing wine in 50 cl bottles compared with 75 cl bottles on the amount of wine consumed at home. DESIGN: Cross-over randomized controlled trial with a 'usual behaviour' period of a maximum of 3 weeks between conditions. SETTING: Households in the United Kingdom. PARTICIPANTS: One hundred and eighty-six households that consumed between two and eight 75 cl bottles of wine each week. INTERVENTION: Households were randomized to the order in which they purchased wine in two bottle sizes. During two 14-day intervention periods, households purchased a pre-set volume of wine-based on their baseline self-reported weekly consumption-in either 75 cl bottles or 50 cl bottles. On days 7 and 14 of each study period, participating households sent photographs of each purchased wine bottle. MEASUREMENTS: The primary outcome was the volume of study wine in millilitres (ml) consumed during each study period estimated through returned photographs. The secondary outcome was the rate of consumption measured by the mean number of days taken to drink 1.5 litres from each bottle size. FINDINGS: One hundred and sixty-six of 186 enrolled households satisfactorily completed the study. After accounting for pre-specified covariates, 191.1 ml [95% confidence interval (CI) = 42.03-339.2] or 4.5% (95% CI = 1.0-7.9%) more wine was consumed per 14-day period from 75-cl bottles than from 50-cl bottles. Consumption was 5.8% faster (95% CI = -10.9 to -0.4%) from 75 cl bottles than from 50 cl bottles. CONCLUSIONS: Consuming wine at home from 50 cl bottles, compared with 75 cl bottles, may reduce both amount consumed and rate of consumption.

Investing in Public School Kitchens and Equipment as a Pathway to Healthy Eating and Equitable Access to Healthy Food.

BACKGROUND: We gathered baseline data about student need of healthy, free school food, and if current school meal programming serves students in need of healthy free school food, in anticipation of the completion of a district-wide kitchen infrastructure and educational farm project in a high-poverty urban school district. METHODS: We used mixed methods to assess student hunger, whether the school meal program met student needs, and to determine associations between presence of a cooking kitchen and perceptions of healthy food. Participants included 72 staff, 143 parents, and 6437 K-5 students in the qualitative component, and 9078 parents and 1693 staff in the quantitative component. RESULTS: Staff participants stated packaging and reheating food influenced student consumption. During observations, students at seven of nine high poverty sites with packaged reheated food did not eat school meals, but this was not true at four out of four high-poverty sites with unpackaged fresh food. Parents (OR = 1.17, 95% CI 1.00-1.39) and staff (OR = 1.58, 95% CI 1.15-2.17) from schools with a cooking kitchen were more likely to perceive school lunch as healthy in adjusted models. CONCLUSIONS: Food preparation and presentation appears to influence student consumption of school food and adult perception of school meal quality.

A regression-based model to predict chemical migration from packaging to food.

Packaging materials can be a source of chemical contaminants in food. Process-based migration models (PMM) predict the chemical fraction transferred from packaging materials to food (FC) for application in prioritisation tools for human exposure. These models, however, have a relatively limited applicability domain and their predictive performance is typically low. To overcome these limitations, we developed a linear mixed-effects model (LMM) to statistically relate measured FC to properties of chemicals, food, packaging, and experimental conditions. We found a negative relationship between the molecular weight (MW) and FC, and a positive relationship with the fat content of the food depending on the octanol-water partitioning coefficient of the migrant. We also showed that large chemicals (MW > 400 g/mol) have a higher migration potential in packaging with low crystallinity compared with high crystallinity. The predictive performance of the LMM for chemicals not included in the database in contact with untested food items but known packaging material was higher (Coefficient of Efficiency (CoE) = 0.21) compared with a recently developed PMM (CoE = -5.24). We conclude that our empirical model is useful to predict chemical migration from packaging to food and prioritise chemicals in the absence of measurements.

Child and adult snack food intake in response to manipulated pre-packaged snack item quantity/variety and snack box size: a population-based randomized trial.

OBJECTIVES: Snacks contribute to overconsumption of energy-dense foods and thence obesity. Previous studies in this area are limited by self-reported data and small samples. In a large population-based cohort of parent-child dyads, we investigated how modification of pre-packaged snack food, i.e. (a) item quantity and variety, and (b) dishware (boxed container) size affected intake. METHODS: Design: Randomized trial nested within the cross-sectional Child Health CheckPoint of the Longitudinal Study of Australian Children, clustered by day of visit. SAMPLE: 1299 11-12 year olds, 1274 parents. EXPOSURE: 2 × 2 manipulation of snack box container size and item quantity/variety: (1) small box, few items, (2) large box, few items, (3) small box, more items, (4) large box, more items. PROCEDURE: Participants received a snack box during a 15 min break within their 3.5 h visit; any snacks remaining were weighed. OUTCOMES: Consumed quantity (grams) and energy intake (kilojoules). ANALYSES: Unadjusted linear regression. RESULTS: Children who were offered a greater quantity and variety of snack items consumed considerably more energy and a slightly higher food mass (main effect for energy intake: 349 kJ, 95% CI 282-416, standardized mean difference (effect size) 0.66; main effect for mass: 10 g, 95% CI 3-17, effect size 0.17). In contrast, manipulating box size had little effect on child consumption, and neither box size nor quantity/variety of items consistently affected adults' consumption. CONCLUSION: In children, reducing the number and variety of snack food items available may be a more fruitful intervention than focusing on container or dishware size. Effects observed among adults were small, although we could not exclude social desirability bias in adults aware of observation.

There's a frog in my salad! A review of online media coverage for wild vertebrates found in prepackaged produce in the United States.

Prepackaged leafy green vegetables represent one of the fastest growing segments of the fresh-produce industry in the United States. Several steps in the production process have been mechanized to meet the downstream demand for prebagged lettuces. The growth in this market, however, has come with drawbacks, and chief among them are consumers finding wild animals in prepackaged crops. These incidents may signal an overburdened produce supply chain, but we currently lack the information needed to determine if this is a food-safety problem or food-quality concern. Here, we address this gap by reviewing online media coverage of wild vertebrates found in prepackaged produce items by customers in the United States. We discovered 40 independent incidents since 2003 with 95% having occurred during 2008-2018, suggesting that the frequency of incidents may have increased during the last decade. The minority of incidents included wild animals found in organic produce (27.5%), whereas the majority involved conventionally grown crops (72.5%). Most incidents involved amphibians (52.5%) and reptiles (22.5%), while fewer contained mammals (17.5%) and birds (7.5%). Frogs and toads made up all of the amphibian-related incidents, with more than 60% comprising small-bodied treefrogs found in various types of fresh leafy greens. At least seven incidents involved Pacific Treefrogs (Hyliola regilla) and three comprised Green Anoles (Anolis carolinensis). One lizard and nine frogs were found alive, and at least two frogs were released into non-native areas. This is the first review quantifying incidents of vertebrates found by customers in prepackaged produce, yet it remains unclear whether these occurrences indicate a food-safety crisis or a complaint against food quality. Nevertheless, wild animals can spread diseases to humans via contaminated produce, therefore we contend that industry professionals can reduce the potential health risk to their consumers and negative economic consequences to themselves through increased attention to this matter.

Assessment of Packaged Foods and Beverages Carrying Nutrition Marketing against Canada's Food Guide Recommendations.

Canadians' food purchases consist largely of packaged processed and ultra-processed products, which typically fall outside the "core" foods recommended by Canada's Food Guide (CFG). Almost half of packaged products in Canada carry nutrition marketing (i.e., nutrient content and health claims). This study assessed whether packaged foods carrying nutrition marketing align with recommendations outlined in the 2007 CFG. Label data (n = 9376) were extracted from the 2013 Food Label Information Program (FLIP). Label components (including nutrition marketing) were classified using the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) labelling taxonomy. The Health Canada Surveillance Tool (HCST) was used to assess the alignment of products to CFG. Each food or beverage was classified into one of five groups (i.e., Tier 1, Tier 2, Tier 3, Tier 4, "Others"). Products in Tier 1, 2 or water were considered "in line with CFG". Most products in the analyzed sample were classified as Tier 2 (35%) and Tier 3 (27%). Although foods with nutrition marketing were significantly more likely to align to CFG recommendations (p < 0.001), many products not "in line with CFG" still carried nutrition marketing. This study provides important baseline data that could be used upon the implementation of the new CFG.

A cross-sectional survey of nutrition labelling use and its associated factors on parents of school students in Shanghai, China.

OBJECTIVE: To understand parents' knowledge and use of nutrition labelling and to explore its associated factors. DESIGN: Cross-sectional survey. SETTING: Two schools providing a nine-year educational programme in Putuo District, Shanghai, China, were selected for the study. Information was included on demographic data and knowledge of the Chinese Food Pagoda. SUBJECTS: Students and their parents (n 1770) participated in a questionnaire survey. RESULTS: Of questionnaires, 1766 were completed (response rate 99·8 %). Utilization rate of nutrition labelling was 19·3 %. Among 624 parents knowing nutrition labelling, 22·1 % understood all the information included, 70·7 % understood it partially and 7·2 % could not understand it at all. Use of nutrition labelling by parents was related to the following factors (OR; 95 % CI): high educational level of parent (1·465; 1·165, 1·841), parent's knowledge of the Chinese Food Pagoda (1·333; 1·053, 1·688), parent's consumption of top three snacks which are unhealthy (1·065; 1·023, 1·109), parent's assumption that nutrition labelling would affect their choice of food (1·522; 1·131, 2·048), student's willingness to learn about labels (1·449; 1·093, 1·920) and student's knowledge and use of labels (2·214; 1·951, 2·513). CONCLUSIONS: Parents' knowledge and use of nutrition labelling are still at a lower level, and some information included in the nutrition labels is not understood by parents. The forms of the existing nutrition labelling need to be continuously improved to facilitate their understanding and usefulness. It is necessary to establish nutrition projects focusing on education and use of nutrition labels which help parents and their children make the right choices in selecting foods.

Concentrations and congener profiles of chlorinated paraffins in domestic polymeric products in China.

Chlorinated paraffins (CPs) are widely used in domestic polymeric products as plasticizers and fire retardants. In this study, concentrations and congener profiles of short-chain and medium-chain chlorinated paraffins (SCCPs and MCCPs) were investigated in domestic polymeric products, including plastics, rubber and food packaging in China. The average concentrations of SCCPs in polyethylene terephthalate (PET), polypropylene (PP), polyethylene (PE) and food packaging were 234, 3968, 150 and 188 ng/g, respectively and the corresponding average concentrations of MCCPs in these samples were 37.4, 2537, 208 and 644 ng/g, respectively. The concentrations of CPs in rubber and polyvinylchloride (PVC) were significantly higher than in other matrices. The highest concentrations of SCCPs and MCCPs were found in a PVC cable sheath with 191 mg/g and 145 mg/g, respectively. Congener group profiles analysis indicated C11- and C13-congener groups were predominant in carbon homologues of SCCPs, and C14-congener groups were predominant in MCCPs. High levels of SCCPs and MCCPs in domestic polymeric products implied that they might be a significant source to the environment and human exposure.

Serum perfluoroalkyl acids (PFAAs) and associations with behavioral attributes.

The ubiquitous use of poly- and perfluoroalkyl substances (PFASs) in a variety of industrial and consumer products has resulted in chronic exposure in most industrialized nations, and led to measurable concentrations in blood and other tissues in humans across all life stages; however, behavioral attributes that relate to exposure are not well studied. To further investigate how behavior may relate to PFAS exposure, 37 adults were recruited from central North Carolina. Participants provided blood samples and behavioral questionnaires were administered, asking questions about a variety of household, dietary, and behavioral outcomes. Six PFAAs, including PFHxA (geometric mean: 0.14 ng/mL), PFOA (1.57 ng/mL), PFNA (0.67 ng/mL), PFDA (0.28 ng/mL), PFHxS (3.17 ng/mL) and PFOS (4.96 ng/mL) were detected in >50% of the samples. Generally, males had higher serum levels than females across all chemicals, and levels were very similar to NHANES levels; however, PFHxS and PFDA levels were higher in our study population. Several personal characteristics and behaviors were associated with serum PFAS levels. Reported use of filtration devices was associated with lower levels of PFOA (28% lower, p = 0.03), but higher levels of PFHxA (122% higher, p = 0.04). Serum PFHxS levels were also elevated in individuals that vacuumed less often, and in individuals that reported consuming more microwavable foods. These results suggest that personal behaviors may be important determinants of PFAS exposures.

Depicted serving size: cereal packaging pictures exaggerate serving sizes and promote overserving.

BACKGROUND: Extensive work has focused on the effects of nutrition label information on consumer behavior on the one hand, and on the effects of packaging graphics on the other hand. However, little work has examined how serving suggestion depictions - graphics relating to serving size - influence the quantity consumers serve themselves. The current work examines the prevalence of exaggerated serving size depictions on product packaging (study 1) and its effects on food serving in the context of cereal (study 2). METHODS: Study 1 was an observational field survey of cereal packaging. Study 2 was a mixed experimental cross-sectional design conducted at a U.S. university, with 51 student participants. Study 1 coded 158 US breakfast cereals and compared the serving sizes depicted on the front of the box with the suggested serving size stated on the nutrition facts panel. Study 2 measured the amount of cereal poured from exaggerated or accurate serving size depictions. Study 1 compared average servings via t-tests. Study 2 used a mixed model with cereal type as the repeated measure and a compound symmetry covariance matrix. RESULTS: Study 1 demonstrated that portion size depictions on the front of 158 cereal boxes were 65.84% larger (221 vs. 134 calories) than the recommended portions on nutrition facts panels of those cereals. Study 2 showed that boxes that depicted exaggerated serving sizes led people to pour 20% more cereal compared to pouring from modified boxes that depicted a single-size portion of cereal matching suggested serving size. This was 45% over the suggested serving size. CONCLUSIONS: Biases in depicted serving size depicted on cereal packaging are prevalent in the marketplace. Such biases may lead to overserving, which may consequently lead to overeating. Companies should depict the recommended serving sizes, or otherwise indicate that the depicted portion represents an exaggerated serving size.

Walmart and Other Food Retail Chains: Trends and Disparities in the Nutritional Profile of Packaged Food Purchases.

INTRODUCTION: Proliferation of food retail chains has created an environment in which a few food retailers account for the majority of U.S. packaged food purchases (PFPs). Despite the major potential for these food retail chains (FRCs) to impact what U.S. consumers buy and eat, little is known about the nutritional profile of PFPs from these retailers, particularly PFPs from Walmart, the largest U.S. grocer. METHODS: A data set of household PFPs from Nielsen Homescan was linked to data from the Nutrition Facts Panel (N=164,315), analyzed in 2014. Fixed effects models and inverse probability weights accounting for selectivity of shopping at a retailer were used to examine shifts in nutrient densities and key food groups purchased at Walmart and other FRCs from 2000 to 2013, and whether these changes differed for low-income or racial/ethnic-minority households. RESULTS: There were substantial declines in energy (-73 kcal/100 g); total sugar (-8 g/100 g); and sodium density (-33 mg/100 g) of Walmart PFPs, coupled with decreases in percentage volume purchased from sweets (-11%); grain-based desserts (-2%); and savory snacks (-3%) and increases in fruits (+3%) and vegetables (+1%). PFPs from other FRCs had a more favorable nutritional profile than Walmart PFPs in 2000, but demonstrated smaller shifts over time. Disparities in the nutritional profile of Walmart PFPs by race/ethnicity but not by income level shrank over time. CONCLUSIONS: The nutritional profile of Walmart purchases has improved over time and in 2013 was similar to PFPs from other FRCs.

Exploring the Impact of the New WIC Food Package on Low-Fat Milk Consumption Among WIC Recipients: A Pilot Study.

OBJECTIVE: To examine if the mothers and their eldest child participating in WIC would accept the 2009 new Women, Infants, and Children (WIC) program package and drink more low-fat milk. METHODS: Mothers and their eldest child at two Atlanta WIC clinics were recruited. Data were collected at baseline (before the new WIC package), at one week and four weeks. RESULTS: The percentage of children consuming low-fat milk significantly increased: 41.3% at baseline, 58.8% at week one, and 79.5% at week four (p<.001). After four weeks, the mothers reported increased child's consumption of low-fat milk vs. whole milk (AOR = 7.36; CI: 1.44-37.52). Mothers' consumption of low-fat milk did not significantly change after introduction of the new package. CONCLUSIONS: Policy changes for WIC vouchers were implemented to encourage mothers to reduce fat calories in dairy products for them and their children. This represents a powerful, low-resource intervention to change health behaviors among low-income families.

Sodium content in packaged foods by census division in the United States, 2009.

Excess sodium intake correlates positively with high blood pressure. Blood pressure varies by region, but whether sodium content of foods sold varies across regions is unknown. We combined nutrition and sales data from 2009 to assess the regional variation of sodium in packaged food products sold in 3 of the 9 US census divisions. Although sodium density and concentration differed little by region, fewer than half of selected food products met Food and Drug Administration sodium-per-serving conditions for labeling as "healthy." Regional differences in hypertension were not reflected in differences in the sodium content of packaged foods from grocery stores.