A cross-sectional study of the relative availability and prominence of shelf space allocated to healthy and unhealthy foods in supermarkets in urban Ireland, by area-level deprivation.

BACKGROUND: Diet-related noncommunicable diseases (NCDs) are a leading cause of ill-health and death across Europe. In Ireland, dietary intakes of saturated fat, free sugar and salt exceed World Health Organization recommendations, and excess consumption follows a social gradient increasing population risk of diet-related NCDs. The retail food environment can influence consumer food choice and subsequent dietary intakes. In high income countries, supermarkets are an increasingly influential actor in consumer food availability, choice, purchase, and subsequent food intake. This study aims to assess the relative availability and prominence of healthy and unhealthy foods in Irish supermarkets, by area-level deprivation. METHODS: This study used a cross-sectional study design, and applied a validated measure, as described in the INFORMAS Protocol: Food Retail - Food availability in supermarkets. Between October 2021 and February 2022, shelf space (m2) (height or depth (cm) × length (cm)) and prominence (visibility), of foods, classified as healthy and unhealthy and represented by a proxy indicator, were collected in supermarkets (n = 36) in County Dublin, Ireland. Overall the proportion of mean relative shelf space (m2), allocated to healthy and unhealthy foods, and its prominence, by area-level deprivation, and retailer, were determined. We used t-tests and one-way ANOVA to analyse possible differences between the proportion of relative shelf space available to healthy and unhealthy foods, and its prominence, by area-level deprivation and retailer. RESULTS: The study found the proportion of shelf space measured allocated to unhealthy food was 68.0% (SD 10.6). Unhealthy foods were more likely to be in areas of high prominence. Overall, there was no statistically significant difference between the proportion of relative shelf space available to unhealthy foods in areas of high and low deprivation. A statistically significant difference in the proportion of relative shelf space allocated to healthy and unhealthy food by area level deprivation was found in one retailer. CONCLUSION: Unhealthy foods had a higher proportion of shelf space and were more prominent than healthy foods in supermarkets in County Dublin, Ireland. The current availability and prominence of foods in supermarkets does not align with Food Based Dietary Guideline recommendations and does not support consumers to make healthier food choices. There is a need for supermarkets in Ireland to improve the availability and prominence of healthy foods to support consumers to make healthier food choices.

The Role of Food and Beverage Environments in Child Health and Weight-Related Behaviors.

This article explores how food and beverage environments influence child health and obesity risk and addresses institutional settings, retail environments, food assistance programs, and food and beverage industry marketing. It emphasizes social determinants of health, evidence-based interventions, and policy recommendations to promote healthier food options and reduce inequities. Pediatric health care providers play a critical role in addressing the need for systemic changes to eliminate inequities in food environments and the systems that support these inequities.

University Food Environment Assessment Methods and Their Implications: Protocol for a Systematic Review.

BACKGROUND: While the retail food environment has been well studied, research surrounding the university food environment is still emerging. Existing research suggests that university food environments can influence behavioral outcomes such as students' dietary choices, which may be maintained long-term. Despite a growing interest in assessing university food environments, there is no standardized tool for completing this task. How researchers define "healthy" when assessing university food environments needs to be clarified. This paper describes the protocol for systematically reviewing literature involving university food environment assessments. OBJECTIVE: This paper aimed to describe the protocol for a systematic review of the assessments of university food environments. The review will summarize previously used tools or methods and their implications. METHODS: Electronic databases, including PubMed (NLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycINFO (EBSCO), CINAHL (Cumulative Index to Nursing & Allied Health) Complete (EBSCO), ProQuest Nursing and Allied Health, and Google Scholar were searched for papers published between 2012 and 2022 using combinations of related medical subject headings terms and keywords. The electronic databases were supplemented by reviewing the reference list for all included papers and systematic reviews returned with our search results. The review will include all study types, including randomized controlled trials, observational studies, and other pre-post designs. Papers that examine at least 1 aspect of the university food environment, such as cafeterias, campus convenience stores, and vending machines, were considered for inclusion. A total of 2 reviewers will independently screen titles and abstracts, complete a full-text review, extract data, and perform a quality assessment of included papers, with a third reviewer resolving any conflicts. The Quality Assessment for Diverse Studies (QuADS) tool was used to determine the methodological quality of selected studies. A narrative and tabular summary of the findings were presented. There will not be a meta-analysis due to the methodological heterogeneity of the included papers. RESULTS: The initial queries of 4502 records have been executed, and papers have been screened for inclusion. Data extractions were completed in December 2023. The results of the review were accepted for publication in May 2024. The systematic review generated from this protocol will offer evidence for using different assessment tools to examine the campus food environment. CONCLUSIONS: This systematic review will summarize the tools and methods used to assess university food environments where many emerging adults spend a significant part of their young adult lives. The findings will highlight variations in practice and how "healthy" has been defined globally. This review will provide an understanding of this unique organizational food environment with implications for practice and policy. TRIAL REGISTRATION: PROSPERO CRD42023398073; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=398073. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54955.

Strategies associated with improved healthiness of consumer purchasing in supermarket interventions: a systematic overview of reviews and evaluation of primary articles.

Background: Growing evidence suggests that it is possible to change the retail food environment to enable healthier choices via in-store interventions. It has been difficult to draw clear conclusions as to which interventions are most effective in positively influencing consumer purchasing behaviour given the significant heterogeneity within the food retail research literature. The aim of this study was to (1) summarise current high-quality systematic, scoping, and/or narrative reviews (Part I: overview of reviews); and (2) synthesise high-quality original research, to understand the range, types and effectiveness of strategies implemented in food retail settings (Part II: evaluation of primary studies). Methods: To identify reviews describing the effects of intervention strategies aiming to improve the healthiness of consumer purchasing in supermarkets, a systematic search across seven electronic databases was completed in April 2023. The methodological quality of reviews was assessed using the risk of bias in systematic reviews for systematic and scoping reviews, and the Scale for the Assessment of Narrative Review Articles for narrative reviews. High-quality reviews were further inspected and synthesised narratively (Part I). Next, to understand strategies associated with improved healthiness of consumer purchasing high-quality, primary articles from high-quality reviews identified in Part I were retrieved, and the strategies implemented within these interventions were summarised (Part II). Results: Thirty-eight reviews met the inclusion criteria for Part I; two-thirds (n = 25, 66%) were rated as high-quality (66%). These reviews indicated that pricing strategies had the greatest proportion of reported positive or promising effects on outcomes (n = 8 of 11 reviews, 73%). Twenty reviews met the inclusion criteria for Part II and the 771 primary articles from these reviews were screened with 23 high-quality primary articles included in analysis. Findings indicated that promotional strategies in combination with another strategy appeared to be most successful among regular shoppers (the general population), whereas pricing was most successful in low socio-economic status and rural sub-groups. Conclusion: Promotion, pricing and prompting were the most commonly tested strategies across the overview of reviews and review of primary articles. Promotion, in combination with other strategies, and pricing appear to be most promising, but the effectiveness of pricing strategies may vary by sub-groups of the population. How pricing and promotion in combination with other strategies can be implemented responsibly and sustainably to change purchase habits towards healthier items should be explored further. Systematic Review registration: OSF, https://osf.io/jyg73/.

Agreement between a web collaborative dataset and an administrative dataset to assess the retail food environment in Mexico.

BACKGROUND: Latin American countries are often limited in the availability of food outlet data. There is a need to use online search engines that allow the identification of food outlets and assess their agreement with field observations. We aimed to assess the agreement in the density of food outlets provided by a web collaborative data (Google) against the density obtained from an administrative registry. We also determined whether the agreement differed by type of food outlet and by area-level socioeconomic deprivation. METHODS: In this cross-sectional study, we analyzed 1,693 census tracts from the municipalities of Hermosillo, Leon, Oaxaca de Juarez, and Tlalpan. The Google service was used to develop a tool for the automatic acquisition of food outlet data. To assess agreement, we compared food outlet densities obtained with Google against those registered in the National Statistical Directory of Economic Units (DENUE). Continuous densities were assessed using Bland-Altman plots and concordance correlation coefficient (CCC), while agreement across tertiles of density was estimated using weighted kappa. RESULTS: The CCC indicated a strong correlation between Google and DENUE in the overall sample (0.75); by food outlet, most of the correlations were from negligible (0.08) to moderate (0.58). The CCC showed a weaker correlation as deprivation increased. Weighted kappa indicated substantial agreement between Google and DENUE across all census tracts (0.64). By type of food outlet, the weighted kappa showed substantial agreement for restaurants (0.69) and specialty food stores (0.68); the agreement was moderate for convenience stores/small food retail stores (0.49) and fair for candy/ice cream stores (0.30). Weighted kappa indicated substantial agreement in low-deprivation areas (0.63); in very high-deprivation areas, the agreement was moderate (0.42). CONCLUSIONS: Google could be useful in assessing fixed food outlet densities as a categorical indicator, especially for some establishments, like specialty food stores and restaurants. The data could also be informative of the availability of fixed food outlets, particularly in less deprived areas.

Weight Loss Maintainers Sustain High Diet Quality in Diverse Residential Retail Food Environments.

BACKGROUND: The relationship between the retail food environment and diet quality has received minimal investigation among weight loss maintainers. OBJECTIVE: The aim of this study was to investigate the association between the residential retail food environment and diet quality in weight loss maintainers from WeightWatchers in the United States. DESIGN: Cross-sectional data were collected between January 2018 and February 2020. The Retail Food Environment Index (RFEI), based on geocoded home addresses, classified the environment as follows: RFEI <1.6 = healthiest; RFEI 1.6 to <2.5 = moderately healthy; RFEI 2.5 to <4.0 = moderately unhealthy; RFEI ≥4.0 = least healthy. Dietary data were obtained using a food frequency questionnaire. PARTICIPANTS/SETTING: Adult participants (n = 1,159) who had lost weight using WeightWatchers and maintained ≥9.1-kg weight loss for ≥1 year (mean 24.7-kg loss for 3.4 years). MAIN OUTCOME MEASURES: Healthy Eating Index 2015 (HEI-2015) component and total scores (0-100; higher scores indicate better alignment with the 2015-2020 Dietary Guidelines for Americans). STATISTICAL ANALYSES PERFORMED: Regression models included RFEI category, the independent variable, and HEI-2015 and component scores (outcomes) controlling for age, sex, race and ethnicity, educational attainment, and household income. RESULTS: Compared with individuals living in the healthiest food environments (mean HEI-2015 score = 71.5) those in the unhealthiest environments had a mean HEI-2015 score of 70.1 (95% CI 68.8 to 71.3), those in moderately unhealthy environments had a score of 71.3 (95% CI 70.3 to 73.1) and those in moderately healthy environments had a score of 70.3 (95% CI 68.9 to 71.2), indicating a nonlinear relationship. Compared with those in the healthiest environments, those in the least healthy environments had an approximately 0.47 lower added sugar HEI-2015 component score (95% CI -0.86 to -0.08), indicating approximately 5% higher added sugar intake. CONCLUSIONS: Weight loss maintainers maintained high diet quality in diverse retail food environments. Compared with those in the healthiest food environments, those in the least healthy had a higher consumption of added sugars.

What North American retail food environment indices miss in Guatemala: Cultural considerations for the study of place and health.

We evaluated the cross-context validity and equivalence of the US- and Canada-originated Retail Food Environment Index (RFEI) and modified RFEI (mRFEI) against a retail food environment dataset from the indigenous-majority city of Quetzaltenango (Xela), Guatemala. The RFEI/mRFEI failed to identify 77% of retailers and misclassified the healthiness of 42% of the remaining retailers in Xela, inaccurately labeling the city a food swamp. The RFEI/mRFEI are not currently suitable for mapping retail food environments in places like Quetzaltenango. Alternative functional and temporal classifications of retail food environments may provide measures with greater contextual fit, highlighting important cultural considerations for the study of place and dietary health.

Occurrence and Characteristics of Toxigenic Staphylococcus aureus in Retail Foods in Iran.

Staphylococcus aureus causes various toxigenic and invasive diseases in humans worldwide. This study examined the prevalence, virulence genes, and antibiotic resistance of S. aureus isolates collected from 894 retail food samples in Ardabil, Iran. Staphylococcal cassette chromosome mec (SCCmec), spa, and multilocus sequence typing methods were employed to further investigate the molecular characteristics of methicillin-resistant S. aureus (MRSA) isolates. The results revealed that 11.18% (n = 100) of food samples exhibited contamination with S. aureus (10.50% methicillin-sensitive S. aureus [MSSA] and 0.67% MRSA). Notably, raw minced meat (29.41%), Faloodeh (25%), and Olivier salad (21.42%) emerged as the most frequently contaminated food items. Among the 100 isolates of S. aureus, 94% were characterized as MSSA, with the remaining 6% identified as MRSA. The highest resistance was observed for penicillin (12%). MRSA isolates exhibited significantly higher resistance rates. Seventy-nine percent of the isolates were positive for sea, 14% for seb, 8% for a sec, and 0% for sed enterotoxin-encoding genes. Sixteen percent of isolates harbored two or more staphylococcal enterotoxin genes, simultaneously. Moreover, 97%, 94%, 24%, and 22% of isolates were positive for hla, hld, tst, and pvl virulence-encoding genes, respectively. No isolate was positive for the exfoliative toxins encoding eta and etb genes. MRSA isolates belonged to CC8 (n = 4) and CC22 (n = 2). Isolates in CC8 belonged to lineage ST239-MRSA-III and spa type t030; the isolates in CC22 belonged to ST22-MRSA-IV and spa types t310 and t223. In conclusion, a relatively high proportion of our retail food samples were contaminated with S. aureus. The high incidence of isolates with toxigenic genes raises serious health concerns. Furthermore, the presence of MRSA lineages linked to humans suggests that retail foods may be contaminated with human origin.

Urban school neighbourhoods dominated by unhealthy food retailers and advertisements in Greater Tunis: a geospatial study in the midst of the nutrition transition.

OBJECTIVE: Food environments are a major determinant of children's nutritional status. Scarce evidence on food environments exists in low- and middle-income countries (LMIC). This study aims to fill this gap by documenting the obesogenicity of food environments around schools in Greater Tunis, Tunisia - an LMIC of the Middle East and North Africa region with an ongoing nutrition transition and increasing rates of childhood obesity. DESIGN: In this cross-sectional study, we assessed built food environments around fifty primary schools. Ground-truthing was performed to collect geographic coordinates and pictures of food retailers and food advertisement sets within an 800-m road network buffer of each school. Retailers and advertisement sets were categorised as healthy or unhealthy according to a NOVA-based classification. Associations between school characteristics and retailers or advertisement sets were explored using multinomial regression models. SETTING: Greater Tunis, Tunisia. PARTICIPANTS: Random sample of fifty (thirty-five public and fifteen private) primary schools. RESULTS: Overall, 3621 food retailers and 2098 advertisement sets were mapped. About two-thirds of retailers and advertisement sets were labelled as unhealthy. Most retailers were traditional corner stores (22 %) and only 6 % were fruit and vegetable markets. The prevailing food group promoted was carbonated and sugar-sweetened beverages (22 %). The proportion of unhealthy retailers was significantly higher in the richest v. poorest areas. CONCLUSIONS: School neighbourhood food environments included predominantly unhealthy retailers and advertisements. Mapping of LMIC food environments is crucial to document the impact of the nutrition transition on children's nutritional status. This will inform policies and interventions to curb the emergent childhood obesity epidemic.

Designing and Evaluating a Hierarchical Framework for Matching Food Outlets across Multi-sourced Geospatial Datasets: a Case Study of San Diego County.

Research on retail food environment (RFE) relies on data availability and accuracy. However, the discrepancies in RFE datasets may lead to imprecision when measuring association with health outcomes. In this research, we present a two-tier hierarchical point of interest (POI) matching framework to compare and triangulate food outlets across multiple geospatial data sources. Two matching parameters were used including the geodesic distance between businesses and the similarity of business names according to Levenshtein distance (LD) and Double Metaphone (DM). Sensitivity analysis was conducted to determine thresholds of matching parameters. Our Tier 1 matching used more restricted parameters to generate high confidence-matched POIs, whereas in Tier 2 we opted for relaxed matching parameters and applied a weighted multi-attribute model on the previously unmatched records. Our case study in San Diego County, California used government, commercial, and crowdsourced data and returned 20.2% matched records from Tier 1 and 18.6% matched from Tier 2. Our manual validation shows a 100% matching rate for Tier 1 and up to 30.6% for Tier 2. Matched and unmatched records from Tier 1 were further analyzed for spatial patterns and categorical differences. Our hierarchical POI matching framework generated highly confident food POIs by conflating datasets and identified some food POIs that are unique to specific data sources. Triangulating RFE data can reduce uncertain and invalid POI listings when representing food environment using multiple data sources. Studies investigating associations between food environment and health outcomes may benefit from improved quality of RFE.

Australian Stakeholder Perspectives on Healthier Retail Food Environments for Toddlers-The Era of "Band Aids and Small Inroads".

Background: A healthy diet in young children is crucial for optimal growth and development. However, many toddlers (1-3 y) consume suboptimal diets, and as a result, are at a high risk of experiencing negative health outcomes. Moreover, minimal progress has been made to improve the healthiness of retail food environments for toddlers to date despite the potential and advocacy for the issue. Objectives: To gain insight into stakeholder perceptions and opinions on the healthiness of Australian retail food environments for toddlers, as well as perspectives on the options and barriers to improve their healthiness. Methods: Qualitative, online study utilizing semi-structured individual interviews with 27 key stakeholders from food industry, academia, nongovernment organizations, public health, and government in Australia. Results: Most stakeholders agreed that retail food environments for toddlers were not health promoting. Stakeholders identified that a multifaceted approach including nutrition education and strong government mandated regulation were essential to improve the healthiness of retail food environments for toddlers. Interviews also highlighted the main perceived barriers to progress, and reasons for policy inaction in this area are the food industry and government support. Many stakeholders were concerned that child health is being undermined due to the government favoring business needs over public health. Conclusions: Stakeholders in this study overwhelmingly agreed that there is more that can and should be done to create health promoting retail food environments for toddlers in Australia. Stakeholders identified a range of strategies that can be used to improve the healthiness of toddler food environments, but advocacy efforts are being undermined due to government inaction. Stakeholders believed that strong governance is required to create equitable, sustainable healthy retail food environments for young children. Improving the healthiness of retail food environments for young children will not only reduce diet related disease across the lifespan but will help to address financial and societal costs of a poor diet.

Store-specific grocery shopping patterns and their association with objective and perceived retail food environments.

OBJECTIVE: To explore store-specific grocery shopping patterns and assess associations with the objective and perceived retail food environment (RFE). DESIGN: This cross-sectional study used principal component analysis and hierarchical cluster analysis to identify grocery shopping patterns and logistic regression models to assess their associations with the RFE, while adjusting for household characteristics. SETTING: The Montpellier Metropolitan Area, France. PARTICIPANTS: To be eligible for inclusion, participants had to be 18 years of age or older and reside in the Montpellier Metropolitan Area. Analyses were carried out on 415 households. RESULTS: Households of cluster 'Supermarket' (49 % of households) primarily shopped at supermarkets and were less likely to live near a convenience store. Households of cluster 'Diversified' (18 %) shopped mostly at organic stores, at markets, at specialised stores, and from producers and were more likely to have a market in their activity space. Households of cluster 'Discount' (12 %) primarily shopped at discounters and were less likely to perceive a producer in their activity space. Households of cluster 'Convenience' (12 %) mostly shopped online or in convenience stores. Finally, households of cluster 'Specialized' (9 %) had high expenditures in greengrocers and in other specialised food stores and were more likely to live near a specialised food store. CONCLUSIONS: This study highlighted the importance of considering both perceived and objective RFE indicators, as well as assessments around the home and in activity space. Understanding how people buy food and interact with their RFE is crucial for policymakers seeking to improve urban food policies.

Occurrence and Patterns of Enterotoxin Genes, spa Types and Antimicrobial Resistance Patterns in Staphylococcus aureus in Food and Food Contact Surfaces in Singapore.

Staphylococcus aureus contamination of food and food contact surfaces is a public health concern given its virulent and antimicrobial-resistant properties worldwide. In this study, a total of 181 MSSA isolates were analyzed for SE genes, antimicrobial resistance patterns, and spa types. Overall, 24.9% of isolates were positive for SE gene detection, with sea being the most prevalent classical SE (18.8%). The most predominant sample sources for SE gene contamination were hand swabs for sea (6/48), meat dishes for seb (3/14) and seafood dishes for sec (2/24). Antimicrobial resistance was also observed at relatively high frequencies for the clinically important antibiotics penicillin G and ampicillin (both 54.7%), followed by tetracycline (14.9%) and azithromycin (8.8%). In addition, characterization of spa types revealed spa type t5078 to be the most predominant (40.3%), with significant associations between spa types t127 and t5521 and the sea gene. This study offers insights into the enterotoxin gene and antimicrobial resistance profiles of S. aureus in cooked or ready-to-eat food to inform future surveillance and epidemiological studies.

Trends in food and beverage purchases in informal, mixed, and formal food outlets in Mexico: ENIGH 1994-2020.

Background: The retail food environment in Mexico is characterized by the co-existence of both, formal and informal food outlets. Yet, the contribution of these outlets to food purchases over time has not been documented. Understanding the longitudinal trends where Mexican households purchase their foods is critical for the development of future food retail policies. Methods: We used data from Mexico's National Income and Expenditure Survey from 1994 to 2020. We categorized food outlets as formal (supermarkets, chain convenience stores, restaurants), informal (street markets, street vendors, acquaintances), and mixed (fiscally regulated or not. i.e., small neighborhood stores, specialty stores, public markets). We calculated the proportion of food and beverage purchases by food outlet for each survey for the overall sample and stratified by education level and urbanicity. Results: In 1994, the highest proportion of food purchases was from mixed outlets, represented by specialty and small neighborhood stores (53.7%), and public markets (15.9%), followed by informal outlets (street vendors and street markets) with 12.3%, and formal outlets from which supermarkets accounted for 9.6%. Over time, specialty and small neighborhood stores increased 4.7 percentage points (p.p.), while public markets decreased 7.5 p.p. Street vendors and street markets decreased 1.6 p.p., and increased 0.5 p.p. for supermarkets. Convenience stores contributed 0.5% at baseline and increased to 1.3% by 2020. Purchases at specialty stores mostly increased in higher socioeconomic levels (13.2 p.p.) and metropolitan cities (8.7 p.p.) while public markets decreased the most in rural households and lower socioeconomic levels (6.0 p.p. & 5.3 p.p.). Supermarkets and chain convenience stores increased the most in rural localities and small cities. Conclusion: In conclusion, we observed an increase in food purchases from the formal sector, nonetheless, the mixed sector remains the predominant food source in Mexico, especially small-neighborhood stores. This is concerning, since these outlets are mostly supplied by food industries. Further, the decrease in purchases from public markets could imply a reduction in the consumption of fresh produce. In order to develop retail food environment policies in Mexico, the historical and predominant role of the mixed sector in food purchases needs to be acknowledged.

A healthier retail food environment around the home is associated with longer duration of weight-loss maintenance among successful weight-loss maintainers.

Few studies have examined associations between the retail food environment and weight maintenance. This study examined the residential Retail Food Environment Index (RFEI) of weight loss maintainers and associations with weight maintenance duration, perceived effort and difficulty managing weight, and coping and monitoring strategies. Participants were 6947 members of the WW Success Registry (enrolled January 2018-February 2020), a nationwide (United States) convenience sample of individuals who lost weight using Weight Watchers (WW) and maintained a ≥ 9.1 kg weight loss for ≥1 year (Mean 24.7 kg loss for 3.4 years). Home addresses were geo-coded and the RFEI (ratio of unhealthy [fast-food and convenience stores] to healthy [supermarkets, grocery stores, and fruit/vegetable vendors] outlets) was used to classify the healthfulness of the food environments. Validated questionnaires measured psychological coping and self-monitoring. Compared to individuals living in the healthiest food environments (RFEI<1.6), those in the least healthy food environments (RFEI ≥4.0) maintained weight loss for 0.5 years less (3.2 vs 3.7 years; 95% CI between-group difference = 0.20, 0.80), reported statistically higher scores but not clinically relevant differences on perceived effort (4.6 vs. 4.5; 95% between-group difference = 0.01, 0.21) and difficulty managing their weight (3.1 vs. 3.0; 95% CI between-group difference = 0.01, 0.17) and practice of self-monitoring (2.7 vs. 2.6; 95% CI between-group difference = 0.01, 0.14). No differences in psychological coping were observed. Weight loss maintainers living in the least healthy retail food environments maintained weight loss for a shorter duration compared to those in the healthiest food environments.

Retail Food Equivalents for Post-Oral Immunotherapy Dosing in the Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen Oral Immunotherapy in Food-Allergic Children and Adults (OUtMATCH) Clinical Trial.

BACKGROUND: Patients with food allergy may be advised to introduce specific foods into their diets, both to increase tolerance gradually and as next steps after completing oral immunotherapy or other therapeutic interventions. However, the safe use of retail foods depends on the ability to establish the specific allergen protein content of these foods. OBJECTIVE: To develop a systematic approach to estimate the protein content of peanut, milk, egg, wheat, cashew, hazelnut, and walnut in a variety of retail food equivalents for each allergen and associated patient education materials. METHOD: We created an algorithm that used a multistep process with information from product food labels, nutrient databases, independent weighing and measuring of foods, and information provided by manufacturers, including certificates of analysis, and e-mail communication to estimate the allergen protein content of multiple retail foods for each of seven allergens. Once a variety of retail food equivalents for each allergen and allergen serving size was determined, we developed participant education handouts, which were reviewed by study teams at 10 food allergy centers, the National Institute of Allergy and Infectious Diseases, and the Consortium for Food Allergy Research coordinating center. After 1 year of use, multiple queries were addressed and the retail food equivalents and educational materials were reviewed and edited. RESULTS: We identified a variety of retail food equivalents for seven allergens at six serving sizes, and created 48 unique patient education materials. CONCLUSION: Our results provide extensive guidance on a variety of retail equivalents for seven foods, and a method to estimate retail food protein equivalents systematically with ongoing reassessment.

Reformulation of Processed Yogurt and Breakfast Cereals over Time: A Scoping Review.

Poor diet is responsible for a quarter of European non-communicable disease (NCD)-related deaths. The reformulation of sugar, salt, and saturated fat in processed packaged foods offers an opportunity to reduce consumption of nutrients of concern and also support a reduction in energy intake. To date, there have been no publications measuring progress in food reformulation by compiling published evidence for a food category. The aim of this scoping review was to identify, characterize and summarise the findings of studies analysing the reformulation of processed yogurt and breakfast cereals. The review answered the research question: "What is the impact of food reformulation on the nutrient quality of yogurt and breakfast cereals available in the retail environment?" The research protocol was defined based on PRISMA-ScR guidelines. Five databases were searched in May 2022. Thirteen studies, published between 2010 and 2021 and completed across seven countries were eligible for inclusion. There were sufficient eligible studies to identify trends in sodium, salt, and sugar reduction in breakfast cereals. However, there was minimal or no reduction in energy, which may bring into question the use of food reformulation as part of an overall health strategy for obesity reduction.

A Systematic Review of Marketing Practices Used in Online Grocery Shopping: Implications for WIC Online Ordering.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) plans to allow participants to redeem their food package benefits online, i.e., online ordering. As grocery shopping online has become more common, companies have developed strategies to market food products to customers using online (or mobile) grocery shopping platforms. There is a significant knowledge gap in how these strategies may influence WIC participants who choose to shop for WIC foods online. This review examines the relevant literature to (1) identify food marketing strategies used in online grocery shopping platforms, (2) understand how these strategies influence consumer behavior and consumer diet, and (3) consider the implications for WIC participants. A total of 1862 references were identified from a systematic database search, of which 83 were included for full-text screening and 18 were included for data extraction and evidence synthesis. The included studies provide policymakers and other stakeholders involved in developing WIC online order processes with valuable information about the factors that shape healthy food choices in the online food retail environment. Findings indicate that some marketing interventions, such as nutrition labeling and food swaps, may encourage healthier food choices in the online environment and could potentially be tailored to reinforce WIC messaging about a healthy diet.

Rethinking Efforts to Improve Dietary Patterns Among Long-Haul Truck Drivers: Transforming Truck Stop Retail Food Environments Through Upstream Change.

A multitude of upstream occupational exposures influence poor dietary patterns that contribute to cardiometabolic health disparities among long-haul truck drivers in the United States. Herein, we delineate the unique characteristics of the truck driving profession that shape dietary patterns. Next, we discuss current health promotion efforts and why they are unlikely to be sufficient for improving population-level dietary patterns. We then advocate for prioritizing health promotion efforts that target upstream factors that influence population dietary patterns and have the potential to holistically and sustainably support drivers' nutrition. Finally, we propose novel research directions to catalyze upstream-oriented health promotion efforts.

UK government's new placement legislation is a 'good first step': a rapid qualitative analysis of consumer, business, enforcement and health stakeholder perspectives.

BACKGROUND: The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders. METHODS: A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders. RESULTS: Stakeholders perceived the legislation to be a 'good first step' towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health. CONCLUSIONS: This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20-30 years.