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Bellikci-Koyu E, Karaağaç Y, Yürük AA. Factors associated with food label use: focus on healthy aspects of orthorexia and orthorexia nervosa. Eat Weight Disord 2024; 29:32. [PMID: 38703233 PMCID: PMC11069476 DOI: 10.1007/s40519-024-01661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/14/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE This study aimed to investigate the potential relationships between the use of different section of food label, and healthy and pathological aspects of orthorexia among adults. METHODS This cross-sectional study was conducted using an online survey (n = 1326). Inclusion criteria were being 19-64 years and graduated from at least primary school. Pregnant and lactating women were excluded. Data were collected using questionnaire including socio-demographic variables, lifestyle factors, body weight and height, frequency of reading different sections of food label ("always", "when buying a food for the first time", "when comparing similar packaged foods", "rarely", "never"), food label literacy, and Teruel Orthorexia Scale. Participants were categorized as nutrition facts panel-users, ingredients list-users or claim-users if they read at least one item from the relevant parts. RESULTS The proportions of nutrition facts, ingredients list, and claims sections users were 72.3%, 76.3%, and 79.9%, respectively. Both healthy and pathological aspects of orthorexia were associated with reading food labels. The healthy orthorexia had the strongest association with using the ingredients list (OR 1.76, 95% CI 1.41-2.20), whereas the orthorexia nervosa showed the highest association with using nutrition facts panel (OR 1.48, 95% CI 1.20-1.81). While women, physically active participants and those with higher food label literacy were more likely to use all sections of food labels; older age, having children, and chronic disease increased the likelihood of using claims and ingredients list (p < 0.05). Besides, following a diet was associated with higher use of nutrition facts and ingredients list (p < 0.05). CONCLUSIONS The study demonstrates that food label users have higher orthorexia tendencies compared to non-users. Of the food label sections, healthy orthorexia showed the strongest association with use of the list of ingredients, while pathological orthorexia showed the strongest association with use of the nutrition facts panel. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
- Ezgi Bellikci-Koyu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Kâtip Çelebi University, Izmir, Türkiye
| | - Yasemin Karaağaç
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Kâtip Çelebi University, Izmir, Türkiye
| | - Armağan Aytuğ Yürük
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye.
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López-Sánchez M, Moreno-Salazar Y, Cuenca J, Ortega J, Román-Aguirre R. Incidence of traffic light labelling on noncommunicable diseases: a roadmap for achieving sustainable development. Int J Food Sci Nutr 2024; 75:185-196. [PMID: 37982330 DOI: 10.1080/09637486.2023.2280503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
The production and diversity of the supply of food products has grown exponentially in recent decades, along with the increase in cardiovascular diseases associated with poor diet. Among the factors, one of the most important is the lack of information for the consumer when purchasing. The present work evaluates the impact of implementing the traffic light labelling of foods in reducing deaths due to Noncommunicable Diseases (NCD). Econometric techniques of two-way effects panel data from 21 Ecuadorian provinces taken from official sources for the analysis period 2010-2019. For Ecuador, a favourable impact was found in the reduction of the NCD mortality rate, especially in the last three years; in 2017, it was reduced by 0.129%, in 2018 by 0.305%, and in 2019 by 0.289%. An implication of economic policy is the advertising regulation of products that may affect health, strengthening surveillance and sanctioning companies that fail to comply with the regulation.
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Affiliation(s)
| | - Yenny Moreno-Salazar
- Carrera de Contabilidad y Auditoría, Universidad Nacional de Loja, Loja, Ecuador
| | - Josselyn Cuenca
- Carrera de Economía, Universidad Nacional de Loja, Loja, Ecuador
| | - Jackeline Ortega
- Carrera de Economía, Universidad Nacional de Loja, Loja, Ecuador
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Thrasher JF, Villalobos-Daniel VE, Fang D, Nieto C, White CM, Armendariz G, Jáuregui A, Hammond D, Davis RE. Assessing transnational spillover effects of Mexico's front-of-package nutritional labeling system among Mexican Americans in the US. Prev Med 2024; 179:107855. [PMID: 38215993 PMCID: PMC10929004 DOI: 10.1016/j.ypmed.2024.107855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE In 2020, Mexico implemented innovative front-of-package nutrition warning labels (FoPWLs) for packaged foods to increase the salience and understanding of nutrition information. This study evaluated Mexican Americans' self-reported exposure to Mexican FoPWLs and self-reported effects of FoPWLs on purchasing behavior. METHODS The 2021 International Food Policy Study surveyed online panels of adult Mexican Americans in the US (n = 3361) to self-report on buying food at Mexican-oriented stores, noticing Mexican FoPWLs, and being influenced by FoPWLs to purchase less of eight different unhealthy foods (each assessed separately). After recoding the frequency of buying foods in Mexican stores and noticing FoPWLs (i.e., "often" or "very often" vs. less often), logistic models regressed these outcomes on sociodemographics, adjusting for post-stratification weights. RESULTS Most participants (88.0%) purchased foods in Mexican stores. Of these, 64.1% reported noticing FoPWLs, among whom many reported that FoPWLs influenced them to buy fewer unhealthy foods (range = 32% [snacks like chips] - 44% [colas]). Participants were more likely to buy foods in Mexican stores and notice FoPWLs if they were younger, had ≥two children at home vs no children (AOR = 1.40, 95%CI = 1.15-1.71; AOR = 1.37, 95%CI = 1.03-1.80, respectively), and more frequently used Spanish (AOR = 1.91, 95%CI = 1.77-2.07; AOR = 1.87, 95%CI = 1.69-2.07). Also, high vs. low education (AOR = 1.51, 95%CI = 1.17-1.94) and higher income adequacy (AOR = 1.37, 95%CI = 1.25-1.51) were positively associated with noticing FoPWLs. Being female and more frequent Spanish use were consistently associated with reporting purchase of fewer unhealthy foods because of FoPWLs. CONCLUSIONS Many Mexican Americans report both exposure to Mexican FOPWLs and reducing purchases of unhealthy foods because of them.
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Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA; Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Victor Eduardo Villalobos-Daniel
- Non Communicable Diseases and Mental Health, Pan American Health Organization, Washington DC, USA.; Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Dai Fang
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, USA
| | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Gabriela Armendariz
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Canada
| | - Rachel E Davis
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA
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Sagaceta-Mejía J, Tolentino-Mayo L, Cruz-Casarrubias C, Nieto C, Barquera S. Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases. PLoS One 2022; 17:e0269892. [PMID: 35749373 PMCID: PMC9231753 DOI: 10.1371/journal.pone.0269892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.
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Affiliation(s)
- Janine Sagaceta-Mejía
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- * E-mail:
| | - Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
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Bui C, Lin LY, Wu CY, Chiu YW, Chiou HY. Association between Emotional Eating and Frequency of Unhealthy Food Consumption among Taiwanese Adolescents. Nutrients 2021; 13:2739. [PMID: 34444899 PMCID: PMC8401002 DOI: 10.3390/nu13082739] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022] Open
Abstract
Emotional eating is one factor that increases the consumption of unhealthy food. This study aimed to investigate the association between emotional eating and frequencies of consuming fast food, high-fat snacks, processed meat products, dessert foods, and sugar-sweetened beverages (SSBs) in adolescents. The baseline survey data (2015) from the Taiwan Adolescent to Adult Longitudinal Study (TAALS) were fitted into multivariate logistic regression models adjusted for sex, school type, Body Mass Index (BMI), eating while doing something, nutrition label reading, skipping breakfast, smoking, binge drinking, sedentary lifestyle, physical activity, peer and school support, and parental education level. Among the 18,461 participants (48.5% male and 51.5% female), those exhibiting emotional eating were more likely to consume fast food (Odds ratio (OR) = 2.40, 95% Confidence interval (CI): 2.18-2.64), high-fat snacks (OR = 2.30, 95% CI: 2.12-2.49), processed meat products (OR = 1.92, 95% CI: 1.78-2.08), dessert foods (OR = 2.49, 95% CI: 2.31-2.69), and sugar-sweetened beverages (OR = 1.83, 95% CI: 1.70-1.98). Factors that were positively associated with unhealthy food consumption included eating while doing other activities, binge drinking, smoking, and sedentary lifestyle. Among all the covariates, nutrition label reading was the only factor that was inversely associated with frequent unhealthy food consumption. Sex and school type may moderate the effect of emotional eating on the frequent consumption of specific unhealthy food groups. In conclusion, adolescents with high emotional eating were more likely to report frequent consumption of unhealthy foods in Taiwan. Our findings showed that male participants appeared to consume fast foods, high-fat snacks, processed meat, and SSBs more often and dessert foods less often than females. Future longitudinal studies are recommended for understanding the causal relationship between emotional eating and unhealthy food consumption.
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Affiliation(s)
- Chung Bui
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan;
- Department of Health Communication and Education, Quang Ninh Provincial Center for Disease Control (CDC) in Vietnam, 651 Le Thanh Tong St., Bach Dang Ward, Ha Long 01108, Vietnam
| | - Li-Yin Lin
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan;
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan
- Department of Leisure Industry and Health Promotion, National Taipei University of Nursing and Health Sciences, 365 Mingde Road, Beitou District, Taipei 11219, Taiwan
| | - Chih-Yi Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County 35053, Taiwan;
| | - Ya-Wen Chiu
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan;
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan Town, Miaoli County 35053, Taiwan;
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Lee KW, Shin D. Relationships of Dietary Factors with Obesity, Hypertension, and Diabetes by Regional Type among Single-Person Households in Korea. Nutrients 2021; 13:nu13041218. [PMID: 33917110 PMCID: PMC8067825 DOI: 10.3390/nu13041218] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022] Open
Abstract
This study aims to investigate whether dietary factors are differentially associated with metabolic abnormalities by regional type among single-person households in Korea. A total of 685,327 Korean adults aged ≥19 years who participated in the household and individual surveys of the Korea Community Health Survey 2015–2017 are included in the analysis. The regions are divided into three categories: metropolitan areas, mid-sized cities, and rural areas. Using multivariable logistic regressions, the adjusted odds ratios and 95% confidence intervals for metabolic abnormalities are estimated by regional type after adjusting for covariates. Among the total study population, 12.21% occupy single-person households, and 47.5%, 25.1%, and 27.4% of those single-person households are in rural areas, mid-sized cities, and metropolitan areas, respectively. Compared with single-person households in rural areas, those in mid-sized and metropolitan cities tend to be more familiar with and frequently refer to nutrition labels, skip breakfast, and experience food insecurity. Regional differences are found in the associations of dietary factors and behavior with obesity, hypertension, and diabetes. The use of nutritional fact labels is associated with obesity and hypertension in single-person households in rural areas, and the degree of association between food insecurity and diabetes is highest among single-person households in metropolitan areas. Our findings suggest that policies for improving unhealthy dietary factors by regional type are needed to reduce regional health disparities among single-person households in Korea.
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Affiliation(s)
- Kyung Won Lee
- Department of Home Economics Education, Korea National University of Education, Cheongju 28173, Korea;
| | - Dayeon Shin
- Department of Food and Nutrition, Inha University, Incheon 22212, Korea
- Correspondence: ; Tel.: +82-32-860-8123
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Abstract
Mexico recently voted to implement front-of-pack warning labels on food and beverage products deemed high in calories, sugar, saturated fat, trans fat, and sodium, and those containing non-caloric sweeteners. Research shows that warning labels allow consumers to quickly identify healthy and unhealthy products. Supporters claim these labels can help people make healthier decisions and combat growing rates of obesity and diet-related diseases. Warning labels will replace the Guideline Daily Amount (GDA) nutrition labels, which were implemented in 2014 against the guidance of public health leaders who argued the GDA was hard to understand and ineffective at conveying health risks. Conflicting interests between public health, government, and food industry slowed efforts to adopt a new nutrition label. Actions by academia and civil society to change the GDA were met with common strategies used to interfere in public health policies. However, in 2019, several factors came together to create favorable conditions for the approval of warning labels. The new leftist government's public promises to fight corruption fit well with labeling advocates' calls for transparency. Civil society and academia developed a highly coordinated response thanks to international funding, which propelled extensive marketing campaigns around the country and supported research efforts. These actions helped make the topic visible and place it strategically in the political and public agendas. Despite this legislative victory, the opposition has been strong and there are struggles ahead. Only time will reveal how effectively the law is implemented and to what extent it is upheld and defended.
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Affiliation(s)
- Mariel White
- National Institute of Public Health , Cuernavaca, Mexico
| | - Simon Barquera
- National Institute of Public Health , Cuernavaca, Mexico
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Bello-Chavolla OY, Bahena-López JP, Antonio-Villa NE, Vargas-Vázquez A, González-Díaz A, Márquez-Salinas A, Fermín-Martínez CA, Naveja JJ, Aguilar-Salinas CA. Predicting Mortality Due to SARS-CoV-2: A Mechanistic Score Relating Obesity and Diabetes to COVID-19 Outcomes in Mexico. J Clin Endocrinol Metab 2020; 105:5849337. [PMID: 32474598 PMCID: PMC7313944 DOI: 10.1210/clinem/dgaa346] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The SARS-CoV-2 outbreak poses a challenge to health care systems due to its high complication rates in patients with cardiometabolic diseases. Here, we identify risk factors and propose a clinical score to predict COVID-19 lethality, including specific factors for diabetes and obesity, and its role in improving risk prediction. METHODS We obtained data of confirmed and negative COVID-19 cases and their demographic and health characteristics from the General Directorate of Epidemiology of the Mexican Ministry of Health. We investigated specific risk factors associated to COVID-19 positivity and mortality and explored the impact of diabetes and obesity on modifying COVID-19-related lethality. Finally, we built a clinical score to predict COVID-19 lethality. RESULTS Among the 177 133 subjects at the time of writing this report (May 18, 2020), we observed 51 633 subjects with SARS-CoV-2 and 5,332 deaths. Risk factors for lethality in COVID-19 include early-onset diabetes, obesity, chronic obstructive pulmonary disease, advanced age, hypertension, immunosuppression, and chronic kidney disease (CKD); we observed that obesity mediates 49.5% of the effect of diabetes on COVID-19 lethality. Early-onset diabetes conferred an increased risk of hospitalization and obesity conferred an increased risk for intensive care unit admission and intubation. Our predictive score for COVID-19 lethality included age ≥ 65 years, diabetes, early-onset diabetes, obesity, age < 40 years, CKD, hypertension, and immunosuppression and significantly discriminates lethal from non-lethal COVID-19 cases (C-statistic = 0.823). CONCLUSIONS Here, we propose a mechanistic approach to evaluate the risk for complications and lethality attributable to COVID-19, considering the effect of obesity and diabetes in Mexico. Our score offers a clinical tool for quick determination of high-risk susceptibility patients in a first-contact scenario.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- Division of Research, Instituto Nacional de Geriatría
- Corresponding author: Omar Yaxmehen Bello-Chavolla. Division of Research. Instituto Nacional Geriatría. Anillo Perif. 2767, San Jerónimo Lídice, La Magdalena Contreras, 10200, Mexico City, Mexico. Phone: +52 (55) 5548486885. E-mail:
| | | | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | | | - Alejandro Márquez-Salinas
- Division of Research, Instituto Nacional de Geriatría
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | - Carlos A Fermín-Martínez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico
| | - J Jesús Naveja
- Instituto de Química, Universidad Nacional Autónoma de México
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- Department of Endocrinolgy and Metabolism. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud
- Corresponding author: Carlos A. Aguilar-Salinas. Unidad de Investigación de Enfermedades Metabólicas. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14080; Tlalpan, Distrito Federal, México. Phone: +52(55)54870900, 5703. E-mail:
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