Characterizing Food Policy Councils' Network Partnerships and COVID-19 Responses.

The COVID-19 pandemic pushed millions of Americans into food insecurity. Food policy councils (FPCs) across the country played a vital role in organizing coordinated food responses across multiple sectors. We used a social network analysis (SNA) approach to investigate: (1) the network of partnering organizations and agencies within FPCs; (2) how the characteristics of FPCs' network partnerships (i.e., degree, coreness, and density) related to programmatic, policy, and advocacy actions in response to the pandemic; and (3) how FPCs' use of a racial or social equity framework shifted their network partnerships and responses. Local government agencies and food supply chain actors were core in FPCs' network partnerships, while public utilities, correctional facilities, social justice groups, and others were non-core partners. Network density was more likely to be associated with any action by FPCs, and it was especially pronounced for advocacy actions taken by FPCs; trends were similar among FPCs that reported using a racial or social equity framework. The findings begin to uncover core actors in FPCs' partnerships and opportunities to establish new partnerships, particularly with social justice groups. The results also suggest that network density (interconnectedness) may be more important than other network characteristics when responding to food-related needs.

Evolution of Food and Nutrition Policy: A Tasmanian Case Study from 1994 to 2023.

Food security is a concept with evolving definitions and meanings, shaped by contested knowledge and changing contexts. The way in which food security is understood by governments impacts how it is addressed in public policy. This research investigates the evolution of discourses and practices in Tasmanian food and nutrition policies from 1994 to 2023. Four foundational documents were analysed using qualitative document analysis, revealing persistent food insecurity issues over three decades. The analysis identified a duality in addressing the persistent policy challenges of nutrition-related health issues and food insecurity: the balancing act between advancing public health improvements and safeguarding Tasmania's economy. The research revealed that from 1994 to 2023, Tasmania's food and nutrition policies and strategies have been characterised by various transitions and tensions. Traditional approaches, predominantly emphasising food availability and, to a limited extent, access, have persisted for over thirty years. The transition towards a more contemporary approach to food security, incorporating dimensions of utilisation, stability, sustainability, and agency, has been markedly slow, indicating systemic inertia. This points to an opportunity for future policy evolution, to move towards a dynamic and comprehensive approach. Such an approach would move beyond the narrow focus of food availability to address the complex multi-dimensional nature of food security.

Development of a sustainable diet index in US adults.

BACKGROUND: A transformation towards healthy diets through a sustainable food system is essential to enhance both human and planet health. Development of a valid, multidimensional, quantitative index of a sustainable diet would allow monitoring progress in the US population. We evaluated the content and construct validity of a sustainable diet index for US adults (SDI-US) based on data collected at the individual level. METHODS: The SDI-US, adapted from the SDI validated in the French population, was developed using data on US adults aged 20 years and older from the National Health and Nutrition Examination Survey, 2007-2018 (n = 25,543). The index consisted of 4 sub-indices, made up of 12 indicators, corresponding to 4 dimensions of sustainable diets (nutritional quality, environmental impacts, affordability (economic), and ready-made product use behaviors (sociocultural)). A higher SDI-US score indicates greater alignment with sustainable diets (range: 4-20). Validation analyses were performed, including the assessment of the relevance of each indicator, correlations between individual indicators, sub-indices, and total SDI-US, differences in scores between sociodemographic subgroups, and associations with selected food groups in dietary guidelines, the alternative Mediterranean diet (aMed) score, and the EAT-Lancet diet score. RESULTS: Total SDI-US mean was 13.1 (standard error 0.04). The correlation between SDI-US and sub-indices ranged from 0.39 for the environmental sub-index to 0.61 for the economic sub-index (Pearson Correlation coefficient). The correlation between a modified SDI-US after removing each sub-index and the SDI-US ranged from 0.83 to 0.93. aMed scores and EAT-Lancet diet scores were significantly higher among adults in the highest SDI-US quintile compared to the lowest quintile (aMed: 4.6 vs. 3.2; EAT-Lancet diet score: 9.9 vs. 8.7 p < .0001 for both). CONCLUSIONS: Overall, content and construct validity of the SDI-US were acceptable. The SDI-US reflected the key features of sustainable diets by integrating four sub-indices, comparable to the SDI-France. The SDI-US can be used to assess alignment with sustainable diets in the US. Continued monitoring of US adults' diets using the SDI-US could help improve dietary sustainability.

Mapa de Evidências

O Mapa de Evidências de Má-nutrição e Intervenções na APS é uma parceria entre a Coordenação-Geral de Alimentação e Nutrição do Ministério da Saúde do Brasil (CGAN/DEPROS/SAPS/MS) e a Organização Pan-Americana da Saúde (OPAS/OMS). Os Mapas de evidências apresentam uma visão geral das avaliações de impacto e revisões sistemáticas em um setor ou área, que são mapeados em uma estrutura por tipo de programa avaliado (a intervenção) e resultados medidos, destacando graficamente as lacunas, onde poucas ou nenhuma revisão ou avaliação de impacto existe e onde há uma concentração de evidência.

Mapa de Evidências (espanhol)

El Mapa de Evidencias de Malnutrición e Intervenciones en la Atención Primaria de Salud es una colaboración entre la Coordinación General de Alimentación y Nutrición del Ministerio de Salud de Brasil (CGAN/DEPROS/SAPS/MS) y la Organización Panamericana de la Salud (OPS/OMS). Los Mapas de Evidencias proporcionan una visión general de las evaluaciones de impacto y revisiones sistemáticas en un sector o área, que se organizan en una estructura por tipo de programa evaluado (la intervención) y resultados medidos, destacando gráficamente las brechas, donde hay pocas o ninguna revisión o evaluación de impacto, y donde existe una concentración de evidencia.

The Evidence Map

The Map of Evidence on Malnutrition and Interventions in Primary Health Care is a partnership between the General Coordination of Food and Nutrition of the Brazilian Ministry of Health (CGAN/DEPROS/SAPS/MS) and the Pan American Health Organization (PAHO/WHO). The Evidence Maps provide an overview of impact assessments and systematic reviews in a sector or area, which are mapped onto a framework by type of program evaluated (the intervention) and measured outcomes, graphically highlighting gaps, where few or no reviews or impact assessments exist, and where there is a concentration of evidence.

Vitrine do Conhecimento

A Vitrine do Conhecimento de Alimentação e Nutrição em Saúde Pública é uma parceria entre a Coordenação-Geral de Alimentação e Nutrição do Ministério da Saúde do Brasil (CGAN/DEPROS/SAPS/MS) e a Organização Pan-Americana da Saúde (OPAS/OMS).

Vitrine do Conhecimento (espanhol)

La Vitrina del Conocimiento de Alimentación y Nutrición en Salud Pública es una colaboración entre la Coordinación General de Alimentación y Nutrición del Ministerio de Salud de Brasil (CGAN/DEPROS/SAPS/MS) y la Organización Panamericana de la Salud (OPS/OMS).

The Showcase of Knowledge

The Knowledge Showcase on Food and Nutrition in Public Health is a partnership between the General Coordination of Food and Nutrition of the Ministry of Health of Brazil (CGAN/DEPROS/SAPS/MS) and the Pan American Health Organization (PAHO/WHO).

Urban-Rural Differences in School Districts' Local Wellness Policies and Policy Implementation Environments.

Higher rates of obesity in rural compared to urban districts suggest environmental differences that affect student health. This study examined urban-rural differences in districts' local wellness policies (LWPs) and LWP implementation environments. Cross-sectional data from two assessments in Texas were analyzed. In assessment one, each district's LWP was reviewed to see if 16 goals were included. In assessment two, an audit was conducted to identify the presence of a wellness plan (a document with recommendations for implementing LWPs), triennial LWP assessment, and school health advisory councils (SHACs) on the district website. Rural districts' LWPs had a smaller number of total goals (B = -2.281, p = 0.014), nutrition education goals (B = -0.654, p = 0.005), and other school-based activity goals (B = -0.675, p = 0.001) in their LWPs, compared to urban districts. Rural districts also had lower odds of having a wellness plan (OR = 0.520, 95% CI = 0.288-0.939), p = 0.030) and a SHAC (OR = 0.201, 95% CI = 0.113-0.357, p < 0.001) to support LWP implementation, compared to urban districts. More resources may be needed to create effective SHACs that can help develop and implement LWPs in rural areas. Important urban-rural differences exist in Texas LWPs and LWP implementation environments.

Implementation of National Nutrition Policies and Strategies to Reduce Unhealthy Diets: An Ecological Analysis of 194 Countries from 2017 to 2021.

This study investigates the implementation of national policies and strategies to control unhealthy diets, which are pivotal in the global surge of non-communicable diseases. Leveraging data from the World Health Organization's Non-Communicable Diseases Progress Monitors and Country Capacity Surveys, we calculated aggregate implementation scores for 13 diet-related policies across 194 countries from 2017 to 2021. We used descriptive statistics and linear regression to investigate the implementation trends and associations between key national-level factors and implementation scores. The mean score in 2021 was 52% (SD = 24), with no statistical differences in the 5-year period. Stark disparities in implementation efficacy were noted, ranging from comprehensive adoption in some nations to minimal application in others. Our analysis also highlights a shifting focus in policy adoption: notably, an increased commitment to taxing sugar-sweetened beverages juxtaposed with a decline in dietary awareness initiatives. Significant predictors of policy implementation include the Human Development Index, the cost of a healthy diet, and health service coverage. These findings suggest a complex interdependence of socioeconomic factors influencing policy implementation. Our research underscores the need for multifaceted, globally collaborative strategies to effectively combat diet-related diseases, emphasizing the importance of comprehensive policy frameworks in public health interventions.

Robust implementation of school food policy is needed to improve nutritional outcomes of children in European and Western Pacific countries: A systematic review.

OBJECTIVE: The present systematic review explored compliance status with school food policies in Europe and the Western Pacific regions, challenges and facilitators of policy compliance, and its impact on children's diets and nutrient intakes. RESEARCH METHODS: An electronic search for full-text research articles published between January 2009 and July 2023 was conducted in Science Direct and PubMed scientific databases. RESULTS: A total of 659 titles and abstracts were screened, and final data was extracted from 34 included studies. Results showed low compliance with the school food policy in Europe and the Western Pacific regions. The European schools chad better compliance than the Western Pacific, and supportive interventions improved policy adherence. Impact assessment studies reported that the implementation of the school food policy increased fruit and vegetable consumption, thus increasing nutrient intakes (vitamin A, vitamin D, iron, calcium, folate, and dietary fibers). However, its impact on the availability and consumption of foods high in fat, sugar, and salt (HFSS) was less conclusive. The effects of the policy on the school food environment indicated no significant improvement. CONCLUSION: Results highlighted the need for additional support and surveillance at the school level to ensure adequate policy compliance.

Integrating Healthy Nutrition Standards and Practices Into Food Service Contracting in a Large US County Government.

Purpose and Objectives: Although considered a promising model of practice, integrating healthy nutrition standards and practices into a large county government's contracting process with food vendors has not been widely described in empirical literature. We conducted an implementation evaluation project to address this gap. Intervention Approach: County of Los Angeles food vendors provide food or meals annually to more than 100,000 employees and millions of clients and visitors. In 2011, the County of Los Angeles Board of Supervisors adopted a policy to integrate healthy nutrition standards and practices into its requests for proposals (RFPs) and contracting process with food vendors. The policy required all contracts awarded to adhere to these new standards. Evaluation Methods: In 2011, the Los Angeles County Department of Public Health (DPH) began reviewing RFPs for food services for county departments that procured, served, or sold food. From 2011 through 2021, DPH applied a 4-pronged formative-evaluative approach to help county departments implement the Board of Supervisors policy and ensure that nutritional requirements were appropriately integrated into all RFPs for new and renewing contracts with food vendors. We focused our evaluation on understanding the process and tracking the progress of this policy intervention. Our evaluation included 13 key informant interviews, a 2-part survey, reviews of contract data, and synthesis of lessons learned. Results: Based on reviews and subsequent actions taken on more than 20 RFPs, DPH successfully assisted 7 county departments to incorporate healthy nutrition standards and practices into their food vendor contracts. Implementation of the food policy encountered several challenges, including staffing and training constraints and a limited infrastructure. An iterative approach to program improvement facilitated the process. Implications for Public Health: Although the model for integrating healthy nutrition standards and practices into a government contracting process is promising, more work is needed to make it less resource-intensive and to increase user buy-in.

Environmental impact of Norwegian self-selected diets: comparing current intake with national dietary guidelines and EAT-Lancet targets.

OBJECTIVES: Dietary environmental impact in a Norwegian adult population was estimated for six environmental impact categories. Moreover, environmental benefits of scenario diets complying with the Norwegian Food-Based Dietary Guidelines (FBDG) and the EAT-Lancet reference diet were assessed. DESIGN: The current diet of Norwegian adults was estimated according to 24-h dietary recall data from a national dietary surveillance survey (Norkost 3). Scenario diets were modelled to represent the Norwegian FBDG and the EAT-Lancet healthy reference diet. Dietary environmental impact in terms of global warming potential, freshwater and marine eutrophication, terrestrial acidification, water use and transformation and use of land was estimated for the current and scenario diets using environmental impact data representative of the Norwegian market. Significant associations between impact and gender/educational attainment were assessed at P < 0·05. SETTING: Norway. PARTICIPANTS: Adults (n=1787) aged 18-70 years who participated in the Norkost 3 survey (2010-2011). RESULTS: Environmental impact varied significantly by gender and educational attainment. The food groups contributing most to environmental impact of Norwegian diets were meat, dairy, beverages, grains and composite dishes. Compared with the current Norwegian diet, the FBDG scenario reduced impacts from 2 % (freshwater eutrophication) to 32 % (water use), while the EAT-Lancet scenario reduced impacts from 7 % (marine eutrophication) to 61 % (land use). The EAT-Lancet scenario resulted in 3-48 % larger reductions in impact than the FBDG scenario. CONCLUSIONS: The Norwegian FBDG, while not as environmentally friendly as the EAT-Lancet reference diet, can still be an important tool in lessening environmental burden of Norwegian diets.

The economic impact of eliminating industrially produced trans fatty acids in Barbados

The fact sheet facilitates the dissemination of evidence in Barbados on the potential impact of industrially produced trans-fatty acids elimination best practice policies in mortality, productivity and reducing the incidence of noncommunicable diseases. This information may help inform Member States' policy formulation in advancing food labeling regulations in the Region.

Did child obesity decline after 2016 food regulations in Chile? / ¿Disminuyó la obesidad infantil en Chile después de la introducción de las regulaciones alimentarias en el 2016? / A obesidade infantil diminuiu após a regulamentação de alimentos de 2016 no Chile?

[ABSTRACT]. We estimated trends in the prevalence of obesity and overweight among Chilean primary and secondary students before and after Chile’s 2016 regulations on the marketing and availability of foods high in energy, total sugars, sodium, or saturated fat. We used data from Chile’s Survey of Nutrition, which measured the body mass index (BMI) of students in government-funded schools. Using BMI thresholds defined by the World Health Organization, we calculated the prevalence of overweight and obesity for each year from 2013 to 2019 among students attending pre-kindergarten (age 4 years), kindergarten (age 5 years), first grade (6 years), and ninth grade (14 years). In ninth grade students, overweight and obesity prevalence rose by 2 percentage points over the 3 years after introduction of the 2016 regulations. In pre-kindergarten, kindergarten, and first grade, overweight and obesity fell 1 to 3 percentage points 1 year after the regulations were introduced, but rebounded to previous levels the next year. Chile’s food regulations were not followed by a sustained decline in obesity in primary- and secondary-school students. Future research should examine whether and how children in Chile and other countries maintain high levels of overweight and obesity despite food regulations designed to reduce consumption of obesogenic foods and beverages.

[RESUMEN]. Se estimaron las tendencias en la prevalencia de la obesidad y el sobrepeso en estudiantes chilenos de educación primaria y secundaria, antes y después de las regulaciones introducidas en Chile en el 2016 sobre la comercialización y disponibilidad de productos hipercalóricos, con un alto contenido de azúcares, sodio o grasas saturadas. Se utilizaron datos del Mapa Nutricional de Chile, una encuesta en la que se midió el índice de masa corporal (IMC) de la población estudiantil de las escuelas públicas. Tomando los umbrales de IMC definidos por la Organización Mundial de la Salud, se calculó la prevalencia del sobrepeso y la obesidad para cada año entre el 2013 y el 2019 en estudiantes de jardín de infancia (4 años), preescolar (5 años), primer grado (6 años) y noveno grado (14 años). En los estudiantes de noveno grado, la prevalencia del sobrepeso y la obesidad aumentó en 2 puntos porcentuales durante los 3 años posteriores a la introducción de las regulaciones del 2016. En el caso de los grupos de jardín de infancia, preescolar y primer grado, el sobrepeso y la obesidad disminuyeron entre 1 y 3 puntos porcentuales un año después de la introducción de las regulaciones, pero al año siguiente volvieron a los niveles anteriores. La introducción de las regulaciones alimentarias de Chile no estuvo seguida de una disminución continua de la obesidad en la población estudiantil de primaria y secundaria. En las investigaciones futuras se deberá examinar si la población infantil de Chile y otros países mantiene niveles altos de sobrepeso y obesidad a pesar de las regulaciones alimentarias diseñadas para reducir el consumo de productos y bebidas obesogénicos, así como las características específicas que adopta este problema de salud.

[RESUMO]. Foram estimadas tendências de prevalência da obesidade e do sobrepeso em alunos chilenos do ensino fundamental e médio antes e depois da regulamentação de 2016 da propaganda e disponibilidade de alimentos com alto teor calórico ou ricos em açúcares totais, sódio ou gorduras saturadas no Chile. Foram utilizados dados obtidos da Pesquisa em Nutrição do Chile, que aferiu o índice de massa corporal (IMC) de escolares da rede pública. Com base nos limiares de IMC definidos pela Organização Mundial da Saúde (OMS), calculou-se a prevalência anual de sobrepeso e obesidade em crianças na pré-escola (4 anos), no jardim da infância (5 anos), no primeiro ano (6 anos) e no nono ano (14 anos) em cada ano no período entre 2013 e 2019. Entre os alunos do nono ano, a prevalência de sobrepeso e obesidade aumentou 2 pontos percentuais nos 3 anos que se seguiram à introdução da regulamentação de 2016. Entre os alunos da pré-escola, do jardim de infância e do primeiro ano, ocorreu uma redução de 1 a 3 pontos percentuais na prevalência de sobrepeso e obesidade um ano após a introdução da regulamentação, mas os níveis voltaram a subir no ano seguinte. A regulamentação de alimentos não resultou em um declínio sustentado da obesidade nos alunos do ensino fundamental e médio do Chile. Pesquisas futuras devem ser realizadas para avaliar se, e como, a prevalência de sobrepeso e obesidade nas crianças chilenas e de outros países se mantém alta a despeito da regulamentação de alimentos visando à redução do consumo de alimentos e bebidas obesogênicos.

Adherence to dietary guidelines associated with lower medical service utilization in preschoolers: a longitudinal study.

OBJECTIVE: We aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers. METHODS: We selected 614 preschoolers (2-6 years) who had one day of 24-h dietary recall data from the 2013-2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants' outpatient and emergency medical service utilization were obtained for 2013-2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases. RESULTS: After adjustment for confounding factors, children aged 2-3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69-0.83) and 16% (95% CI 0.77-0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4-6 years in the T2 group exhibited 15% (95% CI 0.80-0.91) and 11% (95% CI 0.82-0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group. CONCLUSIONS: TCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers.

[Application of Delphi method in the revision of dietary quality index in the elderly].

OBJECTIVE: To revise the dietary evaluation method of the elderly, and scientifically evaluate the dietary quality. METHODS: Delphi method was used to revise a diet quality evaluation method for the elderly according to expert consultation and statistical analysis. The recommended recipes in The Dietary Guidelines for Chinese Residents(2016) were selected for preliminary verification. RESULTS: Two rounds of expert consultation were conducted, 25 experts in the industry were invited. The withdraw rate of two rounds were 100% and 84%, respectively. The authoritative coefficient were 0.82 and 0.80, the degree of familiarity was 0.92, and the basis for determination were 0.73 and 0.70, respectively. The coordination coefficient W value were 0.095 and 0.098 respectively. CONCLUSION: Delphi method had some advantages in the revision of dietary index for the elderly. Dietary quality index had some practicability, but it still needs further verification and improvement.

Mapa de Evidências - Estratégias em programas e políticas de alimentação e nutrição

O Mapa apresenta uma visão geral das evidências sobre os efeitos de ações e estratégias para promover a nutrição e a alimentação saudável nas diretrizes previstas na Política Nacional de Alimentação e Nutrição (PNAN). A partir de uma ampla busca bibliográfica para as nove diretrizes da PNAN e “Programas e Políticas de Nutrição e Alimentação”, foram incluídas 101 revisões sistemáticas (RS). O mapa representa graficamente 640 associações entre 82 tipos de intervenções distribuídos em 5 categorias e 119 desfechos distribuídos em 8 categorias, com o efeito reportado para cada associação: positivo, potencialmente positivo, inconclusivo, sem efeito ou negativo. Principais Achados: ● As RS abordaram cinco, das nove diretrizes da PNAN: Organização da Atenção Nutricional; Promoção da Alimentação Adequada e Saudável; Qualificação da Força de Trabalho; Controle e Regulação dos Alimentos; e Cooperação e articulação para a Segurança Alimentar e Nutricional. ● As 82 intervenções analisadas nas revisões foram categorizadas em: Atenção Nutricional, Alimentação Saudável, Força de Trabalho, Controle e Regulação, Segurança Alimentar. ● Os 119 desfechos foram distribuídos em oito categorias: Aleitamento materno; Educação e conhecimento; Hábito alimentar; Indicador de Saúde; Problema de Saúde; Qualidade dos alimentos; Segurança alimentar; Venda e publicidade.