The extent and nature of food promotion directed to children in Australian supermarkets

The aim of this study was to describe the nature and amount of sales promotion use on food packaging in selected Australian supermarkets, specifically those directed at children through the use of premium offers, such as giveaways and competitions, and cartoon and movie character promotions. The study also examined the promotion of healthy versus unhealthy foods. Nine supermarkets located across the metropolitan area of Sydney, Australia were surveyed to assess the extent and nature of food promotion directed at children. The number and types of promotions were measured within seven food categories: sweet biscuits, snack foods, confectionery, chips/savoury snacks, cereals, dairy snacks and ice cream. Any foods that utilized promotional tactics were categorized as either healthy or unhealthy, according to set criteria. The study found that within the seven food categories between 9 and 35% of food products used promotional tactics. The use of television, movie celebrities and cartoon characters for promotion was most common, making up 75% of all promotions. Giveaways accounted for 13% of all promotions. When used, giveaways were commonly used in conjunction with another promotional method. Data from this study also confirmed that 82% of all food promotions were for unhealthy foods and only 18% were used to promote healthy foods. However, for dairy snacks and ice cream the majority of promotions, 99 and 65%, respectively, were healthier choices. This was the first study to describe the extent and nature of food promotions used in supermarkets. The promotion of unhealthy foods in supermarkets is common and is one of the many factors contributing to today's obesity promoting environment. Further research is required to determine the impact of food promotions on children's dietary intake, and to determine the most effective ways to restrict the promotion of unhealthy foods.     

Fried Food Consumption and Cardiovascular Health: A Review of Current Evidence

Fried food consumption and its effects on cardiovascular disease are still subjects of debate. The objective of this review was to summarize current evidence on the association between fried food consumption and cardiovascular disease, diabetes, hypertension and obesity and to recommend directions for future research. We used PubMed, Google Scholar and Medline searches to retrieve pertinent publications. Most available data were based on questionnaires as a tool to capture fried food intakes, and study design was limited to case-control and cohort studies. While few studies have reported a positive association between frequencies of fried food intake and risk of coronary artery disease, heart failure, diabetes or hypertension, other investigators have failed to confirm such an association. There is strong evidence suggesting a higher risk of developing chronic disease when fried foods are consumed more frequently (i.e., four or more times per week). Major gaps in the current literature include a lack of detailed information on the type of oils used for frying foods, stratification of the different types of fried food, frying procedure (deep and pan frying), temperature and duration of frying, how often oils were reused and a lack of consideration of overall dietary patterns. Besides addressing these gaps, future research should also develop tools to better define fried food consumption at home versus away from home and to assess their effects on chronic diseases. In summary, the current review provides enough evidence to suggest adverse health effects with higher frequency of fried food consumption. While awaiting confirmation from future studies, it may be advisable to the public to consume fried foods in moderation while emphasizing an overall healthy diet.     

Are the Dietary Guidelines for Meat,Fat, Fruit and Vegetable Consumption Appropriate for Environmental Sustainability? A Review of the Literature

This paper reviews the current literature around the environmental impacts of dietary recommendations. The focus of the review is on collating evidence relating to environmental impacts of the dietary advice found in the World Health Organisation guidelines, and environmental impact literature: reducing the consumption of fat, reducing the consumption of meat-based protein and animal-based foods, and increasing the consumption of fruit and vegetables. The environmental impact of reducing dietary fat intake is unclear, although reducing consumption of the food category of edible fats and oils appears to have little impact. However most, but not all, studies support environmental benefits of a reduced consumption of animal-based foods and increased consumption of fruit and vegetables. In general, it appears that adhering to dietary guidelines reduces impact on the environment, but further study is required to examine the environmental impacts of animal-based foods, and fruit and vegetable intake in depth.     

A Hierarchy of Unhealthy Food Promotion Effects: Identifying Methodological Approaches and Knowledge Gaps

We assessed the evidence for a conceptual “hierarchy of effects” of marketing, to guide understanding of the relationship between children’s exposure to unhealthy food marketing and poor diets and overweight, and drive the research agenda. We reviewed studies assessing the impact of food promotions on children from MEDLINE, Web of Science, ABI Inform, World Health Organization library database, and The Gray Literature Report. We included articles published in English from 2009 to 2013, with earlier articles from a 2009 systematic review. We grouped articles by outcome of exposure and assessed outcomes within a framework depicting a hierarchy of effects of marketing exposures. Evidence supports a logical sequence of effects linking food promotions to individual-level weight outcomes. Future studies should demonstrate the sustained effects of marketing exposure, and exploit variations in exposures to assess differences in outcomes longitudinally.Systematic reviews have shown that food marketing has an effect on children’s food preferences and consumption.1,2 The lack of evidence directly linking food marketing to children’s weight has proved a barrier to policymakers introducing legislation to limit this practice.3 Food companies would not invest so heavily in marketing to children and in lobbying against legislation to limit marketing4 if this did not increase product sales. Nevertheless, evidence is needed to define the mechanisms that underpin marketing’s influence on children’s weight, and the magnitude of these effects.The argument supporting the need to regulate children’s exposure to unhealthy food marketing hinges on 3 pieces of evidence: (1) food marketing not only encourages brand switching within a product category but also attracts new consumers to the broad food group, (2) the majority of promoted foods are energy-dense and nutrient-poor (“unhealthy”), and (3) consumption of promoted foods contributes to excess energy intake that is not compensated for, leading to weight gain and diet-related disease.4Recent and complex theories recognize marketing as one form of socialization agent that transmits norms, attitudes, motivations, and behaviors to the learner.5,6 Social and learning theories posit that exposure to positive media messages cues children to want portrayed products and to model observed behaviors.5,7 Importantly, these theories suggest that such effects can occur even in the absence of conscious perception of marketing stimuli.6 Less prominent elements of marketing, and the emotions that are evoked, may be stored in memory and individuals may not consciously acknowledge or believe that a promotion has affected them when it has.8The effect of promotions on children’s weight outcomes can be explained by a cascade of effects in which exposure to promotions influences children’s brand awareness, preferences, and consequently their purchases and consumption,9 similar to the hierarchy of effects underpinning social marketing.10 Earlier systematic reviews on this topic have variously grouped these outcomes of exposure as potential determinants of behavior (preferences, attitudes, knowledge, beliefs), effects on behavior (purchase, purchase requests, consumption patterns), and diet-related health outcomes (e.g., body weight)11; or as mediators of diet (preferences, beliefs, purchase requests), diet (short-term consumption, usual dietary intake), and diet-related health outcomes.2 In marketing literature, the relationship between brand awareness and consumption is referred to as “brand equity.”12 Brand equity is achieved when a brand is highly recognizable and associated with positive attributes.12 With this review, we aimed to outline a conceptual pathway of effects of how marketing may ultimately influence children’s weight. We also sought to collate information on methods used to measure the impact of food promotions on different levels of effects. Within the term “marketing,”13 this review specifically focused on food advertising, sponsorships, and sales promotions (collectively referred to as promotions).     

Phenol Biological Metabolites as Food Intake Biomarkers,a Pending Signature for a Complete Understanding of the Beneficial Effects of the Mediterranean Diet

The Mediterranean diet (MD) has become a dietary pattern of reference due to its preventive effects against chronic diseases, especially relevant in cardiovascular diseases (CVD). Establishing an objective tool to determine the degree of adherence to the MD is a pending task and deserves consideration. The central axis that distinguishes the MD from other dietary patterns is the choice and modality of food consumption. Identification of intake biomarkers of commonly consumed foods is a key strategy for estimating the degree of adherence to the MD and understanding the protective mechanisms that lead to a positive impact on health. Throughout this review we propose potential candidates to be validated as MD adherence biomarkers, with particular focus on the metabolites derived from the phenolic compounds that are associated with the consumption of typical Mediterranean plant foods. Certain phenolic metabolites are good indicators of the intake of specific foods, but others denote the intake of a wide-range of foods. For this, it is important to emphasise the need to increase the number of dietary interventions with specific foods in order to validate the biomarkers of MD adherence. Moreover, the identification and quantification of food phenolic intake biomarkers encouraging scientific research focuses on the study of the biological mechanisms in which polyphenols are involved.     

The impact of price promotions on sales of unhealthy food and drink products in British retail stores

We study the health impact of food and beverage price promotion strategies—multi-buy offers and price discounts, typically biased toward unhealthy product categories—in British consumer retail. We are the first to employ econometric models from the marketing literature to analyze the impact of price promotions with a focus on population health. Our dynamic, reduced form demand model incorporates endogenous inventory (stock piling), consumption rates imputed from repeat purchases and allows for unobserved household heterogeneity. We find that removing price discounts is more effective for reducing purchase volume compared to removing multi-buy offers for 10 out of 12 food and drink groups, particularly those products for which price reduction is more common than multibuy. We find that price promotions induce consumption—and waste –through behavioral effects, associated with increased household inventory (stockpiling).     

Food Intake Patterns and Body Mass Index in Older Adults: A Review of the Epidemiological Evidence

The relationship between food intake patterns and obesity remains unclear. The objective of the present review was to evaluate the current body of literature on food intake patterns of older adults and their associations with weight status, including obesity and waist circumference. Eleven observational studies were identified and reviewed. Diets characterized by more favorable dietary scores or indices were generally inversely related to body mass index. Results from data-driven approaches were inconsistent. Findings from this literature review suggest that there is no clear relationship between food intake patterns and body mass index or waist circumference in older adults. Limitations, including heterogeneity of food intake patterns and study populations, hinder the ability to make clear comparisons. Continued efforts to elucidate the relationship between food intake patterns and weight status indicators in older adults, including longitudinal analyses and use of novel statistical approaches for food intake pattern identification, are warranted.     

Monitoring dietary change in populations and the need for specific food targets; lessons from the North West Thames Regional Health Survey

Dietary goals are usually expressed in the form of consumption of absolute quantities of specific nutrients. Translating such information into food patterns is difficult. Consequently it is not easy to convey these goals in the promotion of a healthy diet or to monitor dietary change in populations. This paper explores the difficulties and advantages of a food frequency questionnaire approach as used in a large regional health survey to describe food patterns and hence to monitor change in relation to dietary variables. There was considerable variation in the frequency of consumption of individual foods between different sub-groups in the population and these were as expected. To assess the overall diet a composite dietary index was proposed. The index score was significantly associated with various socio-demographic and lifestyle variables. Unhealthy lifestyles were associated with low scores (i.e. an 'unhealthy' diet) on the index indicating a measure of validity. However there were several limitations in the food frequency questionnaire method used: neither the questionnaire nor simple global indices of a 'healthy' diet derived from the questions used had been validated against a more robust quantifiable measure of diet; some of the questions were not specific for population groups of interest; some questions grouped foods in categories that masked differences in consumption and several did not correspond to recent food targets; and finally there was no energy adjustment, which meant that the obese appeared to have a healthy dietary pattern. The use of a valid set of food frequency questions as an efficient and practical way of monitoring a population's diet by survey is suggested. The questions must be validated against reliable measures of nutrients, and be compatible with food targets based on nutritional recommendations.     

Availability,affordability and quality of a healthy food basket in Adelaide,South Australia

Aim: To investigate the cost, affordability, availability and quality of a healthy food basket in high and low household income areas of Adelaide, and to investigate food promotion in supermarkets. Methods: A cross‐sectional survey was undertaken in May 2009 with a sample of 61 supermarkets, 27 greengrocers and 34 butchers in metropolitan Adelaide. Samples were selected based on household income for extreme tertiles across Adelaide. Results: Low‐income families were significantly worse off in comparison with high‐income families (P < 0.05) regarding affordability of the healthy food basket. The data analysis demonstrated that families on welfare payments and low incomes would need to spend 28–34% of their income in order to be able to afford a healthy food basket. However, there was no significant difference in the cost, availability, and quality of the healthy food basket and food promotions between high and low household income areas. Conclusion: The present study examined the cost, affordability, availability and quality of the healthy food basket, as well as an assessment of food promotions in supermarkets, finding no difference between high and low household income areas. The study provides valuable information to assist in a deeper understanding of food security in Adelaide. It is recommended that a longitudinal study would assist in establishing a reliable healthy food basket monitoring system that could lead to more robust policy outcomes.     

The sweet taste signalling pathways in the oral cavity and the gastrointestinal tract affect human appetite and food intake: a review

Sweet taste is associated with food reward and energy source in the form of carbohydrate. Excessive sweet consumption is blamed for the prevalence of obesity. However, evidence for the potential of sweet taste to influence food intake and bodyweight regulation in humans remains unclear. The purpose of this review was to examine the physiological responses relevant to sweet taste mechanisms and the impact on appetite control. The literature was examined for studies that assessed the effects of non-nutritive sweeteners and natural sugars on hormonal secretions and neural activations via oral and gastrointestinal pathways. The findings indicated that a network of sweet taste signalling pathways in the oral cavity and the gut seem to mediate hormonal responses and some metabolism differences in neural circus that orchestrating the hunger-satiety cycle. Individual variations of sweet taste perception which is modulated by hormonal and genetic factors have been associated with dietary nutrient and sugar consumption.     

Diet Quality Assessment and the Relationship between Diet Quality and Cardiovascular Disease Risk

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in the U.S. and globally. Dietary risk factors contribute to over half of all CVD deaths and CVD-related disability. The aim of this narrative review is to describe methods used to assess diet quality and the current state of evidence on the relationship between diet quality and risk of CVD. The findings of the review will be discussed in the context of current population intake patterns and dietary recommendations. Several methods are used to calculate diet quality: (1) a priori indices based on dietary recommendations; (2) a priori indices based on foods or dietary patterns associated with risk of chronic disease; (3) exploratory data-driven methods. Substantial evidence from prospective cohort studies shows that higher diet quality, regardless of the a priori index used, is associated with a 14–29% lower risk of CVD and 0.5–2.2 years greater CVD-free survival time. Limited evidence is available from randomized controlled trials, although evidence shows healthy dietary patterns improve risk factors for CVD and lower CVD risk. Current dietary guidance for general health and CVD prevention and management focuses on following a healthy dietary pattern throughout the lifespan. High diet quality is a unifying component of all dietary recommendations and should be the focus of national food policies and health promotion.     

Promoting Fruit and Vegetable Consumption for Childhood Obesity Prevention

Currently, food marketing for unhealthy foods is omnipresent. Foods high in fat, salt, and sugar (HFSS) are advertised intensively on several media platforms, including digital platforms that are increasingly used by children, such as social media, and can be bought almost everywhere. This could contribute to the obesity epidemic that we are facing. As the majority of children and adolescents do not eat the recommended amount of fruits and vegetables (F&V), which leads to chronic diseases, we need to change the obesogenic environment to a healthogenic environment. Reducing the marketing of energy-dense snacks to children and increasing the promotion of healthier foods, such as fruits and vegetables, may be an effective and necessary instrument to improve the dietary intake of children and reduce the risk of their experiencing some chronic diseases later in life. With this focused narrative review, we provide an overview of how children and adolescents react to food promotions and how food promotional efforts might be a useful tool to increase the attractiveness of fruit and vegetables. This review therefore contributes to the question of how changing the advertising and media environment of children and adolescents could help create a world where the healthy choice is the easier choice, which would reduce childhood obesity and improve children’s health, as well as to make the food system more sustainable.     

Would Students Prefer to Eat Healthier Foods at School?

BACKGROUND: This study sought to elucidate students' perceptions of school food environments and to assess correlations between perceptions and purchasing and consumption behaviors at school. METHODS: Seventh and ninth graders (n = 5365) at 19 schools in multiethnic, low‐income California communities participating in the Healthy Eating Active Communities program completed questionnaires assessing their attitudes and behaviors regarding school food environments during spring 2006. RESULTS: Most students (69%) reported that fresh fruit was important to be able to buy at school; more than chips (21%), candy (28%), or soda (31%). Reported importance of food offerings was correlated with the consumption of those items. Most students did not perceive foods/beverages offered at school to be healthy; fewer than a quarter reported eating fruits or vegetables (FV) at school. Students eating school lunch were more than twice as likely to consume FV, though if they also purchased from competitive venues, their consumption of candy, chips, and soda was similar to their peers who purchased only competitive foods. CONCLUSION: Students report healthy foods to be important to be able to buy at school, but do not perceive their school food environment to be healthy and consume more unhealthy foods at school. Students served healthy items via school lunch are more likely to consume them; however, they also purchase and consume unhealthy items if available. Findings suggest that modifying school food environments to facilitate consumption of healthy foods and limit unhealthy foods will better match students' preferences and could lead to improved dietary intake.     

Dietary guidelines in singapore

The 2011 Dietary Guidelines were developed with the aim of providing guidance on what dietary strategies can best address increasing rates of obesity and non-communicable chronic disease in Singapore. This set of dietary guidelines was developed with a local expert committee based on a review of scientific literature and data on current dietary patterns from the 2010 National Nutrition Survey. Projected nutrient intakes from a diet adhering to the 2011 Dietary Guidelines were calculated using a local food composition database (FOCOS) and validated against nutrient recommendations. Acknowledging that dietary requirements differ between age groups, different sets of dietary guidelines have been developed and customised for different segments of the population. To date, Singapore has produced dietary guidelines for children and adolescents (focusing on establishing healthy lifelong eating patterns), adults (focusing on preventing obesity and reinforcing healthy eating patterns), and most recently, guidelines for older adults (>50 years of age) that address the issue of potential dietary insufficiency caused by age-related increases in nutrient requirements combined with a reduction in energy requirements. In Singapore, dietary guidelines have been used to inform and direct public policy and promote dietary patterns that meet nutrient requirements while reducing the risk of non-communicable chronic diseases. Examples of public policy include: national guidelines on food advertising and standards for food served in nursing homes; examples of public health promotion programmes include: the Healthier Choice Symbol Programme for packaged food products and programmes encouraging provision of healthier meals in hawker centres, restaurants, and school or workplace canteens.     

The context for choice: health implications of targeted food and beverage marketing to African Americans

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n = 20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.     

Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income,Predominantly Latino Urban Residents: An Agent-Based Model

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)–(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.     

Caffeine,coffee, and appetite control: a review

Coffee and caffeine consumption has global popularity. However, evidence for the potential of these dietary constituents to influence energy intake, gut physiology, and appetite perceptions remains unclear. The purpose of this review was to examine the evidence regarding coffee and caffeine’s influence on energy intake and appetite control. The literature was examined for studies that assessed the effects of caffeine and coffee on energy intake, gastric emptying, appetite-related hormones, and perceptual measures of appetite. The literature review indicated that coffee administered 3–4.5?h before a meal had minimal influence on food and macronutrient intake, while caffeine ingested 0.5–4?h before a meal may suppress acute energy intake. Evidence regarding the influence of caffeine and coffee on gastric emptying, appetite hormones, and appetite perceptions was equivocal. The influence of covariates such as genetics of caffeine metabolism and bitter taste phenotype remain unknown; longer controlled studies are needed.     

Contribution of Fruit,Vegetables, Whole Cereals,and Legumes To Total Fibre Intake in Adult Croatian Dalmatian Population

There is compelling evidence that fruit, vegetables, whole cereals, and legumes make about 80 % of the total food fibre intake and have a potential to help in the prevention of a number of diseases. The aim of our study was to estimate total fibre intake from consumption of this fibre-rich food, partly reported in our earlier study in Croatian adult population. Current data analysis involved a non-probabilistic sample of 1,034 adult participants from Dalmatia, Croatia who responded to a validated food frequency questionnaire between October 2014 and March 2015. We also analysed the sales data obtained from three shopping centres in the Zadar area (Croatian coast) to establish a list of most frequently bought fruit, vegetables, whole cereals, and legumes and to calculate dietary fibre (DF) intake for each of the top-selling items and conversion factors for each food group. We then used these conversion factors to calculate individual total fibre intake (TFI) in our population. It was 11.4 g per person per day, which is less than half the recommended dietary requirements. On average, respondents reported to consume one piece of fruit and one meal of vegetables a day, which is less than half the daily recommendation for either. 25.8 % of respondents reported no consumption of whole cereals at all, and only 0.2 % of the population consumed the recommended 3–5 servings of whole grains or legumes a day. We also observed significantly higher consumption of fruit and whole grains/legumes in women than men. Our findings alert to poor dietary fibre intake in Croatian adult population, which is similar to other western countries and points to issues deeply rooted in these economies. However, our findings may be either an over- or under-estimation and need to be verified through longitudinal research on a wider sample using more precise tools.     

湖南省常住居民营养与健康状况现状分析

目的 了解湖南省10年来居民膳食摄入和营养状况的变化以及与之相关的慢性非传染性疾病的分布情况。方法 采取多阶段分层整群随机抽样法抽取了长沙市芙蓉区、茶陵县、澧县、石门县和保靖县的2700户为调查点。按照统一方案，分别对调查对象进行了问卷调查；包含血压、身高、体重和腰围等测定的体格检查和血红蛋白、血糖和血脂等实验室检测。结果 调查结果显示湖南省人均营养素的供给充足，与1992年结果比较，全省居民膳食结构变化显著，主要表现在谷物类摄入减少，动物类和脂肪类食物摄入增加，农村膳食结构趋向合理，而城市食物结构失衡。体检结果显示全省成人超重和肥胖患病率分别为15．46％和3．35％，高血压患病率为15．38％，贫血患病率为19．11％，血糖超标率为3．54％；血脂不正常的占13．5％。结论 2002年营养调查结果提示：随着社会经济快速发展，10年来人民生活水平有了进～步提高，生活方式也有了很大改变，但伴随这种变化对人们健康造成的隐患没有引起全社会的重视，继1992年后，膳食失衡加重，肥胖和高血压患病率升高。因此合理引导膳食消费，提倡健康生活方式，预防和控制慢性非传染性疾病是今后10年我们面临的严重挑战。