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1.
BMJ ; 368: m688, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32188587

RESUMO

OBJECTIVE: To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice. DESIGN: Prospective population based study. SETTING: UK Biobank. PARTICIPANTS: 195 658 of the 502 536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations. MAIN OUTCOME MEASURES: All cause mortality and incidence of CVD. RESULTS: 4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 v 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% v 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 v 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% v 5% of energy)) and lower intake of polyunsaturated fat (2.66 v 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% v 12% of energy)) and saturated fat (2.66 v 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% v 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake. CONCLUSION: Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).


Assuntos
Doenças Cardiovasculares/mortalidade , Dieta , Carboidratos da Dieta , Gorduras na Dieta , Ingestão de Energia , Adulto , Idoso , Fibras na Dieta , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Política Nutricional , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Reino Unido/epidemiologia
3.
Monogr Oral Sci ; 28: 1-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940634

RESUMO

Diet and nutrition are fundamental in maintaining the general and oral health of populations. Diet refers to the total amount of food consumed by individuals; whereas nutrition is the process of utilising food for growth, metabolism and repair of tissues. The relationship between diet and nutrition and health is 2-way; health status can be affected by nutrient deficiency and vice versa. Dietary guidelines have been developed to provide evidence-based food and beverage recommendations for populations; aiming to promote a diet that meets the nutrient requirement, and to prevent diet-related diseases such as dental caries and obesity. Based on the amount required by the human body for normal metabolism, growth and physical well-being, nutrients are divided into 2 categories: macronutrients consisting of proteins, carbohydrates and fat; and micronutrients consisting of vitamins and minerals. Fats are the most energy-dense macronutrient; whereas carbohydrates are quantitatively the most important dietary energy source for most populations. Proteins are vital structural and functional components within every cell of the body and are essential for growth and repair and maintenance of health. Vitamins and minerals, which are found in small amounts in most foods, are essential for normal metabolic function. This chapter provides an overview of the impact of nutrients on general and oral health, with an emphasis on macronutrients.


Assuntos
Cárie Dentária , Dieta , Humanos , Política Nutricional , Estado Nutricional , Vitaminas
5.
Bull Cancer ; 107(1): 61-71, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31564476

RESUMO

INTRODUCTION: There is a growing interest in diets and their effects on cancer prognosis. In 2014, a report from the World Cancer Research Fund on diet and women with a history of breast cancer did not demonstrate a major effect on breast cancer prognosis. The aim of this literature review was to provide an update of knowledge in this area. METHODS: Randomized trials, prospective cohorts and meta-analyses published between 2012 and 2018 examining the impact of diet on recurrence risk and/or mortality after breast cancer were included, to achieve the objective. We evaluated study quality (according to Haute Autorité de Santé criteria) and the studied diets were categorized: macronutrients, micronutrients and selective foods. RESULTS: We selected eighteen articles that met levels of evidence 1 to 3. For macronutrients, a low-fat diet was associated with better survival. With regard to micronutrients, a diet rich in phytœstrogen reduced the risk of cancer recurrence. Finally, the adoption of a healthy diet was not associated with an improved prognosis for breast cancer but with an improvement in overall survival and risk of death from cardiovascular disease. DISCUSSION: This review suggests that nutrition influences the prognosis of breast cancer. Nevertheless, the level of evidence of the results was insufficient to make recommendations. Ultimately, a healthy and balanced diet could be encouraged in order to reduce global mortality.


Assuntos
Neoplasias da Mama/mortalidade , Estado Nutricional , Neoplasias da Mama/complicações , Neoplasias da Mama/dietoterapia , Neoplasias da Mama/patologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/prevenção & controle , Culinária , Dieta com Restrição de Gorduras , Medicina Baseada em Evidências , Jejum , Feminino , Alimentos/efeitos adversos , Humanos , Inflamação , Desnutrição/complicações , Desnutrição/dietoterapia , Desnutrição/terapia , Metanálise como Assunto , Micronutrientes/administração & dosagem , Nutrientes/administração & dosagem , Política Nutricional , Apoio Nutricional , Fitoestrógenos/uso terapêutico , Prognóstico , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Risco
6.
Food Chem ; 302: 125330, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31404872

RESUMO

This study assessed compliance between declared and analysed values on prepacked foods, considering the tolerance limits for salt, fat and saturated fatty acids. Foods were distributed by food categories (e.g. snacks, ready-to-eat meals, potato and potato-products, bakery and pastry products) and a total of 209 products were analysed. Only half of the samples with a declared value ≥1.25 g/100 g were within tolerance limits for salt content. The lowest number of samples outside tolerance limits was observed for fat content; for saturated fatty acids, 27% of the samples were outside of tolerance limits. Only amongst "cereal products" were 100% of products compliant for fat and salt declarations. It is of utmost importance that manufacturers update continuously values declared for prepacked foods, because this information is crucial for consumers and food policy-makers as well as being a legal requirement.


Assuntos
Rotulagem de Alimentos/normas , Nutrientes/análise , Política Nutricional , Grão Comestível , União Europeia , Fast Foods/análise , Ácidos Graxos/análise , Embalagem de Alimentos/normas , Lanches , Cloreto de Sódio na Dieta/análise
7.
Lancet ; 395(10218): 142-155, 2020 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-31852603

RESUMO

Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.


Assuntos
Doenças não Transmissíveis/prevenção & controle , Política Nutricional/legislação & jurisprudência , Estado Nutricional , Medicina Baseada em Evidências , Qualidade dos Alimentos , Humanos , Desnutrição/etiologia , Desnutrição/prevenção & controle , Obesidade/etiologia , Obesidade/prevenção & controle , Sobrepeso/etiologia , Sobrepeso/prevenção & controle , Fatores Socioeconômicos
8.
BMC Public Health ; 19(1): 1717, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864323

RESUMO

BACKGROUND: Ultra-processed food consumption is a risk factor for obesity and has a negative environmental impact. Food companies spend billions of dollars on advertisements each year to increase the consumption of ultra-processed food. In Australia, USA, and New Zealand, most food advertisements around schools and in train stations promote ultra-processed food, but no similar studies have been conducted in Sweden. The aim of this study was to explore the proportion of ultra-processed food advertisements in two districts of Stockholm, Sweden with low vs. high socioeconomic status (SES). METHODS: Two independent researchers (per area) mapped all advertisements, including storefronts, in two Stockholm districts. During consecutive days, all advertisements were photographed in Skärholmen (low SES district), and Östermalmstorg (high SES district), on the streets inside and outside the subway stations, as well as inside and outside of local shopping malls. Advertisements promoting food products were identified and a trained dietician categorized whether they promoted ultra-processed foods. Chi-Square test was conducted to test for differences in the proportion of ultra-processed food advertisements between the two study areas. RESULTS: In total, 4092 advertisements were photographed in Skärholmen (n = 1935) and Östermalm (n = 2157). 32.8% of all advertisements promoted food, while 65.4% of food advertisements promoted ultra-processed foods. A significantly higher proportion of ultra-processed food advertisements out of total food advertisements was identified in the low SES area, irrespective of the researcher taking the pictures (74.6% vs. 61.8%, p < 0.001 and 70.4% vs. 54.8%, p = 0.001). There was no significant difference in the proportion of food advertisements out of total advertisements between the two areas. CONCLUSIONS: This study provides initial evidence about the scale and the differences in exposure to food advertisements across areas in Stockholm. The observed high proportion of ultra-processed food advertisements is concerning and is in sharp contrast to the Swedish dietary guidelines that recommend reduced consumption of such foods. Based on our results, residents in low SES areas might be more exposed to ultra-processed food advertisements than those in high SES areas in Stockholm. If such findings are confirmed in additional areas, they should be considered during the deployment of food advertisement regulatory actions.


Assuntos
/estatística & dados numéricos , Fast Foods , /legislação & jurisprudência , Humanos , Política Nutricional , Áreas de Pobreza , Classe Social , Suécia
10.
PLoS Med ; 16(12): e1003007, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31887145

RESUMO

BACKGROUND: The French dietary guidelines were updated in 2017, and an adherence score to the new guidelines (Programme National Nutrition Santé Guidelines Score 2 [PNNS-GS2]) has been developed and validated recently. Since overweight and obesity are key public health issues and have been related to major chronic conditions, this prospective study aimed to measure the association between PNNS-GS2 and risk of overweight and obesity, and to compare these results with those for the modified Programme National Nutrition Santé Guidelines Score (mPNNS-GS1), reflecting adherence to 2001 guidelines. METHODS AND FINDINGS: Participants (N = 54,089) were recruited among French adults (≥18 years old, mean baseline age = 47.1 [SD 14.1] years, 78.3% women) in the NutriNet-Santé web-based cohort. Mean (SD) score was 1.7 (3.3) for PNNS-GS2 and 8.2 (1.6) for mPNNS-GS1. Selected participants were those included between 2009 and 2014 and followed up to September 2018 (median follow-up = 6 years). Collected data included at least three 24-hour dietary records over a 2-year period following inclusion, baseline sociodemographics, and anthropometric data over time. In Cox regression models, PNNS-GS2 was strongly and linearly associated with a lower risk of overweight and obesity (HR for quintile 5 versus quintile 1 [95% CI] = 0.48 [0.43-0.54], p < 0.001, and 0.47 [0.40-0.55], p < 0.001, for overweight and obesity, respectively). These results were much weaker for mPNNS-GS1 (HR for quintile 5 versus quintile 1 = 0.90 [0.80-0.99], p = 0.03, and 0.98 [0.84-1.15], p = 0.8, for overweight and obesity, respectively). In multilevel models, PNNS-GS2 was negatively associated with baseline BMI and BMI increase over time (ß for a 1-SD increase in score [95% CI] = -0.040 [-0.041; -0.038], p < 0.001, and -0.00080 [-0.00094; -0.00066], p < 0.001, respectively). In "direct comparison" models, PNNS-GS2 was associated with a lower risk of overweight and obesity, lower baseline BMI, and lower BMI increase over time than mPNNS-GS1. Study limitations include possible selection bias, reliance on participant self-report, use of arbitrary cutoffs in data analyses, and residual confounding, but robustness was tested in sensitivity analyses. CONCLUSIONS: Our findings suggest that adherence to the 2017 French dietary guidelines is associated with a lower risk of overweight and obesity. The magnitude of the association and the results of the direct comparison reinforced the validity of the updated recommendations. TRIAL REGISTRATION: The NutriNet-Santé Study ClinicalTrials.gov (NCT03335644).


Assuntos
Índice de Massa Corporal , Dieta , Política Nutricional/legislação & jurisprudência , Ganho de Peso/fisiologia , Adolescente , Adulto , Estudos de Coortes , Dieta/efeitos adversos , Comportamento Alimentar/fisiologia , Feminino , França , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Estudos Prospectivos , Adulto Jovem
11.
BMC Public Health ; 19(1): 1503, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711452

RESUMO

BACKGROUND: Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting. METHODS: The most recent Malawi Demographic Health Survey (2015-2016) was used and data for 2294 children aged 0-23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women's empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p-value of < 0.05 were considered significant in the final model. RESULTS: Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13-23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight. CONCLUSIONS: Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Comportamento Alimentar , Transtornos do Crescimento/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Magreza/prevenção & controle , Adulto , Transtornos da Nutrição Infantil/prevenção & controle , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Malaui , Masculino , Refeições , Mães , Política Nutricional , Magreza/epidemiologia
12.
BMC Public Health ; 19(1): 1457, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694610

RESUMO

BACKGROUND: The optimal dietary pattern for reducing the extent of metabolic syndrome (MetS) has not been well established yet. The aim of this study was to evaluate dietary patterns and adherence to WHO healthy diet in children and adolescents and their associations with MetS. METHODS: Subjects of this cohort study were selected from among children and adolescents of the Tehran Lipid and Glucose Study participants, aged 6-18 years (n = 424). Dietary measurements were collected using a valid and reliable food frequency questionnaire. MetS was defined as the existence of at least 3 risk factors according to the Cook criteria. Diet was assessed based on dietary components of the WHO healthy diet. Dietary patterns were defined by principal component analysis. RESULTS: The mean ± SD age of participants (42% boys and 57% girls) was 13.5 ± 3.7 years. The most consistency with the WHO healthy diet was observed for cholesterol, free sugar and protein consumption in both genders, and the least was for n-3 poly-unsaturated fatty acid, trans-fatty acid and salt. Intake of SFA up to 12% of energy intake (third quartile) reduced the risk of MetS, compared to the first quartile. Subjects in the third quartile of n-6 poly-unsaturated fatty acid intake (6.2% of energy) showed the lowest odds ratio of MetS compared to the first quartile (OR: 0.18, CI: 0.04-0.66). In the adjusted model, the risk of MetS reduced across quartiles of MUFA intake by 60% (OR: 1, 0.40, 0.40, 0.42; P trend = 0.05). No significant trends were observed in the risk of MetS components across quartiles of the WHO healthy diet components. Three major dietary patterns were identified, the healthy, unhealthy and cereal/meat. An increased risk of MetS was observed in the highest quartile of unhealthy dietary pattern score compared to the lowest quartile (OR: 1, 0.81, 0.93, 2.49; P trend = 0.03). CONCLUSIONS: Our results demonstrated that the majority of our population did not meet some components of WHO healthy diet recommendations. The quality and quantity of fatty acid intakes were associated with risk of MetS. Adherence to unhealthy dietary pattern was associated with two-fold increase in MetS risk.


Assuntos
/estatística & dados numéricos , Dieta/efeitos adversos , Fidelidade a Diretrizes/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Adolescente , Glicemia/análise , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Estudos de Coortes , Dieta/métodos , Inquéritos sobre Dietas , Ingestão de Energia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Lipídeos/sangue , Masculino , Síndrome Metabólica/etiologia , Política Nutricional , Razão de Chances , Fatores de Risco
13.
BMC Public Health ; 19(1): 1510, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718597

RESUMO

BACKGROUND: At a population level, small reductions in energy intake have the potential to contribute to a reduction in the prevalence of childhood obesity. In many school systems, there is the potential to achieve a reduction in energy intake through modest improvements in foods packed in children's school lunchboxes. This study will assess the effectiveness and cost-effectiveness of a multi-component intervention that uses an existing school-based communication application to reduce the kilojoule content from discretionary foods and drinks consumed by children from school lunchboxes whilst at school. METHODS: A Type I hybrid effectiveness-implementation cluster randomised controlled trial will be conducted in up to 36 primary schools in the Hunter New England, Central Coast and Mid North Coast regions of New South Wales, Australia. Designed using the Behaviour Change Wheel, schools will be randomly allocated to receive either a 5-month (1.5 school terms) multi-component intervention that includes: 1) school lunchbox nutrition guidelines; 2) curriculum lessons; 3) information pushed to parents via an existing school-based communication application and 4) additional parent resources to address common barriers to packing healthy lunchboxes or a control arm (standard school practices). The study will assess both child level dietary outcomes and school-level implementation outcomes. The primary trial outcome, mean energy (kJ) content of discretionary lunchbox foods packed in children's lunchboxes, will be assessed at baseline and immediately post intervention (5 months or 1.5 school terms). Analyses will be performed using intention to treat principles, assessing differences between groups via hierarchical linear regression models. DISCUSSION: This study will be the first fully powered randomised controlled trial internationally to examine the impact of an m-health intervention to reduce the mean energy from discretionary food and drinks packed in the school lunchbox. The intervention has been designed with scalability in mind and will address an important evidence gap which, if shown to be effective, has the potential to be applied at a population level. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN:12618001731280 registered on 17/10/2018. Protocol Version 1.


Assuntos
Dieta , Promoção da Saúde/métodos , Almoço , Obesidade Pediátrica/prevenção & controle , Serviços de Saúde Escolar , Instituições Acadêmicas , Telemedicina , Criança , Pré-Escolar , Comunicação , Análise Custo-Benefício , Currículo , Dieta/normas , Ingestão de Energia , Feminino , Humanos , Masculino , Aplicativos Móveis , New South Wales , Política Nutricional , Pais , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa
14.
Metas enferm ; 22(9): 5-14, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185037

RESUMO

Objetivo: identificar y conocer las políticas alimentarias elaboradas por las comunidades y ciudades autónomas en el territorio español. Método: se realizó una investigación documental. La población de estudio fueron las políticas alimentarias de las comunidades autónomas (CC.AA.), Ceuta y Melilla. Se incluyeron planes de salud y programas nutricionales (integrales o infanto-juveniles) publicados en las páginas web de las administraciones públicas regionales (periodo 2006-2018). Se efectuaron diferentes estrategias de búsqueda para identificar los planes y programas procedentes de administraciones públicas a través de las URL descritas. Se elaboró un checklist ad hoc en función del instrumento TREND para valorar la presencia de seis ítems: objetivos, población, descripción de acciones, método, evaluación de las acciones y difusión de los resultados. Resultados: se obtuvieron 38 planes y programas relacionados con las políticas alimentarias, correspondientes a las 17 CC.AA. y a la ciudad autónoma de Ceuta. El 47,4% (n= 18) fueron planes de salud, uno por CC.AA., incluida Ceuta; el 36,8% (n= 14) fueron programas nutricionales integrales y el 15,8% (n= 6) se trataba de programas de obesidad infanto-juvenil. Todos cumplían los cuatro primeros criterios valorados. Sin embargo, no estaban presentes los criterios cinco y seis en algunos programas. Conclusión: todas las CC.AA. tenían plan de salud y también la ciudad autónoma de Ceuta. Andalucía es la región que más políticas ha desarrollado para afrontar la obesidad como problema de salud. País Vasco, Aragón, Canarias, Castilla-La Mancha, Cataluña y Galicia también han elaborado varios programas para tratar este problema. El abordaje de la alimentación saludable y la obesidad en España es heterogéneo en el ámbito regional


Objective: to identify and understand the food policies conducted by the autonomous communities and cities in the Spanish territory. Method: a documentary research was conducted. The study population was the food policies by the autonomous communities (AACC), Ceuta and Melilla; it included the healthcare plans and nutrition programs (comprehensive or child and youth) published in the websites of regional authorities (period 2006-2018). Different search strategies were used to identify the plans and programs from public authorities through the URLs described. An ad hoc checklist was created based on the TREND tool to assess the presence of six items: objectives, population, description of actions, method, evaluation of actions, and dissemination of results. Results: thirty-eight (38) plans and programs associated with food policies were retrieved, corresponding to the 17 AACCs and the autonomous city of Ceuta; 47.4% (n=18) of these were healthcare plans, one per AACC, including Ceuta; 36.8% (n= 14) were comprehensive nutrition programs, and 15.8% (n= 6) were programs on child-youth obesity. All of them met the first four criteria assessed; however, criteria five and six were not present in some programs. Conclusion: all AACCs have healthcare plans, as well as the autonomous city of Ceuta. Andalusia is the region that has developed more policies to address obesity as a health problem. The Basque Country, Aragon, the Canary Islands, Castille-La Mancha, Catalonia and Galicia have also prepared some programs to deal with this problem. In Spain, healthy eating and obesity are addressed heterogeneously in the regional setting


Assuntos
Humanos , Dieta Saudável , Política Nutricional , Obesidade/prevenção & controle , Promoção da Saúde/organização & administração , Pesquisa Participativa Baseada na Comunidade , Enfermagem em Saúde Pública , Obesidade/epidemiologia , Saúde Global , Planejamento em Saúde/organização & administração
15.
Int J Behav Nutr Phys Act ; 16(1): 87, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623663

RESUMO

BACKGROUND: Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world. METHODS: Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding ("easy"/"very easy to understand" vs "difficult"/"very difficult to understand"), and, for NFTs and GDAs, frequency of use ("sometimes"/"often" vs "never"). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors. RESULTS: Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4-5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31-0.37) and the MTL (OR = 0.56, 95% CI = 0.52-0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41-0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07-0.14). CONCLUSIONS: Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.


Assuntos
Compreensão , Grupo com Ancestrais do Continente Europeu , Rotulagem de Alimentos/métodos , Hispano-Americanos , Política Nutricional , Adulto , Comportamento do Consumidor , Dieta , Feminino , Alimentos , Embalagem de Alimentos , Preferências Alimentares , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Estados Unidos
16.
Nutr. hosp ; 36(5): 1213-1222, sept.-oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184647

RESUMO

El Ministerio de Sanidad de España, en noviembre de 2018, notificó oficialmente la adopción del etiquetado nutricional frontal Nutri-Score que permitirá a los consumidores juzgar fácilmente la calidad nutricional de los alimentos en el momento de la compra e incitar a los industriales a mejorar la composición nutricional de sus productos alimentarios. Este artículo sintetiza los trabajos científicos realizados que ponen en relieve la validación del perfil nutricional que subyace al cálculo de Nutri-Score, y los trabajos que demuestran su eficacia y superioridad con respecto a otros logotipos existentes o propuestos por agentes económicos. Asimismo, se hace un balance de su desarrollo en España y en el seno de la Unión Europea y se responde a las fake-news transmitidas por sus detractores. Se presenta también la Iniciativa Ciudadana Europea para que este etiquetado frontal sea obligatorio en Europa


The Spanish Ministry of Health, in November 2018, notified the officially adoption of the front-of-pack nutrition label Nutri-Score which will allow consumers to easily judge the nutritional quality of food at the time of purchase and to encourage industrialists to improve the nutritional composition of food. This article synthesizes the scientific work pertaining to the validation of the nutritional profile that underlies the computation of Nutri-Score and works that demonstrate its effectiveness and superiority in comparison to other existing logos or proposed by food companies. Likewise, it highlights its development in Spain and within the European Union and responds to the fake-news raised by its detractors. It also introduces the European Citizens' Initiative to make it compulsory in Europe


Assuntos
Humanos , Política Nutricional/legislação & jurisprudência , Informação Nutricional , Rotulagem Nutricional , Valor Nutritivo , Saúde Pública/normas , Qualidade de Produtos para o Consumidor/normas , Informação de Saúde ao Consumidor/normas , Publicidade Direta ao Consumidor/normas
17.
Int J Behav Nutr Phys Act ; 16(1): 83, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533737

RESUMO

BACKGROUND: Many lower-income and racially diverse communities in the U.S. have limited access to healthy foods, with few supermarkets and many small convenience stores, which tend to stock limited quantities and varieties of healthy foods. To address food access, in 2015 the Minneapolis Staple Foods Ordinance became the first policy requiring food stores to stock minimum quantities and varieties of 10 categories of healthy foods/beverages, including fruits, vegetables, whole grains and other staples, through licensing. This study examined whether: (a) stores complied, (b) overall healthfulness of store environments improved, (c) healthy customer purchases increased, and (d) healthfulness of home food environments improved among frequent small store shoppers. METHODS: Data for this natural (or quasi) experiment were collected at four times: pre-policy (2014), implementation only (no enforcement, 2015), enforcement initiation (2016) and continued monitoring (2017). In-person store assessments were conducted to evaluate food availability, price, quality, marketing and placement in randomly sampled food retailers in Minneapolis (n = 84) and compared to those in a nearby control city, St. Paul, Minnesota (n = 71). Stores were excluded that were: supermarkets, authorized through WIC (Special Supplemental Nutrition Program for Women, Infants, and Children), and specialty stores (e.g., spice shops). Customer intercept interviews were conducted with 3,039 customers exiting stores. Home visits, including administration of home food inventories, were conducted with a sub-sample of frequent shoppers (n = 88). RESULTS: Overall, findings indicated significant improvements in healthy food offerings by retailers over time in both Minneapolis and St. Paul, with no significant differences in change between the two cities. Compliance was low; in 2017 only 10% of Minneapolis retailers in the sample were fully compliant, and 51% of participating Minneapolis retailers met at least 8 of the 10 required standards. Few changes were observed in the healthfulness of customer purchases or the healthfulness of home food environments among frequent shoppers, and changes were not different between cities. CONCLUSIONS: This study is the first evaluation a local staple foods ordinance in the U.S. and reflects the challenges and time required for implementing such policies. TRIAL REGISTRATION: NCT02774330 .


Assuntos
Abastecimento de Alimentos , Política Nutricional , Valor Nutritivo , Humanos , Obesidade , Estudos Prospectivos , Estados Unidos
18.
Nutrients ; 11(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527411

RESUMO

During the past decade, the concept of sustainability has been added to the factors involved in food security. This has led to a more comprehensive and holistic approach to sustainable food systems which considers drivers-environment, geopolitics, demographics, policy regulations, socio-cultural-economic factors, science and technology and infrastructure. The outcomes, similarly, involve many dimensions-environment, food security and nutrition, health and socio-cultural-economic aspects. This article discusses the Mediterranean diet in the context of sustainable food systems and shows (as in all parts of the world) that there is food insecurity in every country as monitored by the Global Nutrition Index. Three recent, major reports published in 2019 suggest what measures need to be taken to improve sustainable food systems. All environmental analyses agree on the need to promote more plant-based diets-achieved practically by using "more forks than knives". The Mediterranean Diet pattern is a case study for a sustainable diet. It has the best scientific evidence for being healthy, together with economic and socio-cultural benefits. A major challenge is that it is not consumed by the majority of the population in the Mediterranean region, and any solution must involve equity-the socially just allocation of resources. The task now is implementation with multi-stakeholder involvement, in the knowledge that "a well fed nation is a healthy nation is a sustainable and productive nation".


Assuntos
Conservação dos Recursos Naturais , Dieta Mediterrânea , Comportamento Alimentar , Abastecimento de Alimentos , Desnutrição/prevenção & controle , Política Nutricional , Valor Nutritivo , Conservação dos Recursos Naturais/legislação & jurisprudência , Abastecimento de Alimentos/legislação & jurisprudência , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Política Nutricional/legislação & jurisprudência , Estado Nutricional , Formulação de Políticas
19.
BMC Public Health ; 19(1): 1205, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477071

RESUMO

BACKGROUND: Poor diet is a significant contributor to the burden of global disease. There are numerous policies available to address poor diets; however, these policies often require public support to encourage policy action. The current study aimed to understand the level of public support for a range of food policies and the factors associated with policy support. METHODS: An online survey measuring support for 13 food policies was completed by 19,857 adults in Australia, Canada, Mexico, the United Kingdom (UK) and the United States (US). The proportion of respondents that supported each policy was compared between countries, and the association between demographic characteristics and policy support was analysed using multivariate logistic regression. RESULTS: The level of support varied between policies, with the highest support for policies that provided incentives (e.g., price subsidies) or information (e.g., calorie labelling on menus), and the lowest support for those that imposed restrictions (e.g., restrictions on sponsorship of sport events). This pattern of support was similar in all countries, but the level differed, with Mexico generally recording the highest support across policies, and the US the lowest. Several demographic characteristics were associated with policy support; however, these relationships varied between countries. CONCLUSION: The results suggest that support for food policies is influenced by several factors related to the policy design, country, and individual demographic characteristics. Policymakers and advocates should consider these factors when developing and promoting policy options.


Assuntos
Política Nutricional , Opinião Pública , Adulto , Austrália , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , México , Inquéritos e Questionários , Reino Unido , Estados Unidos
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