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1.
Global Health ; 15(1): 56, 2019 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-31551086

RESUMO

BACKGROUND: Sugar sweetened beverages (SSB) are a major source of sugar in the diet. Although trends in consumption vary across regions, in many countries, particularly LMICs, their consumption continues to increase. In response, a growing number of governments have introduced a tax on SSBs. SSB manufacturers have opposed such taxes, disputing the role that SSBs play in diet-related diseases and the effectiveness of SSB taxation, and alleging major economic impacts. Given the importance of evidence to effective regulation of products harmful to human health, we scrutinised industry submissions to the South African government's consultation on a proposed SSB tax and examined their use of evidence. RESULTS: Corporate submissions were underpinned by several strategies involving the misrepresentation of evidence. First, references were used in a misleading way, providing false support for key claims. Second, raw data, which represented a pliable, alternative evidence base to peer reviewed studies, was misused to dispute both the premise of targeting sugar for special attention and the impact of SSB taxes on SSB consumption. Third, purposively selected evidence was used in conjunction with other techniques, such as selective quoting from studies and omitting important qualifying information, to promote an alternative evidential narrative to that supported by the weight of peer-reviewed research. Fourth, a range of mutually enforcing techniques that inflated the effects of SSB taxation on jobs, public revenue generation, and gross domestic product, was used to exaggerate the economic impact of the tax. This "hyperbolic accounting" included rounding up figures in original sources, double counting, and skipping steps in economic modelling. CONCLUSIONS: Our research raises fundamental questions concerning the bona fides of industry information in the context of government efforts to combat diet-related diseases. The beverage industry's claims against SSB taxation rest on a complex interplay of techniques, that appear to be grounded in evidence, but which do not observe widely accepted approaches to the use of either scientific or economic evidence. These techniques are similar, but not identical, to those used by tobacco companies and highlight the problems of introducing evidence-based policies aimed at managing the market environment for unhealthful commodities.


Assuntos
Indústria Alimentícia , Política de Saúde , Pesquisa , Bebidas/economia , Açúcares da Dieta/economia , Humanos , África do Sul , Edulcorantes/economia , Impostos
2.
Bull World Health Organ ; 97(7): 450-459, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31258214

RESUMO

Objective: To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met. Methods: The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030. Findings: If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021. Conclusion: The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets.


Assuntos
Dieta , Indústria Alimentícia/legislação & jurisprudência , Mortalidade Prematura/tendências , Doenças não Transmissíveis/mortalidade , Humanos , Portugal/epidemiologia , Fatores de Risco
3.
Washington, D.C.; PAHO; 2019-06-17.
em Inglês | PAHO-IRIS | ID: phr-51094

RESUMO

[Introduction]. The rapid increase in the prevalence of overweight and obesity, diabetes, and associated chronic noncommunicable diseases (NCDs) in recent decades, threatens the health and well-being and also the economic prospects of all Latin American and the Caribbean countries, now and in the future. To address one crucial aspect of this crisis, in October 2014, the Member States of the Pan American Health Organization (PAHO) approved a five-year Plan of Action whose purpose is to halt a further increase in obesity in children and adolescents in the Americas. The plan calls for the implementation of fiscal policies, such as taxes on sugar-sweetened beverages and energy-dense nutrient-poor products, regulation of food marketing and labeling, improvement of school nutrition and physical activity environments, and promotion of breastfeeding and healthy eating. Its goal is to halt the rise of the epidemic so that there is no increase in current country prevalence rates of obesity... Ultra-processed products typically contain little or no whole foods. They are industrial formulations made mostly from substances extracted or derived from foods, plus additives. They include soft drinks and other sugar-sweetened juices and drinks, sweet and savory snacks, candies (confectionery), industrial breads, cakes, and cookies (biscuits), sweetened breakfast cereals, reconstituted meat products, and pre-prepared dishes. As well as sugars, oils, fats and salt, ultra-processed products include substances also derived from foods but not used in home cooking, such as hydrogenated oils, modified starches, protein isolates, and additives such as colors, flavors and flavor enhancers. Additives are used to imitate and enhance the sensory qualities of natural foods or to disguise unattractive qualities of the final product...


Assuntos
Obesidade , Saúde Pública , Consumo de Alimentos , Fast Foods , América Latina , Indústria de Bebidas Gaseificadas , Programas e Políticas de Nutrição e Alimentação , Planos e Programas de Saúde
4.
BMC Public Health ; 19(1): 490, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046718

RESUMO

BACKGROUND: On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a mechanism designed to address increasing prevalence of obesity and associated ill health by reducing sugar consumption. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative. METHODS: Media content analysis was used to build a dataset of relevant newspaper articles, which were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the network of stakeholders and coalitions evident in the debate as it was presented in UK newspapers, in the lead up to and following the announcement of the Soft Drinks Industry Levy in the UK, from May 2015 to November 2016. RESULTS: Coding identified 3883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Network visualisations revealed a complex network of stakeholders with clear sceptical and supportive coalitions. Industry stakeholders appeared less united in the network than anticipated, particularly before the SDIL announcement. Some key industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver appeared as a dominant stakeholder, firmly embedded with public health advocates. CONCLUSION: This study highlights the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Polarisation of stakeholders arose from differences in ideology, focus on a specific policy and statements about the weight of evidence. Vocal celebrity policy entrepreneurs may be instrumental in gaining public and policy makers' support for future upstream regulation to promote population health, to facilitate alignment around a clear ideology.


Assuntos
Bebidas Gaseificadas/economia , Meios de Comunicação de Massa/tendências , Política Nutricional/economia , Obesidade/prevenção & controle , Açúcares/economia , Bebidas , Defesa do Consumidor/economia , Governo , Humanos , Política Nutricional/legislação & jurisprudência , Saúde Pública/métodos , Impostos/economia , Reino Unido
5.
Obes Rev ; 20(3): 367-374, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30549191

RESUMO

Chile approved the law of food labelling and advertising in 2012; this law aims to address the obesity epidemic, particularly in children. The implementation details were published in 2015, and the law was implemented finally in 2016, as described in the current article. Regulated foods were defined based on a specially developed nutrient profiling, which considered natural foods as gold standard. For liquid foods, amounts of energy, sugars, saturated fats, and sodium in 100 mL of cow's milk were used as cut-offs. For solid foods, values within the 90th - 99th percentile range for energy and critical nutrients were selected as cut-off within a list of natural foods. A stop sign stating "High in " was chosen as warning label for packaged regulated foods. Regulated foods were also forbidden to be sold or offered for free at kiosks, cafeterias, and feeding programme at schools and nurseries. Besides, regulated foods cannot be promoted to children under 14 years. A staggered implementation of the regulation was decided, with nutrients cut-offs becoming increasingly stricter over a 3-year period. These regulatory efforts are in the right direction but will have to be sustained and complemented with other actions to achieve their ultimate impact of halting the obesity epidemic.


Assuntos
/legislação & jurisprudência , Epidemias/prevenção & controle , Indústria Alimentícia/legislação & jurisprudência , Rotulagem de Alimentos/legislação & jurisprudência , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/prevenção & controle , Obesidade/epidemiologia , Obesidade/prevenção & controle , Bebidas , Chile/epidemiologia , Alimentos , Promoção da Saúde , Humanos , Política Nutricional , Valor Nutritivo , Saúde Pública , Instituições Acadêmicas
6.
Appl Physiol Nutr Metab ; 44(1): 74-82, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30273499

RESUMO

Marketing unhealthy foods and beverages to children (M2K) fosters poor dietary patterns, increasing obesity and noncommunicable disease risk. Federal restrictions on M2K have been under development in Canada since 2016; however, at present, M2K is mostly self-regulated by food companies. This study aimed to compare M2K on Canadian websites of food companies with and without voluntary policies or commitments in this area. A systematic content analysis of company websites was conducted in spring/summer 2017 for major packaged food (n = 16), beverage (n = 12), and restaurant chain (n = 13) companies in Canada. M2K policies were sourced from company websites and published corporate documents. Sixteen companies (43%) reported national and/or global M2K policies, while 21 companies (57%) had no published policies. The websites of Canadian companies (n = 154) were scanned for child-directed products and marketing; type and frequency of marketing techniques were recorded. Child-directed marketing appeared on 19 websites of 12 companies (32%), including 9 companies with M2K policies. Websites featured products with unconventional flavours, colours, shapes, or child-oriented packaging, and used promotional characters, contests, games, activities, or lettering and graphics appealing to children. The nutritional quality of products marketed to children was evaluated using a nutrient profile model developed by Health Canada for proposed M2K regulations. Of the 217 products marketed to children, 97% exceeded Health Canada's proposed ∼5% Daily Value threshold for saturated fat, sodium, and/or sugars, 73% of which were products from 9 companies with policies. These findings highlight the limitations of self-regulation in restricting M2K on food company websites, reinforcing the need for government regulations.


Assuntos
Comportamento Infantil , Dieta/efeitos adversos , Publicidade Direta ao Consumidor/legislação & jurisprudência , Comportamento Alimentar , Indústria Alimentícia/legislação & jurisprudência , Internet/legislação & jurisprudência , Política Nutricional/legislação & jurisprudência , Obesidade Pediátrica/prevenção & controle , Formulação de Políticas , Canadá , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Regulamentação Governamental , Humanos , Valor Nutritivo , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/psicologia , Medição de Risco , Fatores de Risco , Volição
7.
Health Res Policy Syst ; 16(1): 102, 2018 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-30376876

RESUMO

OBJECTIVE: To describe the implementation, main intervention areas and initial results of the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal. METHODS: EIPAS was published as a Law, in December of 2017, as a result of a collaboration between several ministries, including the Finance, Internal Affairs, Education, Health, Economy, Agriculture, and Sea Ministries, aiming at improving the dietary habits of the Portuguese population. The working group, led by the Ministry of Health, developed this strategy for over a year. The framework produced was based on WHO and European Commission recommendations as well as on relevant data from the last Portuguese dietary intake survey (2015/2016). EIPAS also reflects the results of a public hearing, including the food industry, among others, and the experience gathered, since 2012, through the National Programme for the Promotion of Healthy Eating. It considers the 'health in all policies' challenge set by WHO and has four different strategic areas, namely (1) creation of healthier food environments, (2) improvement of the quality and accessibility of healthy food choices for consumers, (3) promotion and development of literacy, in order to encourage healthy food choices, and (4) promotion of innovation and entrepreneurship. In order to achieve these goals, a set of 51 actions was established and assigned to the seven ministries involved. RESULTS: Under the scope of this strategy, Portugal has already implemented several actions, including (1) definition of standards for food availability at all public healthcare institutions; (2) implementation of a sugar tax on sweetened beverages; (3) implementation of a voluntary agreement with the food industry sector for food reformulation (work in progress); (4) design of a proposal for an interpretative model of front-of-pack food labelling; (5) improvement of the nutritional quality of food aid programmes for low-income groups; and (6) regulation of marketing of unhealthy foods to children. CONCLUSIONS: For the first time, Portugal has a nutrition policy based on the WHO concept of 'health in all policies' and on the national data on food intake. The implementing process of all 51 actions and the inherent complexities and difficulties found so far have made this process be an authentic political and social laboratory that deserves to be followed.


Assuntos
Comportamento Alimentar , Órgãos Governamentais , Promoção da Saúde/métodos , Política Nutricional , Adulto , Bebidas , Criança , Açúcares da Dieta , Assistência Alimentar , Indústria Alimentícia , Rotulagem de Alimentos , Regulamentação Governamental , Humanos , Marketing , Valor Nutritivo , Saúde Pública , Impostos
8.
PLoS One ; 13(8): e0201707, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30080888

RESUMO

BACKGROUND: Scientific evidence indicates that high dietary salt intake has detrimental effects on blood pressure and associated cardiovascular disease (CVD). However, limited information is available on how to implement salt reduction in low and middle-income countries (LMICs) such as India, where the burden of hypertension and CVD is increasing rapidly. As part of a large study to create the evidence base required to develop a salt reduction strategy for India, we assessed the perspectives of various stakeholders regarding developing an India specific salt reduction strategy. METHODS: A qualitative research design was deployed to elicit various stakeholder's (government and policy-related stakeholders, industry, civil Society, consumers) perspectives on a salt reduction strategy for India, using in-depth interviews (IDIs) and focus group discussions (FGDs). We used an inductive approach for data analysis. Data were analyzed using thematic content analysis method. RESULTS: Forty-two IDIs and eight FGDs were conducted with various stakeholders of interest and relevance. Analysis indicated three major themes: 1. Barriers for salt reduction 2. Facilitators for salt reduction; 3. Strategies for salt reduction. Most of the stakeholders were in alignment with the need for a salt reduction programme in India to prevent and control hypertension and related CVD. Major barriers indicated by the stakeholders for salt reduction in India were social and cultural beliefs, a large unorganized food retail sector, and the lack of proper implementation of even existing food policies. Stakeholders from the food industry reported that there might be decreased sales due to salt reduction. Major facilitators included the fact that: salt reduction is currently a part of the National Multi-Sectoral Action Plan for the prevention and control of NCDs, salt reduction and salt iodine programme are compatible, and that few of the multinational food companies have already started working in the direction of initiating efforts for salt reduction. Based on the barriers and facilitators, few of the recommendations are to generate awareness among consumers, promote salt reduction by processed food industry, and implement consumer friendly food labelling. CONCLUSIONS: In this study of multiple key influential stakeholders in India, most of the stakeholders were in alignment with the need for a salt reduction programme in India to prevent and control hypertension and related CVD. The development and adoption of the National Multi-sectoral Action Plan to reduce premature non-communicable diseases (NCDs) in India, provides a potential platform that can be leveraged to drive, implement and monitor salt reduction efforts.


Assuntos
Dieta , Política Nutricional , Pesquisa Qualitativa , Cloreto de Sódio , Participação dos Interessados , Indústria Alimentícia , Rotulagem de Alimentos , Comportamentos Relacionados com a Saúde , Humanos , Índia , Formulação de Políticas
9.
Salud Publica Mex ; 60(4): 479-486, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30137950

RESUMO

The Mexican Ministry of Health requested the National Institute of Public Health to constitute a group of independent, free of conflict-of-interest academic experts on front-of-pack labelling (FOP). This group was instructed to created a positioning paper to contribute to the development of a FOP system for industrialized products that offers useful information for purchase decision making. This position paper uses the best available scientific evidence, and recommendations from experts of international organizations. The FOP proposal focuses on the contents of energy, nutrients, ingredients and components that if consumed in excess on the diet, can be harmful to people's health, such as added sugars, sodium, total fat, saturated fat and energy. The academic expert group recommends the implementation of a FOP that provides an easy way to quickly assess the quality of a product. It is essential that this FOP provides direct, simple, visible and easily understandable information.


Assuntos
Bebidas , Rotulagem de Alimentos , Alimentos , Comportamento de Escolha , Conflito de Interesses , Comportamento do Consumidor , Tomada de Decisões , Diabetes Mellitus Tipo 2/prevenção & controle , Análise de Alimentos , Rotulagem de Alimentos/legislação & jurisprudência , Comportamentos Relacionados com a Saúde , Humanos , México , Valor Nutritivo , Obesidade/prevenção & controle
10.
Rev Saude Publica ; 52: 34, 2018 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-29641658

RESUMO

OBJECTIVE: To determine the trans fatty acids content of processed foods frequently consumed by adults living in a Rio de Janeiro, Brazil, after the enactment of a mandatory trans fatty acids labelling policy. METHODS: Between February 2014 and January 2015, a specifically dietary questionnaire was completed by 107 adults to assess the frequency of processed foods consumption. The most commonly consumed products from the survey, including vegetable oils, margarine, biscuits, snacks, cheese bread (pão de queijo), french fries, cheeseburger and ice cream, were then analyzed for their trans fatty acids content using gas chromatography with a flame ionization detector. RESULTS: Differences in the levels of trans fatty acids were observed among 22 products analyzed, considering that trans fatty acids content ranged between 0.0 g/100 g in samples of cream cracker biscuit 1 and olive oil to 0.83 g/100 g in samples of cheeseburger (fast food), 0.51 g/100 g in samples of frozen pão de queijo and 12.92 g/100 g in samples of chocolate sandwich cookies with cream filling 2. The overall trans fatty acids content of the different samples of margarine brands was 0.20 g/100 g for brand 1 and 0.0 g/100 g for brand 2. These data are significantly lower than those observed in a survey conducted in 2003, when the regulation had been enacted. CONCLUSIONS: Our data indicate that Brazilian regulation is very likely implicated in the observed drop in trans fatty acids of the most processed foods but has yet to eliminate them, which reinforces the urgent need to revise the legislation, since a minimum amount of trans fat does not mean that the food product does not contain this type of fat.


Assuntos
Gorduras na Dieta/análise , Indústria Alimentícia/legislação & jurisprudência , Rotulagem de Alimentos/legislação & jurisprudência , Política Nutricional/legislação & jurisprudência , Ácidos Graxos Trans/análise , Adulto , Brasil , Estudos Transversais , Feminino , Rotulagem de Alimentos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Política Nutricional/tendências , Adulto Jovem
11.
Nutrients ; 10(2)2018 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-29385758

RESUMO

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.


Assuntos
Dieta Hipossódica , Implementação de Plano de Saúde , Promoção da Saúde , Hipertensão/prevenção & controle , Cloreto de Sódio na Dieta/efeitos adversos , Custos e Análise de Custo , Tempestades Ciclônicas , /etnologia , Dieta Hipossódica/economia , Dieta Hipossódica/etnologia , Fast Foods/efeitos adversos , Fast Foods/análise , Fast Foods/economia , Fiji , Grupos Focais , Indústria Alimentícia/economia , Alimentos em Conserva/efeitos adversos , Alimentos em Conserva/análise , Alimentos em Conserva/economia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Implementação de Plano de Saúde/economia , Promoção da Saúde/economia , Humanos , Hipertensão/economia , Hipertensão/etnologia , Hipertensão/etiologia , Disseminação de Informação , Inquéritos Nutricionais/economia , Cooperação do Paciente/etnologia , Avaliação de Programas e Projetos de Saúde , Parcerias Público-Privadas/economia , Cloreto de Sódio na Dieta/análise
12.
Hastings Cent Rep ; 48(1): 5-7, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29457232

RESUMO

It is staggering to observe the new normal in America: 37.9 percent of adults are obese, and 70.7 percent are either obese or overweight. One out of every five minors is obese. The real tragedy, of course, is the disability, suffering, and early death that devastates families and communities. But all of society pays, with the annual medical cost estimated at $147 billion. The causal pathways are complex, but if we drill down, sugar is a deeply consequential pathway to obesity, and the single greatest dietary source is sugar-sweetened beverages (SSBs). The copious amount of sugar in the American diet is no accident. Industry practices and regulatory failures have fueled this explosion. Yet there are sensible, effective interventions that would create the conditions for healthier behaviors. What are the key interventions, and how can we overcome the social, political, and constitutional roadblocks? Tobacco control offers a powerful model, suggesting that success requires a suite of interventions working in concert: labeling, warnings, taxation, portion sizes, product formulation, marketing restrictions, and bans in high-risk settings such as schools and hospitals. Each intervention deserves detailed analysis, but I'm kick-starting scholarly and policy conversation by systematically laying out the major legal tools.


Assuntos
Sacarose na Dieta/administração & dosagem , Regulamentação Governamental , Obesidade/prevenção & controle , /legislação & jurisprudência , Indústria Alimentícia/legislação & jurisprudência , Humanos , Rotulagem de Produtos/legislação & jurisprudência , Impostos/legislação & jurisprudência
13.
Aust N Z J Public Health ; 42(2): 133-139, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29384238

RESUMO

OBJECTIVES: 1) To report outcomes from a citizens' jury examining regulatory responses to the health impacts of McDonald's Australia; 2) To determine the value of using citizens' juries to develop policy recommendations based on the findings of health impact assessment of transnational corporations (TNCs). METHODS: A citizens' jury engaged 15 randomly selected and demographically representative jurors from metropolitan Adelaide to deliberate on the findings of a Corporate Health Impact Assessment, and to decide on appropriate policy actions. RESULTS: Jurors unanimously called for government regulation to ensure that transnational fast food corporations pay taxes on profits in the country of income. A majority (two-thirds) also recommended government regulation to reduce fast food advertising, and improve standards of consumer information including a star-ratings system. A minority held the view that no further regulation is required of the corporate fast food industry in Australia. CONCLUSION: The jury's recommendations can help inform policy makers about the importance of ending the legal profit-shifting strategies by TNCs that affect taxation revenue. They also endorse regulating the fast food industry to provide healthier food, and employing forms of community education and awareness-raising. Implications for public health: Citizens' juries can play an important role in providing feedback and policy recommendations in response to the findings of a health impact assessment of transnational corporations.


Assuntos
Participação da Comunidade/métodos , Fast Foods , Avaliação do Impacto na Saúde/legislação & jurisprudência , Opinião Pública , Restaurantes/legislação & jurisprudência , Austrália , Humanos
14.
Public Health Nutr ; 21(9): 1608-1617, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29433594

RESUMO

OBJECTIVE: To assess the effectiveness of the self-regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) in limiting advertising of unhealthy foods and beverages on children's preferred websites in Canada.Design/Setting/SubjectsSyndicated Internet advertising exposure data were used to identify the ten most popular websites for children (aged 2-11 years) and determine the frequency of food/beverage banner and pop-up ads on these websites from June 2015 to May 2016. Nutrition information for advertised products was collected and their nutrient content per 100 g was calculated. Nutritional quality of all food/beverage ads was assessed using the Pan American Health Organization (PAHO) and UK Nutrient Profile Models (NPM). Nutritional quality of CAI and non-CAI company ads was compared using χ 2 analyses and independent t tests. RESULTS: About 54 million food/beverage ads were viewed on children's preferred websites from June 2015 to May 2016. Most (93·4 %) product ads were categorized as excessive in fat, Na or free sugars as per the PAHO NPM and 73·8 % were deemed less healthy according to the UK NPM. CAI-company ads were 2·2 times more likely (OR; 99 % CI) to be excessive in at least one nutrient (2·2; 2·1, 2·2, P<0·001) and 2·5 times more likely to be deemed less healthy (2·5; 2·5, 2·5, P<0·001) than non-CAI ads. On average, CAI-company product ads also contained (mean difference; 99 % CI) more energy (141; 141·1, 141·4 kcal, P<0·001, r=0·55), sugar (18·2; 18·2, 18·2 g, P<0·001, r=0·68) and Na (70·0; 69·7, 70·0 mg, P<0·001, r=0·23) per 100 g serving than non-CAI ads. CONCLUSIONS: The CAI is not limiting unhealthy food and beverage advertising on children's preferred websites in Canada. Mandatory regulations are needed.


Assuntos
/legislação & jurisprudência , Indústria Alimentícia/legislação & jurisprudência , Internet/estatística & dados numéricos , Política Nutricional/legislação & jurisprudência , Autonomia Profissional , Canadá , Criança , Pré-Escolar , Feminino , Humanos , Internet/legislação & jurisprudência , Masculino
15.
Public Health Nutr ; 21(3): 454-464, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29094661

RESUMO

OBJECTIVE: Front-of-package (FOP) marketing strategies of a wide variety of beverages were catalogued to examine the prevalence of each strategy prior to a sweeping Chilean restriction of child-directed marketing aimed at reducing obesity-related disease among Chile's youth. DESIGN: Photographs of 1005 beverage packages were quantitatively content-analysed to code whether a variety of child-directed, health-oriented and other marketing strategies (e.g. sales promotions) were present on each product's FOP. Strategies were then analysed based on beverages' product category, total sugar, energy and tax status (beverages with added sugars are taxed at different rates). SETTING: Photographs were taken in six urban supermarkets in Santiago, Chile, representing five different supermarket chains. RESULTS: Beverages using child-directed characters or nature/fruit references were higher in total sugar and beverages with child-directed characters or childhood/family references were higher in energy than beverages without these respective strategies. Of the beverages taxed at the highest rate (greatest amount of added sugars), 49 % used nutrition and health appeals and 80 % used nature or fruit appeals. Plain waters and plain milks were less likely than other selected product categories to use health-oriented appeals or multiple FOP strategies in combination. CONCLUSIONS: FOP marketing on beverages varied according to the nutritional quality of the product, with heavier use of health-oriented and child-directed strategies in less healthy products. Marketing activities warrant continued observation to evaluate how industry responds to new marketing restrictions as these restrictions are evaluated in the light of existing taxes and other regulatory efforts to improve diets and reduce obesity-related disease.


Assuntos
Bebidas , Dieta , Rotulagem de Alimentos , Embalagem de Alimentos , Marketing , Valor Nutritivo , Adolescente , Criança , Chile , Cidades , Comércio , Açúcares da Dieta , Ingestão de Energia , Indústria Alimentícia/legislação & jurisprudência , Humanos , Controle Social Formal , Impostos , População Urbana
16.
Nutrients ; 10(8)2018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30720790

RESUMO

Systematic reviews of trials consistently demonstrate that reducing salt intake lowers blood pressure. However, there is limited evidence on how interventions function in the real world to achieve sustained population-wide salt reduction. Process evaluations are crucial for understanding how and why an intervention resulted in its observed effect in that setting, particularly for complex interventions. This project presents the detailed protocol for a process evaluation of a statewide strategy to lower salt intake in Victoria, Australia. We describe the pragmatic methods used to collect and analyse data on six process evaluation dimensions: reach, dose or adoption, fidelity, effectiveness, context and cost, informed by Linnan and Steckler's framework and RE-AIM. Data collection methods include routinely collected administrative data; surveys of processed foods, the population, food industry and organizations; targeted campaign evaluation and semi-structured interviews. Quantitative and qualitative data will be triangulated to provide validation or context for one another. This process evaluation will contribute new knowledge about what components of the intervention are important to salt reduction strategies and how the interventions cause reduced salt intake, to inform the transferability of the program to other Australian states and territories. This protocol can be adapted for other population-based, complex, disease prevention interventions.


Assuntos
Dieta Hipossódica/normas , Promoção da Saúde/métodos , Política Nutricional , Cloreto de Sódio na Dieta/normas , Dieta Hipossódica/métodos , Humanos , Projetos de Pesquisa , Vitória
17.
Public Health Nutr ; 20(16): 3008-3018, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28879830

RESUMO

OBJECTIVE: Fortification of food-grade (edible) salt with iodine is recommended as a safe, cost-effective and sustainable strategy for the prevention of iodine-deficiency disorders. The present paper examines the legislative framework for salt iodization in Asian countries. DESIGN: We reviewed salt iodization legislation in thirty-six countries in Asia and the Pacific. We obtained copies of existing and draft legislation for salt iodization from UNICEF country offices and the WHO's Global Database of Implementation of Nutrition Actions. We compiled legislation details by country and report on commonalities and gaps using a standardized form. The association between type of legislation and availability of iodized salt in households was assessed. RESULTS: We identified twenty-one countries with existing salt iodization legislation, of which eighteen were mandatory. A further nine countries have draft legislation. The majority of countries with draft and existing legislation used a mandatory standard or technical regulation for iodized salt under their Food Act/Law. The remainder have developed a 'stand-alone' Law/Act. Available national surveys indicate that the proportion of households consuming adequately iodized salt was lowest in countries with no, draft or voluntary legislation, and highest in those where the legislation was based on mandatory regulations under Food Acts/Laws. CONCLUSIONS: Legislation for salt iodization, particularly mandatory legislation under the national food law, facilitates universal salt iodization. However, additional important factors for implementation of salt iodization and maintenance of achievements include the salt industry's structure and capacity to adequately fortify, and official commitment and capacity to enforce national legislation.


Assuntos
Deficiências Nutricionais/prevenção & controle , Alimentos Fortificados , Implementação de Plano de Saúde , Iodo/deficiência , Legislação sobre Alimentos , Cloreto de Sódio na Dieta/uso terapêutico , Ásia/epidemiologia , Deficiências Nutricionais/epidemiologia , Alimentos Fortificados/normas , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/tendências , Humanos , Iodo/normas , Iodo/uso terapêutico , Legislação sobre Alimentos/tendências , Programas Obrigatórios/legislação & jurisprudência , Ilhas do Pacífico/epidemiologia , Risco , Cloreto de Sódio na Dieta/normas , Programas Voluntários/legislação & jurisprudência
18.
Proc Nutr Soc ; 76(3): 220-229, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28595659

RESUMO

Nutrient profiling (NP) models rate the nutritional quality of individual foods, based on their nutrient composition. Their goal is to identify nutrient-rich foods, generally defined as those that contain more nutrients than calories and are low in fat, sugar and salt. NP models have provided the scientific basis for evaluating nutrition and health claims and regulating marketing and advertising to children. The food industry has used NP methods to reformulate product portfolios. To help define what we mean by healthy foods, NP models need to be based on published nutrition standards, mandated serving sizes and open-source nutrient composition databases. Specifically, the development and testing of NP models for public health should follow the seven decision steps outlined by the European Food Safety Authority. Consistent with this scheme, the nutrient-rich food (NRF) family of indices was based on a variable number of qualifying nutrients (from six to fifteen) and on three disqualifying nutrients (saturated fat, added sugar, sodium). The selection of nutrients and daily reference amounts followed nutrient standards for the USA. The base of calculation was 418·4 kJ (100 kcal), in preference to 100 g, or serving sizes. The NRF algorithms, based on unweighted sums of percent daily values, subtracted negative (LIM) from positive (NRn) subscores (NRn - LIM). NRF model performance was tested with respect to energy density and independent measures of a healthy diet. Whereas past uses of NP modelling have been regulatory or educational, voluntary product reformulation by the food industry may have most impact on public health.


Assuntos
Embalagem de Alimentos , Alimentos em Conserva/efeitos adversos , Indústria de Processamento de Alimentos , Promoção da Saúde/métodos , Modelos Biológicos , Prática de Saúde Pública , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Adulto , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Congressos como Assunto , Dietética/métodos , Dietética/tendências , Embalagem de Alimentos/legislação & jurisprudência , Embalagem de Alimentos/normas , Alimentos em Conserva/normas , Indústria de Processamento de Alimentos/legislação & jurisprudência , Indústria de Processamento de Alimentos/tendências , Promoção da Saúde/tendências , Humanos , Determinação de Necessidades de Cuidados de Saúde , Ciências da Nutrição/métodos , Ciências da Nutrição/tendências , Valor Nutritivo , Sociedades Científicas
19.
Epidemiol Prev ; 41(1): 54-60, 2017.
Artigo em Italiano | MEDLINE | ID: mdl-28322529

RESUMO

"The multinational corporations producing tobacco, alcohol, soft drinks, and processed foods have a role of vectors in the increase of chronic diseases, so that one can speak of manufacturing epidemics. The main aim of this paper is to conduct a literature review on different approaches in population-based interventions to stem the rise in consumption of unhealthy products. Different approaches were found: • command-and-control regulations: the route is definitely more advanced for tobacco with the implementation of an international treaty, which requires 180 ratifying states to implement a series of tobacco control policies. Similar regulations have been partially adopted to reduce alcohol use and to increase taxes of sugar-sweetened beverages; • multinational corporations in few Countries can voluntarily adopt recommendations on media campaigns and on labelling of soft drinks and processed foods; • in order to reduce salt in foods, many Countries developed voluntary agreements with industries with monitoring systems to assess compliance. Population-based interventions to try to align the interests of multinational corporations with those of public health are described in literature: • the "Health Footprint" programme; • the performance-based regulation which could oblige industry to take responsibility to reduce the harmful consequences of the use of their unhealthy commodities; • the price-cap regulation, usually applied to the utilities sector, would set a cap on the price of the tobacco industry, raising the tobacco taxes by 500 million euros per year. In order to reduce the burden of chronic disease, one of the objectives of the Italian National Prevention Plan, a working group including non-governmental organizations and experts in communication, social marketing, and lifestyles should be organized by the Ministry of Health in order to identify which population-based interventions could be implemented in Italy in next years to stem the rise of consumption of unhealthy products. ".


Assuntos
Bebidas , Doença Crônica/prevenção & controle , Indústria Alimentícia/normas , Saúde Pública , Indústria do Tabaco , Bebidas/normas , Fast Foods/normas , Guias como Assunto , Política de Saúde , Humanos , Itália , Formulação de Políticas , Saúde Pública/legislação & jurisprudência , Indústria do Tabaco/normas , Produtos do Tabaco
20.
BMJ ; 356: i6699, 2017 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-28073749

RESUMO

OBJECTIVE:  To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. DESIGN:  Global modeling study. SETTING:  183 countries. POPULATION:  Full adult population in each country. INTERVENTION:  A "soft regulation" national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness MAIN OUTCOME MEASURE:  Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years. RESULTS:  Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction was best in South Asia (I$116/DALY); across the world's 30 most populous countries, best in Uzbekistan (I$26.08/DALY) and Myanmar (I$33.30/DALY). Cost effectiveness was lowest in Australia/New Zealand (I$880/DALY, or 0.02×gross domestic product (GDP) per capita), although still substantially better than standard thresholds for cost effective (<3.0×GDP per capita) or highly cost effective (<1.0×GDP per capita) interventions. Most (96.0%) of the world's adult population lived in countries in which this intervention had a cost effectiveness ratio <0.1×GDP per capita, and 99.6% in countries with a cost effectiveness ratio <1.0×GDP per capita. CONCLUSION:  A government "soft regulation" strategy combining targeted industry agreements and public education to reduce dietary sodium is projected to be highly cost effective worldwide, even without accounting for potential healthcare savings.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Dieta Hipossódica/economia , Política Nutricional/economia , Benchmarking , Feminino , Governo , Humanos , Masculino , Cloreto de Sódio na Dieta , Organização Mundial da Saúde
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