How Consumers in the UK and Spain Value the Coexistence of the Claims Low Fat, Local, Organic and Low Greenhouse Gas Emissions.

This study investigates the substitution and complementary effects for beef mince attributes drawing on data from large choice experiments conducted in the UK and Spain. In both countries, consumers were found to be willing to pay a price premium for the individual use of the labels "Low Fat" (UK: €3.41, Spain: €1.94), "Moderate Fat" (UK: €2.23, Spain: €1.57), "Local" (UK: €1.54, Spain: €1.61), "National" (UK: €1.33, Spain: €1.37), "Organic" (UK: €1.02, Spain: €1.09) and "Low Greenhouse Gas Emissions (GHG)" (UK: €2.05, Spain: €0.96). The results showed that consumers in both countries do not treat desirable food attributes as unrelated. In particular, consumers in Spain are willing to pay a price premium for the use of the labels "Local", "Organic" and "Low GHG" on beef mince that is also labelled as having low or moderate fat content. By contrast, consumers in the UK were found to discount the coexistence of the labels "Low Fat" and "Organic", "Low Fat" and "Low GHG" and "Moderate Fat" and "Low GHG". The results, however, suggest that in the UK the demand for beef mince with moderate (low) fat content can be increased if it is also labelled as "Organic" or "Low GHG" ("Local").

The Impact of Body Image on the WTP Values for Reduced-Fat and Low-Salt Content Potato Chips among Obese and Non-Obese Consumers.

The aim of this study is to assess the influence of body image on consumers' willingness to pay (WTP) for potato chips carrying nutritional claims among obese and non-obese people. About 309 non-clinical individuals participated in a Real Choice Experiment. They were recruited by a company and grouped in: (i) non-obese with good body image; (ii) non-obese with body image dissatisfaction; (iii) obese with good body image; (iv) obese with body image dissatisfaction. Results indicate differences in consumers' willingness to pay among consumer groups. Body image dissatisfaction of normal people did not influence the WTP for healthier chips. Obese people with body image dissatisfaction were willing to pay more for healthier chips (i.e., low-salt content potato chips) than normal ones with body image dissatisfaction. Examining the role of knowledge in the light of how this could impact on body image is relevant to improve the health status of individuals and their diet. Knowledge about nutrition could improve the body image of obese people.

Whey protein isolate decreases murine stomach weight and intestinal length and alters the expression of Wnt signalling-associated genes.

The present study examined the underlying mechanisms by which whey protein isolate (WPI) affects energy balance. C57BL/6J mice were fed a diet containing 10% energy from fat, 70% energy from carbohydrate (35% energy from sucrose) and 20% energy from casein or WPI for 15 weeks. Mice fed with WPI had reduced weight gain, cumulative energy intake and dark-phase VO2 compared with casein-fed mice (P< 0.05); however, WPI intake had no significant effects on body composition, meal size/number, water intake or RER. Plasma levels of insulin, TAG, leptin, glucose and glucagon-like peptide 1 remained unchanged. Notably, the intake of WPI reduced stomach weight and both length and weight of the small intestine (P< 0.05). WPI intake reduced the gastric expression of Wingless/int-1 5a (Wnt5a) (P< 0.01) and frizzled 4 (Fzd4) (P< 0.01), with no change in the expression of receptor tyrosine kinase-like orphan receptor 2 (Ror2) and LDL receptor-related protein 5 (Lrp5). In the ileum, WPI increased the mRNA expression of Wnt5a (P< 0.01) and caused a trend towards an increase in the expression of Fzd4 (P= 0.094), with no change in the expression of Ror2 and Lrp5. These genes were unresponsive in the duodenum. Among the nutrient-responsive genes, WPI specifically reduced ileal mRNA expression of peptide YY (P< 0.01) and fatty acid transporter protein 4 (P< 0.05), and decreased duodenal mRNA expression of the insulin receptor (P= 0.05), with a trend towards a decreased expression of Na-glucose co-transporter 1 (P= 0.07). The effects of WPI on gastrointestinal Wnt signalling may explain how this protein affects gastrointestinal structure and function and, in turn, energy intake and balance.

Critical review of economic evaluation studies of interventions promoting low-fat diets.

Various national and local policies encouraging healthy eating have recently been proposed. The present review aims to summarize and critically assess nutrition-economic evaluation studies of direct (e.g., diet counseling) and indirect (e.g., food labeling) interventions aimed at improving dietary habits. A systematic literature review was performed by searching 5 databases (PubMed, Ovid Medline, EconLit, Agricola, and Embase) using a combination of diet-related (fat, diet, intake, nutrition) and economics-related (cost-effectiveness, cost-benefit, cost-utility, health economics, economic evaluation) key words. The search yielded 36 studies that varied in target population, study design, economic evaluation method, and health/economic outcome. In general, all provide limited experimental evidence and adopt the framework of economic evaluations in healthcare. Certain important aspects were not well considered: 1) the non-health-related effects of nutrition interventions on well-being; 2) the private nature of food expenditures; 3) the distributional effects on food expenditures across socioeconomic groups; and 4) the general economic implications (e.g., agrofoods, import/export) of such interventions. Overall, the methodology for the economic evaluation of nutrition interventions requires substantial improvement.

The impact of weight loss on health-related quality-of-life: implications for cost-effectiveness analyses.

PURPOSE: To assess the impact of weight loss on health-related quality-of-life (HRQL), to describe the factors associated with improvements in HRQL after weight loss, and to assess the relationship between obesity as assessed by body mass index (BMI) and HRQL before and after weight loss. METHODS: We studied 188 obese patients with BMI ≥ 32 kg/m(2) with one or more comorbidities or ≥35 kg/m(2). All patients had baseline and follow-up assessments of BMI and HRQL using the EuroQol (EQ-5D) and its visual analog scale (VAS) before and after 6 months of medical weight loss that employed very low-calorie diets, physical activity, and intensive behavioral counseling. RESULTS: At baseline, age was 50 ± 8 years (mean ± SD), BMI was 40. 0 ± 5.0 kg/m(2), EQ-5D-derived health utility score was 0.85 ± 0.13, and VAS-reported quality-of-life was 0.67 ± 0.18. At 6-month follow-up, BMI decreased by 7.0 ± 3.2 kg/m(2), EQ-5D increased by 0.06 [interquartile range (IQR) 0.06-0.17], and VAS increased by 0.14 (IQR 0.04-0.23). In multivariate analyses, improvement in EQ-5D and VAS were associated with lower baseline BMI, greater reduction in BMI at follow-up, fewer baseline comorbidities, and lower baseline HRQL. For any given BMI category, EQ-5D and VAS tended to be higher at follow-up than at baseline. CONCLUSION: Measured improvements in HRQL between baseline and follow-up were greater than predicted by the reduction in BMI at follow-up. If investigators use cross-sectional data to estimate changes in HRQL as a function of BMI, they will underestimate the improvement in HRQL associated with weight loss and underestimate the cost-utility of interventions for obesity treatment.

Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity.

OBJECTIVE: To analyze whether two dietary weight loss interventions--the dietary approaches to stop hypertension (DASH) program and a low-fat diet program--would be cost-effective in Australia, and to assess their potential to reduce the disease burden related to excess body weight. DESIGN: We constructed a multi-state life-table-based Markov model in which the distribution of body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. The target population was the overweight and obese adult population in Australia in 2003. We used a lifetime horizon for health effects and costs, and a health sector perspective for costs. We populated the model with data identified from Medline and Cochrane searches, Australian Bureau of Statistics published catalogues, Australian Institute of Health and Welfare, and Department of Health and Ageing. OUTCOME MEASURES: Disability adjusted life years (DALYs) averted, incremental cost-effectiveness ratios (ICERs) and proportions of disease burden avoided. ICERs under AUS$50,000 per DALY are considered cost-effective. RESULTS: The DASH and low-fat diet programs have ICERs of AUS$12,000 per DALY (95% uncertainty range: Cost-saving- 68,000) and AUS$13,000 per DALY (Cost-saving--130,000), respectively. Neither intervention reduced the body weight-related disease burden at population level by more than 0.1%. The sensitivity analysis showed that when participants' costs for time and travel are included, the ICERs increase to AUS$75,000 per DALY for DASH and AUS$49,000 per DALY for the low-fat diet. Modest weight loss during the interventions, post-intervention weight regain and low participation limit the health benefits. CONCLUSION: Diet and exercise interventions to reduce obesity are potentially cost-effective but have a negligible impact on the total body weight-related disease burden.

Cost-effectiveness analysis of a low-fat diet in the prevention of breast and ovarian cancer.

BACKGROUND: Results of the Women's Health Initiative Randomized Controlled Dietary Modification Trial (WHI-DM) suggest that a low-fat diet may be associated with beneficial health outcomes for specific groups of women. OBJECTIVE: The objective is to assess how cost-effective the WHI-DM would be if implemented as a public health intervention and under the sponsorship of private health insurers and Medicare. Breast and ovarian cancers are the health outcomes of interest. PARTICIPANTS: Two groups of WHI-DM participants form the target population for this analysis: participants consuming >36.8% of energy from fat at baseline, and participants at high risk for breast cancer with 32% or more of energy from fat at baseline. METHODS: This study uses Markov cohort modeling, following societal and health care payer perspectives, with Monte Carlo simulations and one-way sensitivity analyses. WHI-DM records, nationally representative prices, and published estimates of medical care costs were the sources of cost information. Simulations were performed for hypothetical cohorts of women aged 50, 55, 60, 65, or 70 years at the beginning of the intervention. Effectiveness was estimated by quality-adjusted life years (QALYs) and the main outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS: Following the societal perspective, the ICERs for the 50-year old cohort are $13,773/QALY (95% confidence interval $7,482 to $20,916) for women consuming >36.8% of energy from fat at baseline and $10,544/QALY ($2,096 to $23,673) for women at high risk for breast cancer. The comparable ICER from a private health care payer perspective is $66,059/QALY ($30,155 to $121,087) and from a Medicare perspective, it is $15,051/QALY ($6,565 to $25,105). CONCLUSIONS: The WHI-DM is a cost-effective strategy for the prevention of breast and ovarian cancers in the target population, from both societal and Medicare perspectives. Private health care payers have a relative short timeframe to realize a return on investment, since after age 65 years the financial benefits associated with the prevention program would accrue to Medicare. For this reason, the intervention is not cost-effective from a private health care payer perspective.

A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria.

The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and document the financial contribution of such a station. The healthful options station featured daily entrées with fewer than 500 calories and less than 30% of calories from fat. Questionnaires from 655 (24.5% response) employees and students provided data on satisfaction with and usage of the station. The majority of the respondents who had purchased from the healthful options station were female (77.3%), white (51.6%), aged 30 to 50 years (52.0%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). Sales and gross profit from the healthful options station were compared to those of the comfort station. Customers were satisfied with attributes of the healthful options station (means >3 on a 5-point scale). Results of paired t tests suggested that customers who had purchased from the healthful options station rated the station significantly (P<0.001) higher for healthfulness of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, and food choices available compared to their ratings for the cafeteria in general. The healthful options station generated average daily sales of $458 and gross profit of $306. However, the sales and gross profit were significantly (P<0.05) less than the comparison comfort station.

The availability and cost of healthier food alternatives.

BACKGROUND: Many people, especially low-income consumers, do not successfully follow dietary recommendations to eat more whole grains and less fat and added sugar. The food environment may have a significant impact on the choice by low-income consumers to eat healthier foods, as both the availability and price of healthier food items may limit their ability to eat a healthier diet. We investigated the cost and availability of a standard market basket of foods, and a healthier basket that included low-fat meat and dairy and whole grain products. METHODS: Market-basket surveys were conducted in 25 stores in Los Angeles and Sacramento. Stores were selected from neighborhoods that were varied by income and surveyed three times from September 2003 to June 2004. The average cost of a standard market basket (based on the U.S. Department of Agriculture's Thrifty Food Plan [TFP]) and a healthier market basket was calculated from these prices and compared using a standard t-test to determine if they were significantly different from each other. The analysis was conducted in 2005. RESULTS: In neighborhoods served by smaller grocery stores, access to whole-grain products, low-fat cheeses, and ground meat with <10% fat is limited. Among all items that were unavailable, 64% were in small grocery stores. For the 2-week shopping list, the average TFP market-basket cost was $194, and the healthier market-basket cost was $230. The average cost of the healthier market basket was more expensive by $36 due to higher costs of whole grains, lean ground beef, and skinless poultry. The higher cost of the healthier basket is equal to about 35% to 40% of low-income consumers' food budgets of $2410 a year. CONCLUSIONS: The lack of availability in small grocery stores located in low-income neighborhoods, and the higher cost of the healthier market basket may be a deterrent to eating healthier among very low-income consumers. Public policies should take the food environment into account in order to develop successful strategies to encourage the consumption of healthier foods.

Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: a controlled trial.

OBJECTIVE: To compare the results and cost-effectiveness of a cholesterol lowering protocol implemented by registered dietitians with cholesterol lowering advice by physicians. DESIGN: Six month randomized controlled trial, cost-effectiveness analysis. Subjects included 90 ambulatory care patients (60 men, 30 women), age range 21 to 65 years, with hypercholesterolemia and not taking hypolipidemic drugs. Patients were randomly assigned to receive medical nutrition therapy (MNT) from dietitians using a NCEP based lowering protocol or usual care (UC) from physicians. Outcome measures were plasma lipid profiles, dietary intake, weight, activity, patient satisfaction, and costs of MNT. Changes from baseline for each variable of interest were compared between treatment groups using analysis of covariance controlling for baseline value of the variable and gender. RESULTS: MNT achieved a 6% decrease in total and LDL cholesterol levels at 3 and 6 months compared with a 1% increase and a 2% decrease in both values at 3 and 6 months with UC (P<.001 and P<.05, respectively). Weight loss (1.9 vs 0 kg, P<.001) and dietary intake of saturated fat (7% of energy vs 10%, P<.001) were better in the MNT than the UC group. The additional costs of MNT were $217 per patient to achieve a 6% reduction in cholesterol and $98 per patient to sustain the reduction. The cost-effectiveness ratio for MNT was $36 per 1% decrease in cholesterol and LDL level. APPLICATIONS/CONCLUSIONS: MNT from registered dietitians is a reasonable investment of resources because it results in significantly better lipid, diet, activity, weight, and patient satisfaction outcomes than UC.

[Role of diet in cardiovascular prevention]. / Place de la diététique dans la prévention cardiovasculaire.

Several dietary components increase the risk of ischemic cardiovascular disease: excess dietary cholesterol and fats (especially saturated fats with low mono- and polyunsaturated fatty acid content), deficiency of antioxidants, fibers. These dietary factors modify the levels and the physicochemical structure of plasma lipoproteins and consequently their metabolic activities. Some of them also modify platelet aggregation and endothelial function. To reduce the cardiovascular risk, different nutritional schemes have been proposed and applied in prevention studies. Mediterranean-type diet, or traditional Asian food provide a very favorable cost/effectiveness ratio. These diets must be associated with the usual measures for improving lifestyle (increased physical activity, reduction of smoking) and with drug treatment of major risk factors (dyslipidemia, hypertension, diabetes).

Technical constraints in the development of reduced-fat bakery products.

The present study was funded by the Ministry of Agriculture, Fisheries and Food, its aim being to identify the technical barriers to the development of reduced-fat alternatives for bakery products. Using National Food Survey (Ministry of Agriculture, Fisheries and Food, 1998) statistics on dietary consumption within the home, biscuits, cakes and pastries were identified as contributing significant amounts of fat to the population's dietary intake. Face-to-face interviews were conducted with contacts in the technical community of the baking industry, who were usually working in technical and new-product development functions. A discussion guide was developed to cover the main lines of enquiry. The companies selected were ingredient suppliers (eight), manufacturers (twelve) and retailers (four) and so represented each step of the food supply chain. In brief, results showed that current labelling rules were too stringent, and constrained development of reduced-fat bakery products. Products with lower fat levels are harder to make due to altered handling and processing properties. Their quality is usually poorer than standard products, particularly for flavour, texture and mouthfeel. The perception of freshness is reduced and product shelf-life may consequently be shorter. For the product developer, there are relatively few ingredients that can be used in place of fat, and knowledge of how they work is limited, which inhibits product development. There is no identifiable source of technical knowledge in this field. Consumers perceive reduced-fat bakery products to be of lower quality and are generally unwilling to pay higher prices than for standard products.

Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project.

The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. These patients reported reductions in angina comparable with what can be achieved with revascularization.

Profitability and acceptability of fat- and sodium-modified hot entrees in a worksite cafeteria.

OBJECTIVES: To compare the acceptability of fat- and sodium-modified entrees before and after implementation of a marketing program and to determine the effect offering and marketing these healthful entrees had on total cafeteria and entree sales in a worksite cafeteria. DESIGN: The research was conducted in five phases, including sales data collection, acceptance testing of unmodified hot entrees, acceptance testing of modified entrees, and implementation of a marketing campaign for promoting low-fat, sodium-controlled food selections. SETTING: The Kansas Farm Bureau and Affiliated Services (KFB) employee cafeteria. SUBJECTS: KFB employees who ate lunch in the employee cafeteria and were willing to participate in the study. MAIN OUTCOME MEASURES: Sales data (percent of customers purchasing a modified entree and sales of modified entree as a percent of total sales); nutrient analysis data (energy, grams of total fat, percent of energy from fat, milligrams of cholesterol, and milligrams of sodium); and acceptability data (11 characteristics were measured using a seven-point hedonic scale). STATISTICAL ANALYSIS PERFORMED: General linear model analysis of variance was used to compare sales data from phases 1 to 5 and to compare acceptability data from phases 2 to 4. RESULTS: No significant differences in sales data were observed during the 7-month study. No significant changes in overall acceptability were found for any entree. However, customers tended to rate overall acceptability higher when entrees were marketed as lower in fat and sodium. APPLICATIONS/CONCLUSIONS: Customers in worksite cafeterias may be more willing to tolerate changes in flavor attributes when modified entrees are marketed as "healthful" and nutrition information is available.