Assessing the SAIN,LIM nutrient profile of foods sold by fast food restaurants in Tunisia: Exploring ways for improvement

ObjectivesNon-communicable diseases have increased in Tunisia after the epidemiological transition. That is why the national strategy to prevent and control obesity was elaborated and implemented. Improving the quality of foods is one axis of this strategy. The purpose of this paper was to estimate and evaluate the nutritional profiles of Tunisian foods sold by fast food restaurants, and explore ways for improvement.Material and methodsNutritional quality of 35 average recipes or items was assessed by 70 recipes of dishes sold by fast food restaurants. The SAIN,LIM French scoring system was used. Foods were classified into the four SAIN,LIM classes, i.e. from the healthiest (class 1) to the least healthy (class 4). The recipes were then reformulated and improved by deleting or reducing some unfavorable ingredients like salt.ResultsBefore reformulation, the items were spread over the 4 SAIN,LIM classes (class 1: 42.9%; class 2: 8.6%; class 3: 20.0% and class 4: 28.6%). After reformulation, the items were spread over class 1 (85.7%) and class 3 (14.3%), showing clear improvement of their nutritional quality.ConclusionIn Tunisia, an important percentage of foods sold by fast food restaurant have a good nutrient profile (43%). After reformulation, most items were in the healthiest class. This study is the first to show that it is possible to improve the nutritional quality of foods sold by fast food restaurants, and that the SAIN,LIM system can help to that end.     

Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming

Nutrient profiling ranks foods based on their nutrient content. They may help identify foods with a good nutritional quality for their price. This hypothesis was tested using diet modeling with linear programming. Analyses were undertaken using food intake data from the nationally representative French INCA (enquête Individuelle et Nationale sur les Consommations Alimentaires) survey and its associated food composition and price database. For each food, a nutrient profile score was defined as the ratio between the previously published nutrient density score (NDS) and the limited nutrient score (LIM); a nutritional quality for price indicator was developed and calculated from the relationship between its NDS:LIM and energy cost (in euro/100 kcal). We developed linear programming models to design diets that fulfilled increasing levels of nutritional constraints at a minimal cost. The median NDS:LIM values of foods selected in modeled diets increased as the levels of nutritional constraints increased (P = 0.005). In addition, the proportion of foods with a good nutritional quality for price indicator was higher (P < 0.0001) among foods selected (81%) than among foods not selected (39%) in modeled diets. This agreement between the linear programming and the nutrient profiling approaches indicates that nutrient profiling can help identify foods of good nutritional quality for their price. Linear programming is a useful tool for testing nutrient profiling systems and validating the concept of nutrient profiling.     

The Macronutrient Content of Sodium-Modified Foods Is Unchanged Compared with Regular Counterparts: An Evaluation of Select Categories of Packaged Foods in the United States, 2018

BackgroundLowering excess sodium in packaged foods is part of a public health strategy to reduce cardiovascular disease risk. Sales of foods with labeled sodium claims increased during the past decade. Yet, it is unclear whether sugars or fats were added during the reformulation of foods that might counter the benefits of sodium reduction.ObjectiveIt was hypothesized that the nutrient content of packaged foods with lower sodium label claims (ie, sodium-modified) would differ from their regular (ie, unmodified) counterparts.DesignThis cross-sectional study compared label data of 153 sodium-modified foods and 141 regular, matched counterparts within four food categories: soups, processed meats, vegetables, and savory snacks. Foods were identified by searching manufacturer websites of the top-10 brands in each category. Sodium, calories, total carbohydrate, sugar, protein, total fat, saturated fat, and potassium (when reported) were compared by labeled serving and per 100 g food.ResultsThe average amount in milligrams of sodium per serving in regular foods ranged from 162 mg for savory snacks to 782 mg for soups. Compared with regular foods, the matched lower sodium foods had significantly less sodium per serving (–95 to –387 mg) and per 100 g (–184 to –462 mg) (P<0.01 for all comparisons), except for soups per 100 g (P = 0.166), and were similar to their regular counterparts in calories, total carbohydrate, sugar, protein, total fat, and saturated fat (P>0.05 for all comparisons). Of the soups that reported potassium on the label, potassium was 244 mg/serving (P=0.004) and 139 mg/100 g (P=0.002) higher among matched lower sodium soups.ConclusionsThe similarity in macronutrient contents on the labels for sodium-modified foods and their regular counterparts suggests that reformulation did not include the addition of significant amounts of sugars, fats, or other macronutrients among major food brands in the selected categories. Potassium content and additional food categories deserve further investigation.     

Effect of a Nutrient Rich Foods consumer education program: results from the nutrition advice study

BackgroundThe Nutrient Rich Foods (NRF) approach to eating uses the NRF Index, a nutrient profiling metric to help consumers choose foods that contain more vitamins, minerals, and other nutrients per kilocalorie. Research is needed to test the efficacy of dietary guidance using nutrient profiling systems to rank foods.ObjectiveTo examine whether nutrition education and supporting materials would increase understanding of the NRF approach and improve food shopping, meal planning, consumption of nutrient-rich foods, and diet quality.DesignUnbalanced randomized controlled trial conducted in February to May 2009 with participants assigned to NRF education group (n=128) or control group receiving standard nutrition education (n=61).Participants/settingAdult primary food shoppers and preparers with at least one child in the household aged 3 to 17 years.InterventionGroup education session and support tools (pocket guide, shopping list, refrigerator magnet, weekly e-mail messages, and biweekly mailings).Main outcome measuresSurveys of knowledge, attitudes, and behaviors and two 24-hour telephone dietary recalls at baseline and after an 8-week intervention period.Statistical analysesExamined time-by-treatment interactions in outcome measures.ResultsCompared to controls, NRF participants increased meal planning (+24.2% vs ?4.9%; P<0.01), ability to identify nutrient-rich foods (+60.2% vs +24.6%; P<0.001), and use of shopping lists (+14.1% vs +3.3%; nonsignificant trend), and consumed more vegetables and fruits (P<0.05). NRF participants improved overall diet quality as shown by their scores on the Healthy Eating Index (P=0.04) and NRF scale scores (nonsignificant trend). Significant improvements were observed in Healthy Eating Index component scores for total fruit; whole fruit; whole grains; saturated fat; and energy from solid fats, alcohol, and added sugars.ConclusionsFindings of this study showed that a consumer education program increased participants' use of the NRF approach and improved diet quality. Larger and longer-term studies are needed to confirm the findings and better understand processes of change.     

Content of zinc, iron, calcium and their absorption inhibitors in foods commonly consumed in Ethiopia

The zinc, iron, calcium, phosphorus, phytate, tannin and moisture content of 36 foods consumed in rural Ethiopia were analysed. The foods analysed included those based on cereals, starchy tubers and roots, and legumes and vegetables as well as some fruits. Although many foods were relatively rich in zinc and iron, many also contained high levels of phytic acid and tannins, which impair bioavailability of zinc and iron. The phytate:zinc molar ratios were >20 for non-fermented cereal foods, >15 for legumes, and <12 for fermented cereals, starchy tubers and roots. Ratios >15 are associated with low bioavailability of zinc. Given the high iron content and the relatively favourable phytate:iron molar ratio, tef enjera was the best source of bioavailable iron of all foods analysed. Foods prepared from tef, enset and kale are rich sources of calcium. The consumption of diets based on cereals and legumes but poor in animal products can lead to deficiencies of zinc and iron. However, since fermentation can decrease the phytate content by a factor of 3–4, traditional household practices such as fermentation need to be encouraged to address the problem of zinc deficiency, which is particularly prevalent in Ethiopia.     

A Novel Approach to Selecting and Weighting Nutrients for Nutrient Profiling of Foods and Diets

BackgroundNutrient profiling of foods is the science of ranking or classifying foods based on their nutrient composition. Most profiling systems use similar weighting factors across nutrients due to lack of scientific evidence to assign levels of importance to nutrients.ObjectiveOur aim was to use a statistical approach to determine the nutrients that best explain variation in Healthy Eating Index (HEI) scores and to obtain β-coefficients for the nutrients for use as weighting factors for a nutrient-profiling algorithm.DesignWe used a cross-sectional analysis of nutrient intakes and HEI scores.ParticipantsOur subjects included 16,587 individuals from the National Health and Nutrition Examination Survey 2005-2008 who were 2 years of age or older and not pregnant.Main outcome measureOur main outcome measure was variation (R²) in HEI scores.Statistical analysesLinear regression analyses were conducted with HEI scores as the dependent variable and all possible combinations of 16 nutrients of interest as independent variables, with covariates age, sex, and ethnicity. The analyses identified the best 1-nutrient variable model (with the highest R²), the best 2-nutrient variable model, and up to the best 16-nutrient variable model.ResultsThe model with 8 nutrients explained 65% of the variance in HEI scores, similar to the models with 9 to 16 nutrients, but substantially higher than previous algorithms reported in the literature. The model contained five nutrients with positive β-coefficients (ie, protein, fiber, calcium, unsaturated fat, and vitamin C) and three nutrients with negative coefficients (ie, saturated fat, sodium, and added sugar). β-coefficients from the model were used as weighting factors to create an algorithm that generated a weighted nutrient density score representing the overall nutritional quality of a food.ConclusionsThe weighted nutrient density score can be easily calculated and is useful for describing the overall nutrient quality of both foods and diets.     

Achieving eatwell plate recommendations: is this a route to improving both sustainability and healthy eating?

By using data from the National Diet and Nutrition Survey (NDNS) rolling programme, the objective was to determine the extent to which consumers meet the nutrition guidelines implicit in the eatwell plate; to profile those eating healthily and gain insight on how they achieved the recommendations and whether in doing so, their eating pattern was also potentially more sustainable. Only 4% of adults simultaneously met five targets related to fat, saturated fatty acids (SFA), 5 A DAY fruit and vegetables, fibre (non‐starch polysaccharide; NSP) and protein intake and, with the exception of target protein intake, the majority of people (51%) achieved none of the guidelines. The addition of the oil‐rich fish recommendation reduces those meeting all six targets to 1%. Just 12% of the population (n = 94) met the three targets for fat, SFA and fruit and vegetable intake. These were designated achievers, who tended to be older by 5 years and to have a degree (P < 0.05), while non‐achievers were more likely to smoke (P < 0.05). Energy intakes were slightly lower in achievers (non‐significant), who had significantly lower fat and SFA intakes and higher intakes of protein. Intakes of NSP were significantly higher among achievers, who on average met the dietary reference value for NSP. The main NDNS food groups with a significantly higher intake in achievers were skimmed milks, chicken and turkey dishes, white fish (not fried) and shellfish and wholemeal breads, while non‐achievers consumed more coated chicken, meat pies and pastries, cheese, whole milks and white bread. It appears that the achievers have reduced the fat content of their diet by focussing on lower fat/higher fibre alternatives within the same category of foods rather than introducing more plant foods such as legumes, nuts and seeds. There is growing interest in the future sustainability of current dietary patterns in light of expected climate change and an expanding global population. Although only one facet of a very complex picture, plant foods are typically associated with fewer greenhouse gas (GHG) emissions than those of animal origin. On this limited basis, achievers were not necessarily eating more sustainably. It is suggested, by reference to literature values (primarily for potential GHG emissions of food production), that with some rebalancing and through the inclusion in current UK dietary patterns of more plant foods, particularly more plant proteins and starchy foods, the existing eatwell plate could not only provide the basis of a cost‐effective healthy diet, but also a potentially more sustainable one too. However, in order to meet these joint objectives, improved consumer understanding and practical advice on how to use the eatwell plate in this way is clearly required.     

Assessing Foods Offered to Children at Child-Care Centers Using the Healthy Eating Index-2005

The Healthy Eating Index-2005 (HEI-2005) has been applied primarily to assess the quality of individual-level diets but has recently been applied to environmental-level data as well. Currently, no studies have applied the HEI-2005 to foods offered in child-care settings. This cross-sectional study used the HEI-2005 to assess the quality of foods and beverages offered to preschool children (3 to 5 years old) in child-care centers. Two days of dietary observations were conducted and 120 children (six children per center) were observed at 20 child-care centers in North Carolina between July 2005 and January 2006. Data were analyzed between July 2011 and January 2012 using t tests. Mean total HEI-2005 score (59.12) was significantly (P<0.01) lower than the optimal score of 100, indicating the need to improve the quality of foods offered to children. All centers met the maximum score for milk. A majority also met the maximum scores for total fruit (17 of 20 centers), whole fruit (15 of 20 centers), and sodium (19 of 20 centers). Mean scores for total vegetable (mean=2.26±1.09), dark green/orange vegetables and legumes (mean=0.20±0.43), total grain (mean=1.09±1.25), whole grain (mean=1.29±1.65), oils (mean=0.44±0.25), and meat/beans (mean=0.44±0.25) were significantly lower than the maximum scores recommended (P<0.01). Mean scores for saturated fat (mean=3.32±3.41; P<0.01) and calories from solid fats and added sugars (mean=14.76±4.08; P<0.01) suggest the need to decrease the provision of foods high in these components. These findings indicate the need to improve the quality of foods offered to children at the centers to ensure that the foods provided contribute to children's daily nutrition requirements.     

The Impact of Carbohydrate Quality on Dental Plaque pH: Does the Glycemic Index of Starchy Foods Matter for Dental Health?

Sugary carbohydrate foods have long been associated with increased risk of dental caries formation, but the dental health impact of starchy carbohydrates, particularly those with a high glycemic index (GI), has not been well examined. Aim: To investigate the effect of different starchy foods varying in their GI, on acute changes in dental plaque pH. Methods: In a series of sub-studies in healthy adults, common starchy carbohydrate foods, including white bread, instant mashed potatoes, canned chickpeas, pasta, breakfast cereals, white rice, and an oral glucose solution were consumed in fixed 25 g available carbohydrate portions. The change in dental plaque pH was assessed postprandially over 1 h and capillary plasma glucose was measured at regular intervals over 2 h. Results: Higher GI starchy foods produced greater acute plaque pH decreases and larger overall postprandial glucose responses compared to lower GI starchy foods (white bread compared with canned chickpeas: −1.5 vs. −0.7 pH units, p = 0.001, and 99 ± 8 mmol/L min vs. 47 ± 7 mmol/L min, p = 0.026). Controlling for other food factors (food form and nutritional composition), lower GI versions of matched food pairs produced smaller plaque pH excursions compared to higher GI versions of the same food. Using linear regression analysis, the GI value of starchy carbohydrate foods explained 60% of the variation in maximum plaque pH nadir and 64% of the variation in overall acute dental plaque pH excursion (p < 0.01). Conclusion: The findings imply that starchy foods, in particular those with a higher GI, may play a role in increasing the risk of dental caries.     

Price Trends of Healthy and Less Healthy Foods and Beverages in Mexico from 2011–2018

BackgroundCost is one of the main drivers of food selection; thus it is important to monitor food prices. Evidence from low- and middle-income countries such as Mexico is limited.ObjectiveThe aim of this study was to evaluate the prices and price trends of healthy and less healthy food/beverage groups in Mexico from 2011 to 2018.DesignThis study used a time series of the prices of foods and beverages classified by 1) healthiness, 2) processing level, and 3) pairs of healthy/less healthy substitutes.SettingFood and beverage prices used to estimate the Consumer Price Index were obtained. Prices were collected weekly from 46 cities (>20,000 habitants) distributed across the country.Main outcome measuresPrice trend (% change/year) from 2011 to 2018 for all food/beverage groups and price/100 g in 2018 for pairs of healthy/less healthy substitutes were obtained.Statistical analysesLinear regression models were used for each food/beverage group, with the logarithm of deflated price as the dependent variable and time (years) as the independent variable.ResultsOn average, prices for less healthy foods and beverages increased more than prices of healthy foods and beverages (foods: 1.72% vs 0.70% change/year; beverages: 1.61% vs ?0.19% change/year). The price change was similar for unprocessed/minimally processed foods and ultraprocessed foods (1.95% vs 1.85% change/year); however, within each processing category, the price of less healthy foods increased more. By pairs of substitutes (within food/beverage groups), the healthier option for bread, sodas, and poultry was more expensive (price/100 g) in 2018, whereas for red meat, cheese, mayonnaise, and milk, the healthier option was cheaper.ConclusionsOverall, the food prices of less healthy foods and beverages increased more than the food prices of healthy foods and beverages. However, by processing level there was no difference, and for pairs of healthy/less healthy substitutes results were mixed. Continued monitoring of food prices is warranted, and future research is needed to understand how these price changes affect dietary quality.     

The challenges of defining a healthy and ‘sustainable’ diet

Considerable debate exists about changes required to current diets to deliver simultaneous improvements for both human health and environmental sustainability. Media coverage has focussed largely on the environmental and health impacts of animal source foods, particularly red meat. However, animal source foods contribute notably to intakes of micronutrients (e.g. iron, zinc, iodine, calcium) in current UK diets, and evidence indicates nutrient intakes/status may be inadequate if appropriate substitutions are not made when restricting such foods in the diet, highlighting the need to consider the overall dietary pattern. Healthy and sustainable dietary patterns have been modelled based on nutritional adequacy alone (e.g. Eatwell Guide), or nutrition combined with environmental impact (e.g. WWF Livewell Plates). Studies have also considered other aspects, such as the health impact or cost, with some analyses providing ‘optimised’ diets representing the smallest required changes to current diets. Consistent changes are evident for most food groups (e.g. increases in fruit and vegetables, starchy carbohydrates, fish and – in most cases – beans, pulses and other legumes; decreases in red/processed meat, cheese and high‐fat/sugar foods). However, recommendations for dairy consumption (particularly milk) are less consistent. Methodological variation makes it difficult to directly compare recommendations to date, due to use of different data sources, environmental metrics and modelling assumptions/constraints, although reducing food waste is an important consideration regardless of dietary pattern. In the UK, adopting the government’s Eatwell Guide, which incorporates affordability and familiarity, appears a sensible direction of travel at the current time, likely to deliver nutritional, health and environmental benefits.     

Associations Between Ultra-processed Foods Consumption and Indicators of Adiposity in US Adolescents: Cross-Sectional Analysis of the 2011-2016 National Health and Nutrition Examination Survey

BackgroundUltra-processed foods represent a considerable part of the diet of US children and adolescents, yet their association with total, abdominal, and visceral overweight/obesity remains understudied.ObjectiveTo examine associations between dietary contribution of ultra-processed foods and total, abdominal, and visceral overweight/obesity in a nationally representative sample of US adolescents.DesignCross-sectional analyses were performed on data collected from adolescents participating in the 2011-2016 National Health and Nutrition Examination Survey.Participants/settingParticipants included 3587 adolescents aged 12 to 19 years, who had data from at least 1 day of valid 24-hour dietary recall data.Main outcome measuresTotal overweight/obesity, abdominal overweight/obesity, and visceral overweight/obesity data were collected.Statistical analyses performedAll food items (grams per day) recorded in the 24-hour recalls were classified according to Nova. Multiple logistic regressions were used to evaluate associations between the dietary contribution of ultra-processed foods (expressed in percentage of total grams per day) and outcomes. Multivariable models were adjusted for sociodemographic covariates, physical activity, total energy intake, whether the individual was following a special diet for weight loss, and indicators of the nutritional quality of the diet.ResultsIn multivariable analyses, the highest consumption of ultra-processed food was associated with 45%, 52%, and 63% higher odds of total, abdominal, and visceral overweight/obesity, respectively (odds ratio [OR] 1.45, 95% CI 1.03-2.06, P for linear trend = .040; OR 1.52, 95% CI 1.06-2.18, P for linear trend = .026; OR 1.63, 95% CI 1.19-2.24, P for linear trend = .005, respectively), compared with the lowest consumption. A 10% increment in the proportion of ultra-processed foods in the diet was associated with an increased risk of both abdominal overweight/obesity (OR 1.07; 95% CI 1.01-1.13) and visceral overweight/obesity (OR 1.07; 95% CI 1.02-1.13).ConclusionsStudy findings support the growing evidence of cross-sectional and prospective associations between ultra-processed foods and increased adiposity and also with metabolically unhealthy phenotypes of obesity in adolescence. Timely action to reduce the consumption of ultra-processed foods among adolescents is needed.     

Discriminating between carbohydrate‐rich foods: A model based on nutrient density and glycaemic index

Aim: The aim of this study was to develop a model for conceptualising the nutritional quality of carbohydrate‐rich foods, using nutrient density and glycaemic index. Methods: A nutrient density score based on six distinguishing nutrients was developed. Nutrient density scores and glycaemic indices for 95 carbohydrate‐rich foods were plotted on two dimensional axes, arranged into four carbohydrate quality quadrants. The classifications of foods and groups of foods were then assessed against Australian and American dietary guidelines' recommendations. Results: The model showed considerable capacity to discriminate between the nutritional qualities of carbohydrate‐rich foods. In general, the ranking of foods was consistent with dietary guidelines' recommendations with most core foods including dairy products, legumes, starchy vegetables, breads and breakfast cereals falling into the two highest quality categories. Non‐core foods such as biscuits, donuts, pastries, sweets and soft drinks fell into the lowest quality category. There were two points of inconsistency between the model and the dietary guidelines, in relation to some fruits and cereals. Nutrient density scores for fruits varied widely. Many cereal foods, including rice and pasta, fell in the lower quality categories and were ranked similarly to biscuits and pastries. Total sugar content was a minor discriminator of nutritional quality using this model. Conclusions: Ranking the nutritional quality of carbohydrate‐rich foods using this model suggests that dietary recommendations for cereal foods in dietary guidelines and food guides may need to be reconsidered. More emphasis may need to be placed on nutrient density and less on sugar content.     

Diets within Environmental Limits: The Climate Impact of Current and Recommended Australian Diets

Planetary boundaries are an important sustainability concept, defining absolute limits for resource use and emissions that need to be respected to avoid major and potentially irreversible earth system change. To remain within the safe operating space for humanity, there is a need for urgent adoption of climate-neutral diets, which make no additional contribution to warming. In the first study of its kind, a new climate metric, the Global Warming Potential Star (GWP*), was used to assess greenhouse gas (GHG) emissions associated with 9341 Australian adult diets obtained from the Australian Health Survey. Dietary climate footprints averaged 3.4 kg CO₂-equivelent per person per day, with total energy intake explaining around one quarter of the variation. Energy-dense and nutrient-poor discretionary foods contributed around one third. With lower climate footprint food choices, a diet consistent with current Australian dietary guidelines had a 42% lower climate footprint. Currently, it is not possible to define a climate-neutral dietary strategy in Australia because there are very few climate-neutral foods in the Australian food system. To bring Australian diets into line with the climate stabilization goals of the Paris Agreement, the most important need is for innovation across the agricultural and food processing industries to expand the range of climate-neutral foods available.     

The Contribution of Discrete Vegetables,Mixed Dishes,and Other Foods to Total Vegetable Consumption: US Ages 2 Years and Over, 2017-2018

BackgroundThe 2020-2025 Dietary Guidelines for Americans recommend intake of a variety of vegetables, including dark green, red, and orange vegetables and starchy and other vegetables.ObjectivesThis study aims to describe sociodemographic differences in the contribution of different categories of vegetables and the form in which they are consumed (ie, discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetable intake on a given day).DesignThis is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey.Participants/settingThis study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls.Main outcome measuresServing equivalents of vegetables from 20 discrete categories of vegetables and from mixed dishes and other foods as a percentage of total vegetables.Statistical analysesPairwise differences by age, sex, race, Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income were examined using orthogonal polynomials.ResultsMean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups, and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake, and the contribution increased with age in adults and with increasing family income. The top 5 discrete vegetable contributors were other vegetables and combinations, french fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Nonstarchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income.ConclusionsDiscrete vegetables only contributed 55.2% of total vegetable intake, and the top sources were not varied. Three of them potato based, which may explain the reported low vegetable intake, relative to the 2020-2025 Dietary Guidelines for Americans. More than one-third of vegetables consumed were nonstarchy discrete vegetables, many of which are high in vitamins. Nonstarchy discrete vegetable intake was higher in adults than youth and increased with family income.     

LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later

Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy.     

“Healthy”/“Unhealthy” Food Brands Influence Health,Calorie, and Price Ratings of Food

ObjectiveTo assess the effect of healthy or unhealthy food brands on consumer ratings of a food's perceived healthfulness, caloric content, and estimated price.MethodsUsing a crossover design, 35 adults aged 18–25 years scored a variety of healthy and unhealthy foods paired with “healthy” or “unhealthy” brands or with no brand present, on their healthfulness, caloric content, and estimated price. For each outcome measure, ANOVA was used to evaluate the effect of brand condition on healthy and unhealthy foods.ResultsPairing an unhealthy food with a “healthy brand” led to increased ratings of healthfulness (P < .001), decreased estimates of caloric content (P < .001), and increased price (P < .001). Pairing a healthy food with an “unhealthy brand” led to decreased ratings of healthfulness (P < .001), increased estimates of caloric content (P < .001), and decreased price (P < .001).Conclusions and ImplicationsThese findings extend previous research showing that brands may influence perceptions of food products. Future studies are needed to understand the implications of pairing healthy foods with “unhealthy brands” on actual food intake.     

Select Food Group Intake of US Children Aged 2 to 4 Years by WIC Participation Status and Income

BackgroundFood group and nutrient priorities for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package IV for children aged 2 to 4 years were described in the 2017 review of the WIC Food Package. Research has evaluated priority nutrient intake, but priority food group intake remains unknown.ObjectivesTo compare mean intake of priority food groups/subgroups of WIC children to WIC-eligible nonparticipants and higher income children. Further, we hoped to assess differences in percent contribution of food subgroups to total food group intake by WIC participation status and income.DesignCross-sectional study conducted using data from the 2011-14 National Health and Nutrition Examination Survey.Participants/settingOne thousand forty-seven children aged 2 to 4 years.Main outcome measuresMean intake reported in cup equivalents and ounce equivalents. We also looked at mean percent that food subgroups contributed to total intake within a food group. Analyses were performed for high and low priority food groups/subgroups: high = seafood, total vegetables, dark green vegetables, red/orange vegetables, whole grains, and nuts/seeds/soy; low = total starchy vegetables, other vegetables, legumes computed as vegetables, total dairy, and total protein foods.Statistical analyses performedMultivariable linear regression analysis was used evaluate the relationship between income/WIC participation and mean intake/percent food subgroups contributed to total food group intake.ResultsAmong low-income WIC-eligible children, participation in WIC was associated with greater mean intake of red/orange vegetables (0.18 ± 0.03 vs 0.01 ± 0.06 c equivalents; P < 0.05) and legumes (0.07 ± 0.01 vs 0.01 ± 0.02 c equivalents; P < 0.01). No differences in mean intake were observed between WIC children and higher income children. Grain intake of WIC children was composed of a higher percentage of whole grains (19.1% ± 1.6% vs 13.2% ± 1.5%; P < 0.01) compared with higher income children. The percent vegetable subgroups contributed to total vegetable intake varied by income; no differences were observed for dairy or protein subgroups.ConclusionsAmong low-income children, participation in WIC was associated with greater intake of certain vegetables. Participation in WIC may also help close the diet quality gap between low-income and higher income children for priority foods targeted by the WIC food package. Future research should explore socioeconomic disparities in intake of nutrient-poor foods.     

Foods and Beverages Obtained at Worksites in the United States

BackgroundNutrition interventions are a common component of worksite wellness programs and have been recognized as an effective strategy to change employee dietary behaviors. However, little is known about worksite food behaviors or the foods that are obtained at workplaces at the national level.ObjectiveThe aims were to examine the frequency of and the amount of money spent obtaining foods at work among employed US adults, to determine the foods most commonly obtained at work, and to assess the dietary quality of these foods.DesignThis is a cross-sectional analysis of data from the US Department of Agriculture Food Acquisition and Purchasing Survey, a nationally representative household survey conducted from April 2012 through January 2013 on food purchases and acquisitions during a 7-day study period.ParticipantsThe study included 5,222 employed adult Americans.Main outcome measuresThe study assessed the prevalence of obtaining any foods at work overall and according to sociodemographic subgroups, number of acquisitions and calories obtained, most commonly obtained foods and leading food sources of calories, and 2010 Healthy Eating Index (HEI) scores that represent dietary quality.Statistical analyses performedPrevalence estimates of obtaining ≥1 foods at work were compared according to sociodemographic characteristic using χ² tests.ResultsNearly a quarter (23.4%) of working adults obtained foods at work during the week, and the foods they obtained averaged 1,292 kcal per person per week. The leading food types obtained included foods typically high in solid fat, added sugars, or sodium, such as pizza, regular soft drinks, cookies or brownies, cakes and pies, and candy. HEI scores suggest that work foods are high in empty calories, sodium, and refined grains and low in whole grains and fruit.ConclusionsWorking adults commonly obtain foods at work, and the foods they obtain have limited dietary quality. Future research should examine the role worksites can play to help ensure access to and promote healthier options.