Comparing the Effects of Four Front-of-Package Nutrition Labels on Consumer Purchases of Five Common Beverages and Snack Foods: Results from a Randomized Trial

BackgroundFront-of-package (FOP) nutrition labeling systems differ in how they rate food and beverage products. There is a need to examine the implications of these differences, including their focus on nutrients of public health concern.ObjectiveOur aim was to examine the impacts of 4 common FOP labels on consumers’ purchases of products that received conflicting ratings across FOP systems.DesignIn an experimental marketplace, participants were randomized to complete a series of purchases under 1 of 5 FOP conditions: no label, “high in” nutrient labels, multiple traffic light, Health Star Rating, or a 5-color nutrition grade.Participants/settingA final sample of 3,584 Canadians (13 years and older) were recruited from shopping centers in March to May 2018.Main outcome measuresProbability of purchasing was assessed for 5 product categories (100% fruit juice, plain milk, chocolate milk, cheese snacks, and diet beverages), which received conflicting ratings across the FOP conditions.Statistical analysesSeparate generalized linear mixed models estimated the influence of FOP condition on 5 binary outcomes (1 = purchased, 0 = not purchased) corresponding to the product categories.ResultsFew differences were observed among the full sample. Among participants who noticed the labels (n = 1,993), those in the Health Star Rating condition were 4.5 percentage points (95% CI –7.0 to –1.9) more likely to purchase 100% fruit juice (compared to multiple traffic light) and 3.3 (95% CI 0.4 to 6.2) and 3.0 percentage points (95% CI 0.1 to 6.1) more likely to purchase cheese snacks (compared to no label and “high in”). “High in” labels produced fewer purchases of chocolate milk than no label.ConclusionsDespite some similarities, existing FOP systems differ in the extent to which they promote or dissuade purchases of common product categories. Although the Health Star Rating might encourage purchases of products with certain positive nutritional attributes, “high in” and multiple traffic light systems might more effectively discourage purchases of products contributing nutrients of public health concern.     

Self-Reported Dietary Supplement Use Is Reproducible and Relatively Valid in the Cancer Prevention Study-3 Diet Assessment Substudy

BackgroundDietary supplement use is common, particularly among cancer survivors and those at increased risk for cancer.ObjectiveThe objectives of this study were to assess 1-year test–retest reproducibility of dietary supplement use reported via food frequency questionnaire (FFQ-1 vs FFQ-2) and relative validity in comparison to repeated 24-hour dietary recalls (FFQ-2 vs DRs).DesignThis ancillary study was conducted within a large prospective cohort, the American Cancer Society’s Cancer Prevention Study-3.Participants/settingBetween 2015 and 2016, 684 participants in the United States (64% women; 62% non-Hispanic White, 23% non-Hispanic Black, and 15% Hispanic) completed two FFQs and up to six unannounced telephone interviewer-administered DRs over 1 year as part of the Cancer Prevention Study-3 Diet Assessment Substudy.Primary outcome measuresFFQs queried current multivitamin-mineral supplement (≥10 components) use, frequency and dose (range) for seven supplements taken individually or as part of a complex (individual/complex) including calcium, vitamins D, C, and E, folic acid, fish oil, and glucosamine. DRs allowed exact reporting of supplement frequency and dose.Statistical analysesWeighted κ statistics were used to evaluate reproducibility between FFQ-1 and FFQ-2 and Spearman correlation coefficients assessed agreement between supplemental nutrient amounts assessed by FFQ-2 and the average of DRs.ResultsJust more than half of the participants reported taking multivitamin-mineral supplements on the baseline FFQ. Kappa statistics for the comparison of categorical responses between FFQ-1 and FFQ-2 were 0.67 for multivitamin-mineral supplements. Kappas for individual/complex supplements ranged from 0.47 for folic acid to 0.74 for vitamin D, with a mean of 0.64. Results were similar between men and women. Spearman correlation coefficients comparing FFQ-2 with the average of DRs (validity) for nutrient intakes from all sources ranged from 0.65 (fish oil for women) to 0.77 (vitamin D for men and calcium for women); results were similar among men and women.ConclusionsThese findings suggest the FFQ used in Cancer Prevention Study-3 has good reproducibility over 1 year and yields estimates comparable to a more detailed assessment for commonly consumed dietary supplements.     

Relative Validity of a Semi-Quantitative Food Frequency Questionnaire to Estimate Dietary Intake According to the NOVA Classification in Mexican Children and Adolescents

BackgroundUltra-processed foods (UPFs) are associated with poor diet quality and chronic diseases. UPFs fall into 1 of the following 4 groups classified according to the extent and purpose of processing: group 1 is unprocessed or minimally processed foods (MPFs); group 2 is processed culinary ingredients; group 3 is processed foods; and group 4 is UPFs.ObjectiveThe aim of this study was to evaluate the relative validity of a semi-quantitative food frequency questionnaire (SFFQ) compared with two 24-hour dietary recalls (24DRs) `to estimate dietary intake per NOVA food group in Mexican children and adolescents.DesignThis study is a secondary analysis of dietary data from a subsample of children and adolescents who participated in the 2012 Mexican National Health and Nutrition Survey.Participants/settingThe study participants were 217 children (aged 5 through 11 years) and 165 adolescents (aged 12 through 19 years) with complete information for the SFFQ and two 24DRs.Main outcome measuresDaily averages of energy intake and percent of energy intake for each NOVA category were calculated using the SFFQ and two 24DRs.Statistical analysisTo assess relative validity, the SFFQ was compared with two 24DRs to estimate dietary intake per NOVA food group. Mean differences, Spearman correlations, intraclass correlations coefficients (ICCs), and Bland–Altman plots for continuous variables and weighted κ for ordinal variables were calculated.ResultsFor percentage of energy intake, ICCs in children and adolescents were moderate for MPFs (ICC = 0.47 and ICC = 0.56, respectively) and UPFs (ICC = 0.53 and ICC = 0.57, respectively). Bland–Altman plots indicated reasonably consistent agreement for UPFs and MPFs groups in children and adolescents. Classification by quintiles was acceptable in all groups.ConclusionsData from this study indicated reasonable relative validity of the SFFQ to rank the percentage of energy intake from MPFs and UPFs in Mexican children and adolescents.     

Specific Dietary Protein Sources Are Associated with Cardiometabolic Risk Factors in the Boston Puerto Rican Health Study

BackgroundPuerto Rican adults residing in the US mainland experience a high prevalence of metabolic syndrome (MetS). A diet containing healthy protein-rich sources may help control risk factors for MetS.ObjectiveThis study aimed to evaluate 2-year longitudinal associations between intake of various protein-rich foods and changes in the six MetS components.DesignThis is a secondary analysis of a longitudinal cohort study using data from the baseline (2004–2007) and 2-year follow-up visits (2006–2011) in the Boston Puerto Rican Health Study.Participants/settingParticipants were self-identified Puerto Ricans, aged 45 to 75 years, residing in Boston, Massachusetts, or the surrounding area (n = 1,126).Main outcome measuresMetS components were fasting glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, systolic and diastolic blood pressures, and waist circumference.Statistical analysisBaseline intake of foods reported in a semiquantitative food frequency questionnaire were expressed as servings/day, and protein-rich foods were categorized as unprocessed white meat, unprocessed red meat, processed meat, milk and yogurt, cheese, fish and seafood, beans, nuts, and eggs. Associations between each continuous protein food group and continuous 2-year change in MetS components were assessed using linear mixed models adjusted for socioeconomic and behavioral factors, and other dietary sources.ResultsThe top contributors to total protein intake were unprocessed red meat (13.3%) and unprocessed poultry (13.0%), and the lowest were eggs (2.92%) and nuts (0.91%). Higher intake of processed meats was associated with an increase in waist circumference over 2 years (β = 1.28; standard error [SE] = 0.63), whereas higher intake of fish and seafood was associated with a decrease in waist circumference (β = ?3.47; SE = 1.39). Intake of unprocessed poultry was associated with a decrease in triglycerides (β = ?24.5; SE = 9.13). No other significant associations were observed between protein sources and 2-year changes in MetS components.ConclusionsConsuming less processed meat and more fish and seafood and unprocessed poultry was associated with decreases in waist circumference and triglycerides among US mainland Puerto Ricans. Other dietary protein sources were not related to cardiometabolic health.     

北海市区食品和公共场所从业人员HBsAg携带现状分析

本文对1999年度广西北海市区食品生产经营及公共场所从业人员HBsAg的携带情况进行了统计分册。结果表明:①北海市区食品生产经营行业及公共场所从业人员HBsAg的总携带率为4.09％;②食品生产经营行业从业人员HBsAg携带率为4.03％,公共场所从业人员的为4.3％。两者 无显著性差异(x2=0.22,P>0.05);③男性从业人员的HBsAg携带率为5.33％,女性的为3.28％,两者具有显著性差异(x2=27.41,P<0.01);④HBsAg携带率明显呈现出随着年龄性别的提高而降低的趋势。     

Removing risk stratification in food allergy prevention guidelines

There is now level one evidence based on randomized controlled trials that early ingestion of allergenic solids in infancy has a preventive effect against food allergy development. As a result, guidelines now recommend early ingestion of allergenic solids as a means of food allergy prevention. However, guidelines in Canada currently focus this intervention specifically on infants at risk, defined currently as an infant who has a history of atopy such as eczema or food allergy, or who has an immediate family history of atopy. However, this definition fails to account for studies supporting early ingestion as a preventive measure within the broader population. Not all of these risk factors (such as immediate family history of atopy) are consistently supported by the literature to date. Finally, a more universal approach to food allergy prevention simplifies the message, decreases stigmatization, and reduces medicalization of infant feeding. It also has the potential to reduce reticence to feed in infancy. The goal of this commentary is to argue that food allergy prevention guidelines should focus their interventions on the broader population and not just those defined as at higher risk.     

Black–white racial disparities in household food insecurity from 2005 to 2014, Canada

ObjectivesTo understand the differential vulnerability to household food insecurity of the Black population as compared with white counterparts in Canada.MethodsUsing data for households with Black and white respondents in pooled Canadian Community Health Survey cycles from 2005 to 2014, the 18-question Household Food Security Survey Module was analyzed (N = 491,400). Bivariate and multivariate logistic and multinomial regression models were run using respondent’s race, immigration status, and six well-established predictors of household food insecurity in the general population. Additional multivariable logistic regression models were run, with race interacted with each predictor individually to yield predicted probabilities.ResultsThe weighted prevalence of household food insecurity was 10.0% for white respondents and 28.4% for Black respondents. The odds of Black households being food-insecure as compared with white households fell from 3.56 (95% CI: 3.30–3.85) to 1.88 (95% CI: 1.70–2.08) with adjustment for household socio-demographic characteristics. In contrast with white households, there was relative homogeneity of risk of food insecurity among Black subgroups defined by immigration status, household composition, education, and province of residence. Homeownership was associated with lower probabilities of food insecurity for Black and white households, but the probability among Black owners was similar to that for white renters (14.7% vs. 14.3%). Black households had significantly higher predicted probabilities of food insecurity than their white counterparts across all main sources of household income except child benefits and social assistance.ConclusionBeing racialized as Black appears to be an overriding factor shaping vulnerability to food insecurity for the Black population in Canada. Future research and public policy on food insecurity should seriously consider the role of racism at the systemic and institutional levels.     

Food insecurity among Canadian youth and young adults: insights from the Canada Food Study

ObjectiveThis study explored associations between socio-demographic characteristics, self-reported health, and household food security among young adults.MethodsNational cohort study participants from Toronto, Montreal, Vancouver, Edmonton, and Halifax, Canada, aged 16–30 years (n = 2149) completed online surveys. Multinomial logistic regression, weighted to reflect age and sex proportions from the 2016 census, was conducted to examine associations between food security status and covariates.ResultsAlmost 30% of respondents lived in food-insecure households, with 19% in “moderately” food-insecure and 10% in “severely” food-insecure households. Respondents identifying as Black or Indigenous were more likely to live in moderately (AOR = 1.96, CI: 1.10, 3.50; AOR = 3.15, CI: 1.60, 6.20) and severely (AOR = 4.25, CI: 2.07, 8.74; AOR = 6.34, CI: 2.81, 14.30) food-insecure households compared with those identifying as mixed/other ethnicity. Respondents who found it “very difficult” to make ends meet were more likely to be moderately (AOR = 20.37, CI: 11.07, 37.46) and severely (AOR = 101.33, CI: 41.11, 249.77) food insecure. Respondents classified as “normal” weight (AOR = 0.64, CI: 0.43, 0.96) or overweight (AOR = 0.53, CI: 0.34, 0.83) were less likely to be moderately food insecure compared with those affected by obesity. Compared with “very good or excellent,” “poor” health, diet quality, and mental health were each positively associated with severe food insecurity (AOR = 7.09, CI: 2.44, 20.61; AOR = 2.63, CI: 1.08, 6.41; AOR = 2.09, CI: 1.03, 4.23, respectively).ConclusionThe high prevalence of correlates of food insecurity among young adults suggests the need for policies that consider the unique challenges (e.g., precarious income) and vulnerability associated with this life stage.     

Una combinación de alto riesgo: obesidad,marcas de alimentación,menores y retos en YouTube

ObjectiveTo identify high-risk content in food advertising that combines obesogenic features with a highly emotionally engaging format.MethodComparison of 304 videos (47 hours and 41 minutes) from 13 food brand channels (traditional advertising) and from 15 child YouTuber channels (endorsement and influence) posted in 2019. Exploratory content analysis of variables describing the communication style of the “challenges” format.ResultsChallenges are the most common type of content (53.3%; n = 162), with a greater prevalence on child YouTuber channels (59%; n = 131) than on brand channels (41%; n = 31).ConclusionsContent created by consumers is not covered by current audiovisual communication legislation. Increased control of these practices is urgently needed, in terms of legislation, self-regulation and codes of ethics. Creativity, enjoyment or mere entertainment is not a sufficient argument for the persuasive promotion of behaviors that endanger the physical health of children.