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Nutrition in Public Health: Principles, Policies, and Practice
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Nutrition in Public Health: Principles, Policies, and Practice

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (20 June 2021) | Viewed by 69414

Special Issue Editor

Dr. Helen Croker

E-Mail Website
Guest Editor
Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
Interests: obesity; diet; behaviour change; child health

Special Issue Information

This Special Issue will examine the role of nutrition in public health. Nutrition plays a critical role in public health efforts to prevent ill health and promote well-being, for example by reducing the risk of obesity, cardiovascular disease, and nutrient deficiencies. Public health approaches are broad: they can encompass initiatives on the national (including policy development), community, and individual levels and can be targeted across the life-course. These approaches aim to support healthier nutrition-related choices made by individuals, families, and populations. However, multiple and complex factors influence these behaviours, and it is vital that public health initiatives take into account the broad social determinants of health and that they strive to address health inequalities.

The aim of this Special Issue is to publish selected papers (primary research, methodological studies and reviews) addressing important nutritional issues. These could be studies examining drivers of nutrition-related behaviour, reports of interventions/initiatives aiming to improve nutritional behaviours, or studies aiming to develop or describe measures or models for understanding nutritional behaviours. Those examining the role of socio-demographic factors, particularly those specifically aiming to address health inequalities, are especially welcomed.

Dr. Helen Croker
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Nutrition-related behaviour
  • Life-course
  • Public health
  • Policy
  • Social determinants of health
  • Health inequalities

Published Papers (16 papers)

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17 pages, 309 KiB  
Article
Impact of Policies in Nutrition and Physical Activity on Diabetes and Its Risk Factors in the 28 Member States of the European Union
by Szabolcs Lovas, Nour Mahrouseh, Olaniyan Simisola Bolaji, Noel Johny Nellamkuzhi, Carlos Alexandre Soares Andrade, Diana Wangeshi Njuguna and Orsolya Varga
Nutrients 2021, 13(10), 3439; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103439 - 28 Sep 2021
Viewed by 2717
Abstract
Since healthy eating and physically active lifestyles can reduce diabetes mellitus (DM) risk, these are often addressed by population-based interventions aiming to prevent DM. Our study examined the impact of nutritional and physical activity policies, national diabetes plans and national diabetes registers contribute [...] Read more.
Since healthy eating and physically active lifestyles can reduce diabetes mellitus (DM) risk, these are often addressed by population-based interventions aiming to prevent DM. Our study examined the impact of nutritional and physical activity policies, national diabetes plans and national diabetes registers contribute to lower prevalence of DM in individuals in the member states of the European Union (EU), taking into account the demographic and socioeconomic status as well as lifestyle choices. Datasets on policy actions, plans and registers were retrieved from the World Cancer Research Fund International’s NOURISHING and MOVING policy databases and the European Coalition for Diabetes report. Individual-based data on DM, socioeconomic status and healthy behavior indicators were obtained via the European Health Interview Survey, 2014. Our results showed variation in types and numbers of implemented policies within the member states, additionally, the higher number of these actions were not associated with lower DM prevalence. Only weak correlation between the prevalence of DM and preventive policies was found. Thus, undoubtedly policies have an impact on reducing the prevalence of DM, its increasing burden could not be reversed which underlines the need for applying a network of preventive policies. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
16 pages, 815 KiB  
Article
Implementation of the Code of Marketing of Breast-Milk Substitutes in Vietnam: Marketing Practices by the Industry and Perceptions of Caregivers and Health Workers
by Tuan T. Nguyen, Ha T. T. Tran, Jennifer Cashin, Van D. C. Nguyen, Amy Weissman, Trang T. Nguyen, Bridget Kelly and Roger Mathisen
Nutrients 2021, 13(8), 2884; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082884 - 22 Aug 2021
Cited by 19 | Viewed by 9810
Abstract
Background: The promotion of breastmilk substitutes (BMS) is an important barrier to successful breastfeeding. Objective: To examine the enactment and implementation of the Code of Marketing of Breast-Milk Substitutes (the Code) in Vietnam with a focus on marketing practices by the baby food [...] Read more.
Background: The promotion of breastmilk substitutes (BMS) is an important barrier to successful breastfeeding. Objective: To examine the enactment and implementation of the Code of Marketing of Breast-Milk Substitutes (the Code) in Vietnam with a focus on marketing practices by the baby food industry and perceptions of caregivers, health workers, and policy makers. Methods: From May to July 2020, we conducted a mixed-method, cross-sectional study including a survey of 268 pregnant women and 726 mothers of infants aged 0–11 months and in-depth interviews with a subset of interviewed women (n = 39), policy makers, media executives, and health workers (n = 31). Results: In the previous 30 days, two mothers (out of 726) participating in the quantitative survey reported that health workers had recommended BMS, at private hospitals in both cases. In-depth interviews with health workers showed that hospitals have internal procedures to prevent the promotion of BMS by health workers. However, companies employed representatives to promote products not covered under the Code (e.g., commercial milk formula for pregnant women) at antenatal care visits and by gaining contact information from women and using this information to promote BMS outside the hospital, often on social media. In the 30 days preceding the survey, one-fifth of pregnant women were exposed to promotions of commercial milk formula for pregnant women and 7.1% to promotions of BMS. Among mothers of infants, 7.3% and 10.7% of respondents with infants aged 0–5 and 6–11 months, respectively, were exposed to some form of BMS promotion in the past 30 days. Around the time of birth, parents commonly brought BMS to maternity facilities (52.5%) or purchased it nearby (35.4%). Conclusions: Although Vietnam has a strong regulatory environment for the protection, promotion, and support of breastfeeding, there are implementation, monitoring, and enforcement gaps. Stronger enforcement of national policies to regulate the presence of BMS industry representatives in health facilities—both public and private—and the promotion of BMS products on digital platforms are needed. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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15 pages, 503 KiB  
Article
Prevalence and Determinants of Sex-Specific Dietary Supplement Use in a Greek Cohort
by Marina O. Rontogianni, Afroditi Kanellopoulou, Georgios Markozannes, Emmanouil Bouras, Christos Derdemezis, Michail T. Doumas, Dimitrios E. Sigounas, Vasilios T. Tzovaras, Konstantinos Vakalis, Demosthenes B. Panagiotakos, Eleni Aretouli, Ioanna Tzoulaki, Evangelos Evangelou, Evangelos C. Rizos, Evangelia Ntzani and Konstantinos K. Tsilidis
Nutrients 2021, 13(8), 2857; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082857 - 20 Aug 2021
Cited by 15 | Viewed by 2719
Abstract
We describe the profile of dietary supplement use and its correlates in the Epirus Health Study cohort, which consists of 1237 adults (60.5% women) residing in urban north-west Greece. The association between dietary supplement use and demographic characteristics, lifestyle behaviors, personal medical history [...] Read more.
We describe the profile of dietary supplement use and its correlates in the Epirus Health Study cohort, which consists of 1237 adults (60.5% women) residing in urban north-west Greece. The association between dietary supplement use and demographic characteristics, lifestyle behaviors, personal medical history and clinical measurements was assessed using logistic regression models, separately for women and men. The overall prevalence of dietary supplement use was 31.4%, and it was higher in women (37.3%) compared to men (22.4%; p-value = 4.2−08). Based on multivariable logistic regression models, dietary supplement use in women was associated with age (positively until middle-age and slightly negatively afterwards), the presence of a chronic health condition (OR = 1.71; 95% CI, 1.18–2.46), lost/removed teeth (OR = 0.52; 95% CI, 0.35–0.78) and diastolic blood pressure (OR per 5 mmHg increase =0.84; 95% CI, 0.73–0.96); body mass index and worse general health status were borderline inversely associated. In men, dietary supplement use was positively associated with being employed (OR = 2.53; 95% CI, 1.21–5.29). A considerable proportion of our sample used dietary supplements, and the associated factors differed between women and men. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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13 pages, 1134 KiB  
Article
Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study
by Dragana Davidović, Katarina Paunović, Danica Zarić, Ana Jovanović, Nadja Vasiljević, Dragana Stošović and Milena Tomanić
Nutrients 2021, 13(8), 2832; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082832 - 18 Aug 2021
Cited by 8 | Viewed by 2728
Abstract
Nutrition and health claims (NHCs) are a powerful tool that influence consumers’ final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among [...] Read more.
Nutrition and health claims (NHCs) are a powerful tool that influence consumers’ final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers’ food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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18 pages, 324 KiB  
Article
‘Shape-Up’, a Modified Cognitive-Behavioural Community Programme for Weight Management: Real-World Evaluation as an Approach for Delivering Public Health Goals
by Amber Soni, Rebecca J Beeken, Laura McGowan, Victoria Lawson, Paul Chadwick and Helen Croker
Nutrients 2021, 13(8), 2807; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082807 - 16 Aug 2021
Viewed by 2546
Abstract
Obesity is widespread, with serious health consequences; addressing it requires considerable effort at a public health level, incorporating prevention and management along with policies to support implementation. Behavioural weight-management programmes are widely used by public health bodies to address overweight and obesity. Shape-Up [...] Read more.
Obesity is widespread, with serious health consequences; addressing it requires considerable effort at a public health level, incorporating prevention and management along with policies to support implementation. Behavioural weight-management programmes are widely used by public health bodies to address overweight and obesity. Shape-Up is an evidence-based programme combining a structured behavioural intervention (targeting nutrition and physical activity behaviours) within a peer-learning framework. This study was a service-evaluation of Shape-Up, as delivered in Rotherham by a local leisure provider, and included a secondary analysis of data collected in the community by service providers. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to explore programme effectiveness, implementation, and whom it reached. A total of 141 participants were included. Compared to local demographics, participants were older, at 48.9 (SD 14.47) years, with a lower employment rate (41% employed) and greater proportion female (67% female). Mean BMI was 38.0 (SD 7.54) kg/m2. Mean weight-change between baseline and endpoint (12 weeks, 10 group sessions) was −4.4 (SD 3.38) kg, and degree of weight change was associated with session attendance (F (9, 131) = 6.356, p < 0.0005). There were positive effects on participants’ weight, health-related behaviours, and quality of life. The intervention content (including the focus of nutritional recommendations) and structure were adapted during implementation to better suit national guidelines and local population needs. RE-AIM was found to be a useful framework for evaluating and adapting an existing evidence-based weight management programme in line with local population needs. This could be a more cost-effective approach, compared to developing new programmes, for delivering public health goals relating to obesity, nutrition, and physical activity. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
15 pages, 279 KiB  
Article
“Just So You Know, It Has Been Hard”: Food Retailers’ Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings
by Kristy Karying Law, Claire Elizabeth Pulker, Janelle Diann Healy and Christina Mary Pollard
Nutrients 2021, 13(6), 2053; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13062053 - 15 Jun 2021
Cited by 7 | Viewed by 3593
Abstract
Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support [...] Read more.
Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers’ experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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24 pages, 438 KiB  
Article
The Acceptability of Food Policies
by Romain Espinosa and Anis Nassar
Nutrients 2021, 13(5), 1483; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13051483 - 28 Apr 2021
Cited by 5 | Viewed by 3731
Abstract
We propose and test a model of food policy acceptability. The model is structured in four levels: government, topic, policy, and individual. In this study, we focus on two levels that are actionable for policy-makers: the topic and policy levels. We assess nine [...] Read more.
We propose and test a model of food policy acceptability. The model is structured in four levels: government, topic, policy, and individual. In this study, we focus on two levels that are actionable for policy-makers: the topic and policy levels. We assess nine factors using a first online survey with 600 UK nationals and replicate our results in a second survey with 588 participants. Our results suggest that three factors have a positive effect on acceptability at the topic level: awareness of the issue, the legitimacy of state intervention, and social norms. At the policy level, we report a positive effect of the policy’s expected effectiveness, its appropriate targeting of consumers, and the perceived support of the majority. On the other hand, more coercive interventions and those generating inequalities are judged to be less acceptable. Additionally, we report an interaction between awareness and coerciveness on acceptability. Participants who are aware of the issue were more likely to support coercive policies. We also find evidence for a trade-off between coerciveness, effectiveness, and acceptability, as more coercive measures are considered more effective, but less acceptable by participants. Our findings offer policy-makers, nutrition experts, and advocates for healthier and more sustainable diets a new and integrated understanding of the underlying factors that determine food policy acceptability. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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13 pages, 576 KiB  
Article
Association between Health Practice and Food Stockpiling for Disaster
by Moeka Harada, Rie Kobayashi, Jun Oka and Nobuyo Tsuboyama-Kasaoka
Nutrients 2021, 13(5), 1414; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13051414 - 23 Apr 2021
Cited by 3 | Viewed by 2534
Abstract
In this study investigated the association between health practices and food stockpiling for disasters in predicted areas with a high risk of food shortage due to the Nankai Trough earthquake. A survey was conducted during 18–20 December 2019 using a self-administered web-based questionnaire. [...] Read more.
In this study investigated the association between health practices and food stockpiling for disasters in predicted areas with a high risk of food shortage due to the Nankai Trough earthquake. A survey was conducted during 18–20 December 2019 using a self-administered web-based questionnaire. In total, 1200 individuals registered with an online survey company participated in the study. The association between health practices and food stockpiling status was analyzed (n = 998). 59.1% of participants had a poor Breslow’s seven health practice scores (BHPS), 32.9% had a moderate score, and 8.0% had a good score. Multivariable logistic regression analysis revealed that higher BHPS had a significantly higher prevalence of food stockpiling. Additionally, the interrupted group had the highest percentage of participants with low BHPS. Lower BHPS was significantly associated with interrupted stockpiled in the adjusted models. Among the seven health practices, the odds ratio of the “eating breakfast” practice was high. There was a significant positive association between higher health practice scores and food stockpiling for disasters in areas with a high risk of food shortage due to the predicted earthquake. Particularly, it was clarified that individuals who had fewer good health practices were associated with ending up interrupting food stockpiling. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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15 pages, 6729 KiB  
Article
Assessing the Effectiveness of Front of Pack Labels: Findings from an Online Randomised-Controlled Experiment in a Representative British Sample
by Jessica Packer, Simon J. Russell, Deborah Ridout, Steven Hope, Anne Conolly, Curtis Jessop, Oliver J. Robinson, Sandro T. Stoffel, Russell M. Viner and Helen Croker
Nutrients 2021, 13(3), 900; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030900 - 10 Mar 2021
Cited by 31 | Viewed by 8275
Abstract
Front of pack food labels (FOPLs) provide accessible nutritional information to guide consumer choice. Using an online experiment with a large representative British sample, we aimed to examine whether FOPLs improve participants’ ability to identify the healthiness of foods and drinks. The primary [...] Read more.
Front of pack food labels (FOPLs) provide accessible nutritional information to guide consumer choice. Using an online experiment with a large representative British sample, we aimed to examine whether FOPLs improve participants’ ability to identify the healthiness of foods and drinks. The primary aim was to compare ability to rank between FOPL groups and a no label control. Adults (≥18 years), recruited from the NatCen panel, were randomised to one of five experimental groups (Multiple Traffic Light, MTL; Nutri-Score, N-S; Warning Label, WL; Positive Choice tick, PC; no label control). Stratification variables were year of recruitment to panel, sex, age, government office region, and household income. Packaging images were created for three versions, varying in healthiness, of six food and drink products (pizza, drinks, cakes, crisps, yoghurts, breakfast cereals). Participants were asked to rank the three product images in order of healthiness. Ranking was completed on a single occasion and comprised a baseline measure (with no FOPL), and a follow-up measure including the FOPL as per each participant’s experimental group. The primary outcome was the ability to accurately rank product healthiness (all products ranked correctly vs. any incorrect). In 2020, 4504 participants had complete data and were included in the analysis. The probability of correct ranking at follow-up, and improving between baseline and follow-up, was significantly greater across all products for the N-S, MTL and WL groups, compared to control. This was seen for only some of the products for the PC group. The largest effects were seen for N-S, followed by MTL. These analyses were adjusted for stratification variables, ethnicity, education, household composition, food shopping responsibility, and current FOPL use. Exploratory analyses showed a tendency for participants with higher compared to lower education to rank products more accurately. Conclusions: All FOPLs were effective at improving participants’ ability to correctly rank products according to healthiness in this large representative British sample, with the largest effects seen for N-S, followed by MTL. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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13 pages, 440 KiB  
Article
Does the Australian Health Star Rating System Encourage Added Sugar Reformulation? Trends in Sweetener Use in Australia
by Cherie Russell, Sarah Dickie, Phillip Baker and Mark Lawrence
Nutrients 2021, 13(3), 898; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030898 - 10 Mar 2021
Cited by 11 | Viewed by 4595
Abstract
Dietary risk factors, including excess added sugar intake, are leading contributors to Australia’s burden of disease. An objective of the Australian Health Star Rating (HSR) system is to encourage the reformulation of packaged foods. Manufacturers may improve a product’s HSR by replacing added [...] Read more.
Dietary risk factors, including excess added sugar intake, are leading contributors to Australia’s burden of disease. An objective of the Australian Health Star Rating (HSR) system is to encourage the reformulation of packaged foods. Manufacturers may improve a product’s HSR by replacing added sugar with non-nutritive sweeteners (NNS). Concerns have been raised regarding the potential substitution effects of ultra-processed foods containing NNS for whole foods, and the long-term impact this may have on population health. The aim of this study was to determine whether the implementation of the HSR system has impacted the use of added sugars and NNS in the food supply. Four product categories were used: products with no added sweetener, products containing added sugar only, products containing NNS only, and products containing a combination of added sugar and NNS. Of 6477 newly released products analyzed displaying a HSR in Australia between 2014–2020, 63% contained added sugars. The proportion of new products sweetened with added sugars increased over time, while NNS use did not, despite a higher average and median HSR for products sweetened with NNS. These findings suggest that at the current time, the HSR system may not discourage the use of added sugars in new products or incentivize the reformulation of added sugar with NNS. As the health risks of NNS are questioned, increased reformulation of products with NNS to reduce the presence of added sugar in the food supply may not address broader health concerns. Instead, supporting the promotion of whole foods and drinks should be prioritized, as well as policy actions that reduce the proliferation and availability of UPFs. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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12 pages, 1581 KiB  
Article
Food Patterns among Chinese Immigrants Living in the South of Spain
by Bárbara Badanta, Rocío de Diego-Cordero, Lorena Tarriño-Concejero, Juan Vega-Escaño, María González-Cano-Caballero, María Ángeles García-Carpintero-Muñoz, Giancarlo Lucchetti and Sergio Barrientos-Trigo
Nutrients 2021, 13(3), 766; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030766 - 26 Feb 2021
Cited by 9 | Viewed by 3210
Abstract
This article aims to explore the food patterns of Chinese immigrants living in Spain and to understand the factors associated with these behaviors. This qualitative ethnographic study included 133 Chinese immigrants; using interviews with scripts were based on the National Health Survey of [...] Read more.
This article aims to explore the food patterns of Chinese immigrants living in Spain and to understand the factors associated with these behaviors. This qualitative ethnographic study included 133 Chinese immigrants; using interviews with scripts were based on the National Health Survey of Spain. Three categories were defined: “Differences between Chinese food and Western food”; “Products and dishes consumed by Chinese immigrants” and “Modification of eating habits”. Participants found a remarkable difference between eastern (i.e., vegetables and rice) and western (i.e., dairy, high-fat, bread) foods. They also experienced a change in their eating habits, mostly related to acculturation and lack of time. Chinese immigrants have different eating patterns as compared to the native population in Spain and this information could help in future healthcare strategies. Knowing the food culture could infer aspects, such as insertion or integration, and promoting health and well-being. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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10 pages, 258 KiB  
Article
Associations between Food Policy Councils and Policies That Support Healthy Food Access: A National Survey of Community Policy Supports
by Samantha J. Lange, Larissa Calancie, Stephen J. Onufrak, Katherine T. Reddy, Anne Palmer and Amy Lowry Warnock
Nutrients 2021, 13(2), 683; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020683 - 20 Feb 2021
Cited by 5 | Viewed by 4104
Abstract
Food policy councils (FPCs) are one form of community coalition that aims to address challenges to local food systems and enhance availability, accessibility, and affordability of healthy foods for local residents. We used data from the 2014 National Survey of Community-Based Policy and [...] Read more.
Food policy councils (FPCs) are one form of community coalition that aims to address challenges to local food systems and enhance availability, accessibility, and affordability of healthy foods for local residents. We used data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living, a nationally representative survey of US municipalities (n = 2029), to examine the prevalence of FPCs and cross-sectional associations between FPCs and four types of supports for healthy food access (approaches to help food stores, practices to support farmers markets, transportation-related supports, and community planning documents). Overall, 7.7% of municipalities reported having a local or regional FPC. FPCs were more commonly reported among larger municipalities with ≥50,000 people (29.2%, 95% Confidence Interval (CI): 21.6, 36.8) and western region municipalities (13.2%, 95% CI: 9.6, 16.8). After multivariable adjustment, municipalities with FPCs had significantly higher odds of having all four types of supports, compared to those without FPCs (adjusted odds ratio (aOR) range: 2.4–3.4). Among municipalities with FPCs (n = 156), 41% reported having a local government employee or elected official as a member, and 46% had a designated health or public health representative. Although FPCs were uncommon, municipalities that reported having a local or regional FPC were more likely to report having supports for healthy food access for their residents. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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26 pages, 1395 KiB  
Article
Experience of Using an Online Pre-Ordering System for A Workplace Canteen That Offers Lower-Energy Swaps: A Think-Aloud Study
by Sarah Breathnach, Clare H. Llewellyn, Dimitrios A. Koutoukidis, Christopher R. van Rugge, Alex Sutherland and Phillippa Lally
Nutrients 2020, 12(12), 3878; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123878 - 18 Dec 2020
Cited by 5 | Viewed by 3936
Abstract
Online systems that allow employees to pre-order their lunch may help reduce energy intake. We investigated the acceptability of a pre-ordering website for a workplace canteen that prompts customers to swap to lower-energy swaps and the factors influencing swap acceptance. Employees (n [...] Read more.
Online systems that allow employees to pre-order their lunch may help reduce energy intake. We investigated the acceptability of a pre-ordering website for a workplace canteen that prompts customers to swap to lower-energy swaps and the factors influencing swap acceptance. Employees (n = 30) placed a hypothetical lunch order through a pre-ordering website designed for their canteen while thinking aloud. Semi-structured interview questions supported data collection. Data were analysed using thematic analysis. Acceptability was generally high, but potentially context dependent. Practical considerations, such as reminders to pre-order, user-friendliness, provision of images of menu items and energy information while browsing, an ability to reserve pre-ordered meals, and a swift collection service facilitated acceptability. The restrictive timeframe within which orders could be placed, a lack of opportunity to see foods before ordering, and prompts to swap being perceived as threatening autonomy were barriers to acceptability. Swap acceptance was facilitated by the provision of physical activity calorie equivalents (PACE) information, and swap similarity in terms of taste, texture, and expected satiety as well as the perception that alternatives provided meaningful energy savings. Online canteen pre-ordering systems that prompt lower-energy swaps may be an acceptable approach to help reduce energy intake in the workplace. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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11 pages, 255 KiB  
Article
Relationship between Marketing to Children on Food Labeling and Critical Nutrient Content in Processed and Ultra-Processed Products Sold in Supermarkets in Lima, Peru
by Daniella Torres-Schiaffino and Lorena Saavedra-Garcia
Nutrients 2020, 12(12), 3666; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123666 - 28 Nov 2020
Cited by 4 | Viewed by 2803
Abstract
Consumption of ultra-processed foods has increased alarmingly, representing a risk to children’s health. Different techniques in marketing to kids (M2K) used on food labels are influencing the purchasing decisions of these products. This study aims to provide useful information about M2K found in [...] Read more.
Consumption of ultra-processed foods has increased alarmingly, representing a risk to children’s health. Different techniques in marketing to kids (M2K) used on food labels are influencing the purchasing decisions of these products. This study aims to provide useful information about M2K found in labeling of food products sold in a supermarket chain in Lima, Peru and to determine its relationship with critical nutrient content. This was an observational, correlational, descriptive study. Data were collected by photographing the front-of-pack (FoP) of 2747 product labels sold in three supermarkets in Lima, but only those that met all the inclusion criteria were evaluated (n = 1092). A relationship was found between the use of techniques in marketing to kids and the level of critical nutrient regarding saturated fat (PR = 0.56; CI95%: 0.52–0.63), total sugar (PR = 1.70; CI95%: 1.64–1.77), and sodium (PR = 1.05; CI95%: 1.03–1.07). Particularly with sugar, the presence of M2K is a risk factor. New regulatory policies for the use of these food labeling techniques should be implemented to improve children’s health at the population level. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)

Review

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30 pages, 1176 KiB  
Review
Salt Reduction Initiatives in the Eastern Mediterranean Region and Evaluation of Progress towards the 2025 Global Target: A Systematic Review
by Ayoub Al-Jawaldeh, Mandy Taktouk, Aya Chatila, Sally Naalbandian, Al-Anoud Mohammed Al-Thani, Majid M. Alkhalaf, Salima Almamary, Rawhieh Barham, Nimah M. Baqadir, Faisal F. Binsunaid, Gihan Fouad and Lara Nasreddine
Nutrients 2021, 13(8), 2676; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082676 - 31 Jul 2021
Cited by 13 | Viewed by 4860
Abstract
This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and [...] Read more.
This study aims at identifying national salt reduction initiatives in countries of the Eastern Mediterranean Region and describing their progress towards the global salt reduction target. A systematic review of published and grey literature was conducted. Key characteristics of strategies were extracted and classified according to a pre-defined framework: salt intake assessments; leadership and strategic approach; implementation strategies; monitoring and evaluation of program impact. Salt intake levels were estimated in 15 out of the 22 countries (68%), while national salt reduction initiatives were identified in 13 (59%). The majority of countries were found to implement multifaceted reduction interventions, characterized by a combination of two or more implementation strategies. The least common implementation strategy was taxation, while the most common was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%). Monitoring activities were conducted by few countries (27%), while impact evaluations were lacking. Despite the ongoing salt reduction efforts in several countries of the region, more action is needed to initiate reduction programs in countries that are lagging behind, and to ensure rigorous implementation and evaluations of ongoing programs. Such efforts are vital for the achievement of the targeted 30% reduction in salt intake. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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18 pages, 884 KiB  
Review
Assessment of the Methods Used to Develop Vitamin D and Calcium Recommendations—A Systematic Review of Bone Health Guidelines
by Zhaoli Dai, Joanne E. McKenzie, Sally McDonald, Liora Baram, Matthew J. Page, Margaret Allman-Farinelli, David Raubenheimer and Lisa A. Bero
Nutrients 2021, 13(7), 2423; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13072423 - 15 Jul 2021
Cited by 12 | Viewed by 5340
Abstract
Background: There are numerous guidelines developed for bone health. Yet, it is unclear whether the differences in guideline development methods explain the variability in the recommendations for vitamin D and calcium intake. The objective of this systematic review was to collate and compare [...] Read more.
Background: There are numerous guidelines developed for bone health. Yet, it is unclear whether the differences in guideline development methods explain the variability in the recommendations for vitamin D and calcium intake. The objective of this systematic review was to collate and compare recommendations for vitamin D and calcium across bone health guidelines, assess the methods used to form the recommendations, and explore which methodological factors were associated with these guideline recommendations. Methods: We searched MEDLINE, EMBASE, CINAHL, and other databases indexing guidelines to identify records in English between 2009 and 2019. Guidelines or policy statements on bone health or osteoporosis prevention for generally healthy adults aged ≥40 years were eligible for inclusion. Two reviewers independently extracted recommendations on daily vitamin D and calcium intake, supplement use, serum 25 hydroxyvitamin D [25(OH)D] level, and sunlight exposure; assessed guideline development methods against 25 recommended criteria in the World Health Organization (WHO) handbook for guideline development; and, identified types identified types of evidence underpinning the recommendations. Results: we included 47 eligible guidelines from 733 records: 74% of the guidelines provided vitamin D (200~600–4000 IU/day) and 70% provided calcium (600–1200 mg/day) recommendations, 96% and 88% recommended vitamin D and calcium supplements, respectively, and 70% recommended a specific 25(OH)D concentration. On average, each guideline met 10 (95% CI: 9–12) of the total of 25 methodological criteria for guideline development recommended by the WHO Handbook. There was uncertainty in the association between the methodological criteria and the proportion of guidelines that provided recommendations on daily vitamin D or calcium. Various types of evidence, including previous bone guidelines, nutrient reference reports, systematic reviews, observational studies, and perspectives/editorials were used to underpin the recommendations. Conclusions: There is considerable variability in vitamin D and calcium recommendations and in guideline development methods in bone health guidelines. Effort is required to strengthen the methodological rigor of guideline development and utilize the best available evidence to underpin nutrition recommendations in evidence-based guidelines on bone health. Full article
(This article belongs to the Special Issue Nutrition in Public Health: Principles, Policies, and Practice)
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