A review of consumer awareness, understanding and use of food-based dietary guidelines

Sustainability in food-based dietary guidelines: a review of recommendations around meat and dairy consumption and their visual representation

BACKGROUND

The transition away from high meat and dairy consumption and towards more plant-based diets is vital for environmental sustainability targets, including reducing greenhouse gas (GHG) emissions and land use associated with food. Food-based dietary guidelines (FBDG) communicate nutrition information to a country's general public. However, it is unknown how different countries' FBDG communicate reducing meat and dairy intake in the context of sustainability.

METHODS

To address this gap, we reviewed global consumer-facing FBDG (n = 58) in middle- and high-income countries to examine recommendations and information around meat and dairy consumption, and to explore the pictorial representation of these foods.

RESULTS

Few countries used a sustainability argument to recommend reducing meat (6/58) or dairy consumption (2/58). The proportion of dairy images within food guides was consistently higher than meat images. Some countries' guidelines are starting to consider meat intake in the context of sustainability and implementing meat reduction recommendations. However, this is not the case for dairy, potentially due to complex nutritional implications.

CONCLUSION

Overall, our review shows that very few countries recommend reducing either meat or dairy consumption. To reduce the environmental impact of food systems, clearer guidelines backed by current evidence are needed, which provide justification behind recommendations, actionable advice for how to meet the recommendations, and appropriate quantified food targets or limits. This well-rounded advice is imperative to empower citizens to take action on their dietary habits, to reduce global meat and dairy consumption and replace these with more sustainable alternatives for human and planetary health.

Using the theory of planned behaviour to understand the adoption of vegetarianism among females in Saudi Arabia

Background

The adoption of vegetarian diets is increasing worldwide, including among females in Saudi Arabia. This increase has not yet been explained. The present study explores the factors influencing the intention to follow a vegetarian diet among Saudi women using the theory of planned behavior (TPB) framework.

Materials and methods

An online self-administered questionnaire was distributed between July 2023 and January 2024. A total of 998 Saudi females participated, including both vegetarians (n = 417, 41.8%) and non-vegetarians (n = 581, 58.2%), who answered questions relating to their sociodemographic characteristics, awareness and perceived understanding of vegetarian diets, awareness of and adherence to dietary guidelines, dietary habits, and TPB predictors. Multivariable linear regression was used with dietary guideline awareness, body mass index, self-rated perceived weight, socioeconomic status index, and the TPB constructs as predictors to explain the intention to follow a vegetarian diet (outcome).

Results

Attitude (standardized β-coefficient = 0.29, p < 0.001), subjective norms (standardized β-coefficient = 0.10, p < 0.001), and perceived behavioral control (standardized β-coefficient = 0.08, p = 0.03) were significantly and positively associated with the intention to follow a vegetarian diet. However, dietary guideline awareness did not significantly influence the intention (standardized β-coefficient = -0.04, p = 0.1). Socioeconomic status index was negatively correlated with the intention to adopt a vegetarian diet (standardized β-coefficient = -0.073, p = 0.018). Body mass index showed no significant correlation with vegetarian diet intention (standardized β-coefficient = -0.05, p = 0.091).

Conclusion

TPB constructs (attitude, subjective norms, and perceived behavioral control) and socioeconomic status influence the intention to adopt a vegetarian diet, although awareness of dietary guidelines and body mass index do not.

A review of policy levers to reduce meat production and consumption

It is increasingly apparent that we require a substantial reduction in animal production and consumption for the sake of the environment and public health. In this paper, we conducted a systematic review to explore the policy levers available for governments to reduce animal farming and the consumption of meat. The policy levers generated by the review are categorised by four main types of interventions: Financial measures, Command- and-control, Informational, and Behavioural. First, we explore four financial measures: taxes on meat is the most-studied intervention, and the least publicly accepted in polling, sometimes being implemented indirectly via measures such as carbon taxes or rescinding VAT exemptions; subsidies for animal product alternatives are considered as a more publicly acceptable alternative approach, and would reduce long-term demand for meat by making alternatives more competitive; agricultural carbon trading schemes are discussed, and may represent a politically feasible way to hold livestock producers accountable for negative externalities; and buyouts of animal farms can be an impactful way to compensate producers to leave the industry, but must be done with care to avoid unintended social and market consequences. Second, we explore two command-and-control measures: regulating animal production with standards such as animal welfare requirements and health and safety rights for agricultural workers is amongst the most well-supported policies, and is an impactful way to ensure minimum standards of production are met; however, restrictions on animal consumption, such as meat-free days in public catering, are less publicly accepted. Third, we discuss three informational measures: food product labels, such as animal welfare or environmental impact labels, fulfil consumers' expectations to have this information, and although there is limited evidence that they impact consumer behaviour directly, such labels may nonetheless incentivise producers to competitively improve; likewise, national dietary guidelines appear to have little direct impact on food choices, but can impact other institutions such as schools and medical institutions; policies on information campaigns can help or hurt meat reduction efforts, with some jurisdictions prohibiting meat advertisements, while others spend millions on campaigns to promote meat consumption. Fourth, we explore a range of behavioural measures which could be implemented in public catering settings and/or incentivised in food service, including presentation and positioning of meat- and plant-based dishes, and altering the food options on offer - we find that adding more high-quality plant-based options to menus and presenting these options as the default wherever the format allows are highly impactful and tractable behavioural policies that could reduce meat consumption. Informational and behavioural measures can complement traditional fiscal and command-and-control measures to reduce animal production and consumption. We discuss the implications for researchers and policymakers.

Knowledge, attitudes and behavior of Gulf medical students in relation to Food Dome dietary guidelines: a mixed-method research

This mixed-methods research is the first to explore knowledge, attitudes and behaviours in relation to the Food Dome dietary guidelines (FDDG) among Gulf medical students. Quantitative phase included the administration of Food Dome questionnaire among n = 414 students; qualitative phase used focus group discussions. The quantitative findings show that more than half the sample reported that they had heard of the FDDG (55.3%), of which 15.7% followed and 39.6% did not follow the FDDG. An average female knew more about and behaved more in line with the guidelines, Bahrainis and Saudis were more aware than Kuwaitis on average, and those aged 21 or more showed, on average, more behaviour consistency with the FDDG. The qualitative findings show that the food choices of the Gulf medical students largely depend on time, university load, availability, and taste. Suggested recommendations include educational campaigns, FDDG application examples, teaching children from an early age.

Knowledge, attitudes, and practices of oil and salt intake and related influencing factors in Southwestern China

Objects

Excessive oil and salt consumption is a public health issue, notably in China where intakes surpass WHO guidelines. The present study aims to examine the knowledge, attitudes, and practices of Southwestern China residents regarding oil and salt and explore the influencing factors.

Methods

This study used convenience sampling to collect data from 7,367 participants aged 18-75 in the Sichuan, Chongqing, Yunnan, and Guizhou regions of China via on-site face-to-face surveys. Descriptive statistics and generalized linear models were used to analyses knowledge, attitudes, and practices about oil and salt intake and their influencing factors among residents of Southwestern China.

Results

In Southwestern China, residents of Guizhou Province exhibited poor KAP regarding oil and salt. There were urban-rural differences in Yunnan, Sichuan, and Chongqing, and residents living in towns and cities were the favored factors for KAP scores. Groups engaged in self-employment/sales and freelance were risk factors for KAP score. Individuals with higher education was a favorable factor for KAP score. In Yunnan, Sichuan, and Chongqing groups with preference of salty tastes were favorable factors in KAP score. Diabetic patients were more likely to score low on oil and salt-related KAP performance.

Conclusion

In Southwestern China, residents of Guizhou Province displayed poor results in their KAP regarding oil and salt. The region of the province, ethnicity, urban and rural residence, education, taste preference, and prevalence of chronic diseases were the influencing factors of oil and salt-related KAP scores.

Impact of self-rationing on academic performance of college students

OBJECTIVE

Self-rationing or one's ability to regulate allocation of resources for consumption can be an inefficient process. Despite the negative impact of self-rationing inefficiencies (eg unhealthy food choices), there is scarce research to understand this phenomenon. This study investigated college students' self-rationing efficiency of eating behavior and spending choices, and their relationship to academic performance.

PARTICIPANTS AND METHODS

This study used a combination of a real-time experiment, self-reported surveys (n = 101), and interviews with college students (n = 12). Data was collected using two 24-hour recall periods, online surveys, and semi-structured interviews.

RESULTS

College students demonstrated self-rationing inefficiency of eating behavior, but not of expenditure on food. Furthermore, there was a significant relationship between self-rationing inefficiencies in eating behavior and students' academic performance.

CONCLUSIONS

This study directly investigated self-rationing efficiency amongst college students' food choices and food expenditure, and enhances our understanding of its impact on college students' academic performance.

FooDOxS: a database of oxidized sterols content in foods

Dietary oxidized sterols (DOxS) are cholesterol-like molecules known to exert pro-inflammatory, pro-oxidant, and pro-apoptotic effects, among others. We present the FooDOxS database, a comprehensive compilation of DOxS content in over 1680 food items from 120 publications across 25 countries, augmented by data generated by our group. This database reports DOxS content in foods classified under the NOVA and What We Eat in America (WWEIA) systems, allowing a comprehensive and statistically robust summary of DOxS content in foods. Notably, we evaluated the efficacy of using NOVA and WWEIA classifications in capturing DOxS variations across food categories. Our findings provide insights into the strengths and limitations of these classification systems, enhancing their utility for assessing dietary components. This research contributes to the understanding of DOxS in food processing and suggests refinements for classification systems, holding promise for improved food safety and public health assessments.

Protocol: The effects of nutrient- vs food- vs food-substitution-based dietary recommendations for reducing free sugar intakes, on free sugar intakes, dietary profiles and sweet taste outcomes: A randomised controlled trial

BACKGROUND

Dietary guidelines are intended to inform and aid the general public, with the aim of improving healthy diets and reducing health risk. The effectiveness of these guidelines, however, is rarely investigated.

AIM

This work investigates the effects of three different types of dietary recommendations for reducing free sugars, on free sugar intakes over 12 weeks. Secondary aims will also investigate how these different recommendations affect secondary outcomes, outcomes in subsets of the trial population, and identify barriers and facilitators to dietary change.

METHODS

Using a randomised controlled parallel-group trial with three intervention and one control arms, 240 individuals consuming >5% total energy intake from free sugars will be randomized to receive: nutrient-based, nutrient- and food-based, nutrient-, food- and food-substitution-based recommendations or no recommendations, with outcomes assessed for the following 12 weeks. Our primary outcomes are free sugar intakes and adherence to the recommendations. Secondary outcomes are daily energy intake, dietary composition, anthropometry, sweet food perceptions and preferences, sweet food choice, attitudes towards sweet foods, eating behaviour and food choice, knowledge and lifestyle variables, quality of life, adverse events, and barriers and facilitators towards intervention adherence.

RESULTS

Data will contribute to three distinct analyses: 1) Analyses to investigate the effects of the three different dietary recommendations versus control; 2) Analyses of the effects of the dietary recommendations in different population subgroups, and 3) Investigation of the barriers and facilitators to success.

CONCLUSION

This work offers new perspectives on the effects of different dietary recommendations to enact behaviour change.

Food-Based Dietary Guidelines for Infants in Latin America and the Caribbean: A Systematic Review

Food-based dietary guidelines (FBDGs) are tools for promoting healthy eating habits. For the population of children under two years old in Latin America and the Caribbean (LAC), there is a lack of reviews analyzing the quality of these guidelines. The objective of this systematic review is to evaluate publicly available FBDGs for the population under two years old in LAC until mid-2023. Guidelines aimed at caregivers of children were included, sourced from government websites in LAC countries and the Food and Agriculture Organization (FAO) portal. Documents targeted at healthcare professionals were excluded. For qualitative analysis, the Agree II guidelines assessment tool and the FAO guide principles for developing healthy and sustainable diets were used. The results showed that more recently released and revised FBDGs with a greater number of pages obtained better scores in both assessments. Additionally, out of the 32 LAC countries, only 13 had these FBDGs available on websites for public access. As a limitation, this study faced challenges in standardizing the searches on government websites. The authors emphasize the need to develop FBDGs for the population under two years old that align with current health and sustainability needs and promote health education.

Relationship between adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness: A cross-sectional study from Turkey

OBJECTIVES

This study aimed to evaluate the relationship between adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness in adults.

METHODS

This descriptive and cross-sectional study was conducted with 1797 adults ages 19-65 y. Demographic characteristics, anthropometric measurements, adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness were ascertained through a questionnaire.

RESULTS

The mean age of the individuals was 27.5 ± 11.76 y, and 50.5% of the participants were adherent to the Mediterranean diet. A statistically significant difference was found between individuals who did and did not adhere to the Mediterranean diet in terms of age, income status, total score and subscores on the Sustainable and Healthy Eating Behaviors Scale, and subscores for information on climate change causes (P < 0.05). A statistically significant positive correlation was found between the Mediterranean Diet Adherence Scale (MEDAS) total score, the Sustainable and Healthy Eating Behaviors Scale total score and subscores, and the Climate Change Awareness Scale total score and subscores (P < 0.05). It was determined that sex, education level, and income status affected the Climate Change Awareness Scale total score (P < 0.05). It was determined that age, income status, the Sustainable and Healthy Eating Behaviors Scale total score, and the Climate Change Awareness Scale total score affected the MEDAS total score (P < 0.05). Also, it was determined that age, sex, education level, MEDAS total score, and Climate Change Awareness Scale total score affected the Sustainable and Healthy Eating Behaviors Scale total score (P < 0.05).

CONCLUSIONS

This study showed a significant effect of climate change awareness on sustainable and healthy eating behaviors and adherence to the Mediterranean diet.

How Do Brazilian Consumers Understand Food Groups in the Food-based Dietary Guidelines?

In the Food-based Dietary Guidelines (FBDGs), food classification is based on food groups and nutrient sources. Much research has already investigated multiple aspects of consumer understanding of the information described in these documents. However, no study has evaluated consumer understanding of all food items contained in the groups described in the FBDGs. This study aimed to assess Brazilian consumers' understanding of food classification according to food groups in the concepts of the FBDGs. Therefore, an instrument, Consumer Understanding of Food Groups (UFG), was constructed and validated to assess consumer understanding of food groups. The instrument comprised 44 items approved by experts (agreement > 80%). A total of 894 Brazilians from all regions participated in this study. The results suggest that 48.9% of the participants believe it is easier to classify food according to food groups. The classification of food groups is based on the origin of the food (animal and vegetable). Although consumers easily recognize foods according to their origin, we still identify asymmetries regarding including food items from the animal kingdom and species from the plant kingdom. This exploratory study highlights important information that can contribute to improving the FBDGs. It is essential to consider consumers' understanding and guide them regarding choices from a technical point of view.

An audit of the dissemination strategies and plan included in international food-based dietary guidelines

OBJECTIVE

Food-based dietary guidelines (FBDG) are an important resource to improve population health; however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG.

DESIGN

A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance.

SETTING

FBDG from fifty-three countries mostly from high-income (n 28, 52·8 %), and upper-middle income (n 18, 34 %) areas were included.

PARTICIPANTS

n/a.

RESULTS

The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research.

CONCLUSIONS

The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.

Responsiveness to warning sensations and anxiety-related psychological traits modulate individual differences in preference for vegetable foods with varied sensory properties

The innate aversion to warning sensations is an important barrier to the acceptance of vegetable food often characterized by bitter and sour tastes, and astringency. Large individual variations exist in preference for this food category. The present study aimed at exploring differences in demographics, anthropometrics, taste responsiveness, personality traits and attitudes in consumers differing in their preference for vegetable food with varied levels of warning sensations. A panel of Italian consumers (n = 718; 53.6% women, age 18-74 years) self-reported familiarity with, preference for and choice of vegetables with high and low levels of warning sensations. Two clusters were identified: High Warning-Vegetable Consumers (HWVC, n = 464) and Low-Warning Vegetable Consumers (LWVC, n = 254). HWVC showed higher familiarity with and preference for vegetables as a whole and higher choice of vegetables characterized by warning sensations than LWVC. HWVC were more represented by older and normal weight individuals as compared to LWVC. Differences among clusters in liking for and perception of a phenol-enriched plant-based food model specifically developed to induce different levels of bitterness, sourness and astringency were found. HWVC rated bitterness, sourness, and astringency lower and liking higher than LWVC. Scores in anxiety-related psychological traits were lower while attitudes to healthy and high-quality food choice were higher in HWVC than in LWVC. The results of the present study depicted a coherent interplay among several person-related dimensions in modulating preference for vegetable foods. Higher responsiveness to warning sensations, higher level of anxiety-related traits, lower importance assigned to food healthy/quality aspects and younger age all acted as barriers to exposure and acceptance of vegetable food and call for a multidimensional approach to promote the consumption of this food category.

Is There a Convergence between the Food Classification Adopted by Food-Based Dietary Guidelines and Food Science and Technology?

The World Health Organization (WHO) proposed the dietary guidelines presented as the Food-based Dietary Guidelines (FBDG). The FBDG classify foods according to their origin, nature, nutrient source, food group, and processing level. Food science and technology (FST) ranks food according to its origin, perishability, nutrient source, processing, food group, and formulation. This paper aimed to compare the convergence points for food classification according to the FBDG and FST. This study was carried out in two phases. The first step was identifying the Food-Based Dietary Guidelines (FBDG). For each of the FBDG, food items were grouped as fruits, vegetables, cereals, sugars, fat and oils, legumes, foods from animals, dairy products, and others. The second step aimed to identify and describe the different food classification systems. The search was performed on PubMed®, Science Direct, and Web of Science and websites of international organizations such as the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), and the Codex Alimentarius. Our results show that the points of convergence between the classifications were the classification in terms of origin (animal and vegetable), nutrient sources, and food groups. However, inconsistencies were observed for the distribution of food items in each group in the 98 surveyed FBDG. As for nature, there was a convergence for in natura, minimally processed, and processed foods. However, the criteria adopted for minimally processed and processed foods described in the FBDG differ from those considered by the FST. FST also does not recognize the classification of foods concerning the level of processing.

Promoting and disseminating consistent and effective nutrition messages: challenges and opportunities

Nutrition messages are a central part of policy making as well as communication via product information, advertising, healthcare advice and lifestyle campaigns. However, with amplified information (and misinformation) from a growing number of sources, inconsistent and conflicting food landscapes, and limited engagement from the public, nutrition messaging tensions have become more accentuated than previously. In this review, we focus on the challenges facing those wishing to effect dietary change through communication; and identify opportunities and future research questions. Beginning with a new working definition and taxonomy for the term ‘nutrition message’, we consider the evolution of public health nutrition messages from the past century and discuss which types of messages may be more effective. We then turn to the challenges of implementation and highlight specific barriers to recipients' understanding and change. While the evidence has many gaps and there is a need for systematic evaluation of nutrition messages, research indicates that recipients are more likely to act on fewer messages that provide clear benefits and which resonate with their perceived health needs, and which are relatively straightforward to implement. Effectiveness may be improved through consideration of how nutrition messages can be designed to complement key non-health drivers of food choice (taste, cost) and societal/cultural norms. Consistency can be achieved by aligning the wider food and messaging environment to desired public health actions; that is by ensuring that retail settings provide and signpost healthier choices, and that mass media nutrition messages work with, not against, public health advice.

The feasibility of implementing food-based dietary guidelines and food graphics in Ethiopia

This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs.

Differences in Awareness of Chinese Dietary Guidelines Among Urban and Rural Residents: A Cross-Sectional Survey in Southwest China

Objectives: This study aimed to compare the awareness of Chinese dietary guidelines (CDGs, 2016) between rural and urban areas in Southwest China and identify the factors that affect CDGs (2016) awareness. Methods: This cross-sectional survey included 8,320 individuals aged 18-75 years from Chongqing, Sichuan, Guizhou, and Yunnan, China. Convenience sampling method was adopted to select the survey subjects and face-to-face surveys in each region were conducted to collect data. Descriptive statistics and generalized linear model were used to evaluate differences in awareness of CDGs among urban and rural residents and its influencing factors. Results: Overall CDGs awareness was low in urban and rural areas, although the awareness rate was higher in the former than in the latter (29.1% vs. 19.9%, respectively). Region, education level, Body Mass Index (BMI), gender, income, and age are the influencing factors of CDGs awareness. Urban participants were likely to acquire relevant knowledge from social media, books/magazines, family/friends, and experts. However, rural participants were likely to acquire relevant knowledge from food sales staff (p < 0.05). Conclusion: Rural residents are less aware of CDGs than their urban counterparts in Southwest China. Future dietary education should adopt different strategies for different populations, with considerable focus on rural residents.

Representations of Ultra-Processed Foods: A Global Analysis of How Dietary Guidelines Refer to Levels of Food Processing

BACKGROUND

As evidence grows about negative health impacts of ultra-processed foods (UPFs), nutrient-centred advice is contested, and food-based dietary guidelines are increasingly utilised. Previous analyses of dietary guidelines evaluated their potential impact on health and sustainability, but little research has been conducted to examine how the concept of UPFs is reflected in dietary advice for consumers. This paper systematically analyses whether and how UPFs are represented in dietary guidelines internationally.

METHODS

Based on a systematic online search, the consumer-targeted key messages of 106 dietary guidelines were identified and a qualitative content analysis was conducted. A coding framework was developed to classify messages as 'eat more' or 'eat less' according to the language used (eg, 'choose' vs 'avoid') and to differentiate between a focus on nutrients or food processing. Specific foods mentioned in 'eat less' guidelines were classified according to their level of processing using the NOVA framework.

RESULTS

99% of guidelines utilised some type of nutrient-based message, either promoting 'positive' nutrients (eg, vitamins) or discouraging the consumption of 'negative' nutrients (mainly salt, sugar and fat). Explicit references to food processing were present in 45% of 'eat less' guidelines and 5% of 'eat more' guidelines. Implicit references (eg, promoting 'raw' or discouraging 'packaged' foods) were found in 43% of 'eat less' and 75% of 'eat more' guidelines. 53% of the specific foods referred to in 'eat less' advice were UPFs.

CONCLUSION

Overall, nutrient-based messages were more common than messages about processing levels. The majority of discouraged foods were UPFs, however some minimally processed foods were discouraged, which points to tensions and contradictions between nutrient- and processing-based dietary advice. As dietary guidelines begin to include advice about food processing, it is important to consider both consumer understanding of the terms used and their capacity to act on the advice.

Supporting consumers' informed food choices: Sources, channels, and use of information

Information about food is available from several sources using a variety of communication channels. Following an overview of the different types on food information, the most important source/channel combinations are discussed. The key steps in processing the information toward making a food choice are discussed: consumer's exposure to such information, the attention the consumer pays to it, the understanding and/or liking of the information, as well as the importance of motivation, knowledge, and trust. To support consumers in making informed food choices, it is recommended to ensure that food information is easy to understand and targeted to consumers with a specific need or interest, align the information on the food label with the communication about the food elsewhere ("off label"), provide (non-expert) influencers with transparent information to enable an increase in the trustworthiness of their communications on the web in on social media. Furthermore, increase cooperation between authorities and food producers to create standards that fulfill the legal requirements and are feasible as label elements. Improving food literacy among consumers by including it in formal education would provide consumers with better nutrition knowledge and skills to interpret food-related information in a manner that supports informed choices.

How Do Consumers Understand Food Processing? A Study on the Brazilian Population

Food guides are official documents that guide consumers’ food choices. They inform the qualitative classification of food groups and messages on how to adopt a healthy diet. The classifications and nomenclatures adopted in these documents vary according to cultural, nutritional, and scientific criteria. This study aimed to evaluate the understanding of Brazilian consumers regarding food classification according to the Food Guide for the Brazilian Population (FGBP) concepts. An instrument was constructed to assess consumer understanding. It was named “Understanding of the Level of Processing of Food” (ULPF) and validated according to the concepts of constructs presented by psychometrics such as the Delphi methodology. The instrument was composed of 36 items approved by experts (concordance > 80% and with good internal consistency). A total of 2333 Brazilians from all regions participated in the study. The results suggest that food classification according to the level of processing was difficult for participants to understand. About 85% of them did not understand or did not know the definitions and classification of food and preparations according to food and science technology (FST) and the FGBP. More than 50% of the participants believed that it was easier to classify food according to food groups.

Comparing the perceptions and opinions of the 2007 and 2019 Canada's food guides among parents of young children

Background

The Canada's Food Guide (CFG) is recognized as the most prominent authoritative guideline for healthy eating in Canada. In 2019, Health Canada released the latest iteration of the CFG with substantial changes to its messaging and format from the previous 2007 CFG.

Objective

This study compared the awareness, use, knowledge, and opinions of the 2007 and 2019 CFGs among parents with children aged 18 months to 5 years who are participants in a family-based intervention trial, the Guelph Family Health Study.

Methods

The sample consisted of 327 parents (59% women) who responded to questions about the 2007 CFG and 177 parents (60% women) who responded to questions about the 2019 CFG. Parents' awareness and knowledge of the 2007 and 2019 CFGs were compared using Pearson's Chi-Square, while parents' opinions of the two CFGs were compared using Wilcoxon Rank-Sum tests. To describe and provide context about how parents used the 2007 and 2019 CFG descriptive analysis was used. To analyze the open-answer comments parents provided for the 2007 and 2019 CFGs thematic coding was used.

Results

Awareness of the 2007 and 2019 CFGs was high with 94.5 and 90.4% of parents reported having heard about the 2007 and 2019 CFGs, respectively. Knowledge of the plate proportion recommendations in the 2019 CFG was significantly higher than knowledge of the recommended number of servings in the 2007 CFG with 93.4% of parents identifying the Vegetable and Fruit Plate Proportions in the 2019 CFG. Parents identified that the 2019 CFG was a helpful and trustworthy resource, and that it was easier to follow and understand, and more representative of their culture and traditional foods than the 2007 CFG.

Conclusion

Our results suggest that parents' knowledge of the 2019 CFG recommendations was higher than for the 2007 CFG recommendations. Parents also had more positive opinions about the 2019 CFG as compared to the 2007 CFG. Future research is needed to explore whether these higher levels knowledge of the 2019 CFG recommendation translate to healthier eating patterns among Canadian families.

The compatibility of circularity and national dietary recommendations for animal products in five European countries: a modelling analysis on nutritional feasibility, climate impact, and land use

BACKGROUND

National food-based dietary guidelines (FBDGs) are generally designed from a human health perspective and often disregard sustainability aspects. Circular food production systems are a promising solution to achieve sustainable healthy diets. In such systems, closing nutrient cycles where possible and minimising external inputs contribute to reducing environmental impacts. This change could be made by limiting livestock feed to available low-opportunity-cost biomass (LOCB). We examined the compatibility of national dietary guidelines for animal products with livestock production on the basis of the feed supplied by available LOCB.

METHODS

We investigated whether the national dietary recommendations for animal products for Bulgaria, Malta, the Netherlands, Sweden, and Switzerland could be met with domestically available LOCB. We used an optimisation model that allocates feed resources to different species of farm animals. Of the resulting scenarios, we assessed the nutritional feasibility, climate impact, and land use.

FINDINGS

Our results showed the environmental benefits of reducing the recommended animal products in the FBDGs, and that animal products from LOCB could provide between 22% (Netherlands) and 47% (Switzerland) of total protein contributions of the FBDGs. This range covers a substantial part of the nutritional needs of the studied populations. To fully meet these needs, consumption of plant-based food could be increased.

INTERPRETATION

Our results contribute to the discussion of what quantities of animal products in dietary guidelines are compatible with circular food systems. Thus, national dietary recommendations for animal products should be revised and recommended quantities lowered. This finding is consistent with recent efforts to include sustainability criteria in dietary guidelines.

FUNDING

Swiss National Science Foundation and the Dutch Research Council.

Consumer Understanding of the Australian Dietary Guidelines: Recommendations for Legumes and Whole Grains

Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary patterns, although they are most often based on individual foods or food groups. Legumes are a class of food included in current Australian Dietary Guidelines (ADG), mentioned in two of the five food groups, as a vegetable and as an alternative to meat. Whole grain consumption is encouraged in ADG via the statement focused on cereal grains due to their health-promoting properties. Despite their prominence in guidelines, average legume and whole grain consumption in Australia remains lower than recommendations outlined in the ADG. This exploratory study aimed to understand consumer perspectives of wording utilised in dietary guidelines specifically focused on legumes and whole grains. Based on the analysis, there was a significant preference for the statement “each day, consume at least one serve of legumes either as a serve of vegetables or as an alternative to meat” (p < 0.05), which provides a specific frequency and quantification for legume consumption. For whole grain, the significantly preferred statement was “choose whole grain products over refined grains/white flour products whenever you can” indicating a less prescriptive option. Effective messaging in guidelines could consider greater specificity regarding frequency, quantity and quality of foods recommended. This exploratory study suggests an improvement in the adoption and consumption of legumes and whole grains in the Australian diet may be better facilitated through consumer-tested messaging.

Protein Quality in Perspective: A Review of Protein Quality Metrics and Their Applications

For design of healthy and sustainable diets and food systems, it is important to consider not only the quantity but also the quality of nutrients. This is particularly important for proteins, given the large variability in amino acid composition and digestibility between dietary proteins. This article reviews measurements and metrics in relation to protein quality, but also their application. Protein quality methods based on concentrations and digestibility of individual amino acids are preferred, because they do not only allow ranking of proteins, but also assessment of complementarity of protein sources, although this should be considered only at a meal level and not a diet level. Measurements based on ileal digestibility are preferred over those on faecal digestibility to overcome the risk of overestimation of protein quality. Integration of protein quality on a dietary level should also be done based on measurements on an individual amino acid basis. Effects of processing, which is applied to all foods, should be considered as it can also affect protein quality through effects on digestibility and amino acid modification. Overall, protein quality data are crucial for integration into healthy and sustainable diets, but care is needed in data selection, interpretation and integration.

Development of national dietary and lifestyle guidelines for pregnant women in Lebanon

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low- and middle-income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed-method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context-specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture-specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.

Recall of government healthy eating campaigns by consumers in five countries

OBJECTIVE

To examine awareness and recall of healthy eating public education campaigns in five countries.

DESIGN

Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.

SETTING

Online surveys.

PARTICIPANTS

Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).

RESULTS

Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).

CONCLUSIONS

In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.

Principles of Sustainable Healthy Diets in Worldwide Dietary Guidelines: Efforts So Far and Future Perspectives

Food choices and eating behaviours have a large impact on both human and planetary health. Recently, the Food and Agricultural Organisation (FAO) of the United Nations and the World Health Organisation have developed a list of 16 guiding principles to achieve sustainable healthy diets (SHDs). They proposed that development of food-based dietary guidelines (FBDGs) should be a core element in the implementation of these SHDs in each country. The objective of this review is to explore the degree of alignment of current FBDGs to these guiding principles. A total of 43 FBDGs, written or translated into English, were collected from the online repository developed by the FAO and were analysed for their adherence to each of the guiding principles. Results were stratified for period of publication and geographical macro-area. Overall, there were high levels of inclusion of the factors related to health outcomes, especially in the most recent FBDGs. Conversely, environmental impact and socio-cultural aspects of diet were considered less frequently, especially in the older FBDGs. These results highlight the importance of revising FBDGs, especially to include emerging topics which represent the areas with the highest scope for improvement in the future versions of FBDGs. Replication of the present study in the coming years will be worthwhile to monitor improvements in the adherence of global FBDGs to the guiding principles of SHDs. The attainment of such a goal could promote a more rapid transition towards SHDs, as well as highlighting pivotal research trajectories to increase adoption and evaluate the impact on the food system.

European Food Safety Authority (EFSA), Maxim L, Mazzocchi M, Van den Broucke S, Zollo F, Robinson T, Rogers C, Vrbos D, Zamariola G, Smith A. Technical assistance in the field of risk communication

This report assesses peer-reviewed and grey literature on risk communication concepts and practices, as requested by the European Commission to support the implementation of a 'General Plan for Risk Communication', i.e. an integrated framework for EU food safety risk assessors and risk managers at Union and national level, as required by the revised EU General Food Law Regulation. We conducted a scoping review of social research studies and official reports in relation to risk communication in the following areas: understanding and awareness of risk analysis roles and tasks, reducing misunderstanding of the different meaning of the terms 'hazard' and 'risk', tackling misinformation and disinformation, enhancing confidence in EU food safety, taking account of risk perceptions, key factors in trade-offs about risks, audience segmentation and tools, channels and mechanisms for coordinated risk communications. We structured our findings as follows: i) definitions of key concepts, ii) audience analysis and information requirements, iii) risk profiling, models and mechanisms, iv) contributions to communication strategies. We make several recommendations for consideration by the Commission, both in terms of actions to support the design and implementation of the general plan, and research needs that we consider crucial to further inform appropriate risk communication in the EU. EFSA carried out a targeted consultation of experts and a public consultation open to all interested parties including the general public, in preparing and finalising this report.

Types of Nutrition Knowledge, Their Socio-Demographic Determinants and Their Association With Food Consumption: Results of the NEMONIT Study

Objectives: To investigate nutrition knowledge in the German population, its determinants and its association with food consumption. Methods: Data were obtained from the NEMONIT study (2014/15, n = 1,505, participants' age: 22-80 years). Nutrition knowledge was measured using the consumer nutrition knowledge scale (CoNKS) in a computer-assisted telephone interview. Two 24-h recalls were conducted to assess food consumption, which was evaluated using the Healthy Eating Index-NVS II. Results: Areas for knowledge enhancement were the understanding of health benefits of fruit and vegetable consumption, the concept of a balanced diet and saturated fatty acids. Nutrition knowledge was higher among females, younger and high socio-economic status participants. Correlations between nutrition knowledge and a favorable diet were significant but low. Analyses of types of nutrition knowledge yielded similar results for procedural knowledge and knowledge on nutrients but not for knowledge on calories. Conclusions: Areas for knowledge enhancement were identified, but an increase in nutrition knowledge alone seems unlikely to result in large improvements of dietary behavior.

Consumer perception of food variety in the UK: an exploratory mixed-methods analysis

BACKGROUND

'Food variety' is a key term that is frequently used in dietary guidelines around the world. Consuming a variety of foods - be it within a meal, across meals, or as part of the whole diet - is one factor that has been shown to increase food intake. However, little is known about consumer understanding of variety, and this may be a potential barrier to the success of dietary guidelines in today's 'obesogenic' environment. This research sought to explore 1) consumer recognition of different forms of variety, and 2) consumer definitions of variety.

METHODS

In an online study (N = 240), participants were asked to discuss a range of photographs depicting different forms of variety, and to directly define the term 'food variety'. They were unaware of the research aim.

RESULTS

Using a mixed methods approach, directed content analysis of these data showed that individuals referenced multiple forms of variety in the presence of food photographs. However, when asked to define variety, participants tended to only discuss variety in the context of the whole diet.

CONCLUSIONS

These findings emphasise a need to educate consumers about variety to encourage adherence to dietary guidelines and help consumers better manage their own food intake.

Framing the Intractable: Comprehensive Success Factor Analysis for Grand Challenges

Complex socio-technical challenges, often referred to as grand challenges or wicked problems, lack a robust method for their holistic framing. Current approaches to framing fall into two primary categories. On one hand, models grounded in reductionist perspectives tend to oversimplify the problems and thus fall short of capturing the true complexity that must be understood to make tangible progress. On the other, notable attempts to achieve holism are more effective at incorporating contextual nuance, but still lack systematicity to identify and drive effective inclusion of critical issues, and also tend to suffer from the inherent bias of select expert input. In this article, we report on an extension of holistic problem framing techniques called comprehensive success factor analysis (CSFA) that makes-sense of web-mined information reflective of both expert and general population perspectives as well as pattern-informed ontological knowledge organization structure, to yield 'richer pictures' of grand challenges. This method has been developed and refined over a seven-year period by application to a variety of distinct socio-technical challenges, and emphasizes that framing complex problems requires one to embrace multiple levels of abstraction, a plurality of perspectives, careful contextualization, and an overarching system view. The CSFA method results in 'success factor trees' that are more comprehensive than seen otherwise and present a holistic view of the essential factors that need to be considered when engaging in large scale socio-technical problems. The success factor trees provide common grounds for meaningful collaboration and discourse on grand challenges, facilitate more informed resource allocation decisions, and provide guidance for designing solutions through careful consideration of system factors that are not always apparent. The paper illustrates CSFA applied to the challenge of 'food security for a nation in a low- to middle-income country context' to ascertain the value of the approach and finds that it results in a robust view of the challenge that greatly exceeds perspectives arrived at in the literature using current framing methods, on dimensions of scope, levels of abstraction, plurality, and context detail.

Supporting adherence to the UK's Eatwell Guide in the general public

Sara Patience looks at how improvements to the nation's diet could reduce the impact of chronic illness

A systematic review of recall errors associated with portion size estimation aids in children

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.

The effect of nudges aligned with the renewed Flemish Food Triangle on the purchase of fresh fruits: An on-campus restaurant experiment

OBJECTIVE

This study examined the effect of nudges, inspired by the recently renewed Flemish Food Triangle, on fruit sales in a Belgian on-campus university restaurant.

METHODS

In this mixed-method real-life experiment, nudges were added weekly over a period of four consecutive weeks: placement of (1) Food Triangle posters in the restaurant, (2) 'green heart' icons above the fruit stands, and (3) substitution and (4) social norm messages at the fruit stands. During baseline (no intervention) and all intervention weeks, dessert sales were registered. Short interviews were used to ask customers about their perceptions regarding the intervention. Follow-up measurements (7 and 30 weeks later) evaluated the longer-term effectiveness, while all nudges remained in place. Dessert sales were analyzed separately for both sexes, students and staff categories (based on academic degree).

RESULTS

Compared to baseline, the combination of the Food Triangle and the green heart intervention materials in week 2 resulted in significant increases in fruit consumption across almost all subgroups. The other intervention materials used in the current study had rather limited effects in the short term. After 7 weeks of follow-up, significant fruit sale increases were established for all subgroups compared to baseline. At 30 weeks follow-up, the effect for staff B (Bachelor's degree) disappeared. The majority of the respondents (66.4%) had noticed at least one of the nudges, while only 3.4% indicated to have adjusted their dessert choice as a result of the nudges.

CONCLUSIONS

The combination of nudges was effective in the long term and increased fruit purchase in nearly all subgroups. Short interviews show that a more active approach may be needed to increase effect sizes.

A comparison of European countries FBDG in the light of their contribution to tackle diet-related health inequalities

Background

The purpose of this article is to report on a comparative analysis of the official food-based dietary guidelines (FBDG) that were applicable in 2015 in 25 EU Member States. We assess FBDG in relation to the main guidelines established by the FAO/WHO, the EURODIET project and the EFSA, with a particular focus on identifying strengths and limitations of current FBDG in Europe towards addressing diet-related health inequalities.

Methods

This is a review research, in which a mixed-methods sequenced procedure was utilized. In each EU country key informants, including sociologists, economists, dietitians and nutritionists were asked to provide data regarding: (i) current dietary guidelines and national health priorities, (ii) model of health promotion currently available, (iii) results of the latest food consumption survey. All documents were reviewed by the coordinating team. Full data were analysed by two nutritionists, using a tabulated sheet to organize and compare the results.

Results

While all countries have national FBDG, the level of detail and quality varies substantially with regard to: time of last update; availability of recommendations for specific target groups; specification of frequency and portion size; the graphical representation; recommended amounts and limits of foods consumed; and recommendations regarding physical activity.

Conclusions

European countries have great opportunities to improve FBDG to better serve Public Health policy through a more consistent foundation of how these guidelines are developed, the inclusion of different population subgroups as a target for recommendations and the implementation of monitoring systems.

The Willingness to Modify Portion Sizes or Eat New Protein Foods Largely Depends on the Dietary Pattern of Protein Intake

Promoting a more balanced animal/plant dietary protein ratio by changing portion sizes or introducing new foods is a promising means to improve diet quality, but little is known about the willingness of individuals to adopt such changes. Our objective was to assess the willingness to adopt dietary changes by these means. In a French cross-sectional study in 2018 (n = 2055), we analyzed the association between the willingness to eat smaller or larger portions or to introduce non-consumed protein foods and the current dietary patterns of individuals and their socio-demographic characteristics. These modifications had previously been identified as improving the nutrient adequacy of diets. Participants were more willing to eat smaller portion sizes than to introduce new foods and to eat larger portion sizes. The willingness for any modification varied depending on the food groups concerned. Participants were also more willing to eat larger portions and less willing to eat smaller portions when they were the most frequent consumers of the foods concerned. Participants were more willing to eat a new food if it was consumed in large quantities by individuals with a similar dietary pattern. This study underlines the importance of accounting for individual food habits when issuing nutritional recommendations.

Development of healthy and sustainable food-based dietary guidelines for the Netherlands

Objective:

To derive healthy and sustainable food-based dietary guidelines (FBDG) for different target groups in the Netherlands and describe the process.

Design:

Optimised dietary patterns for children, adolescents, adults and the elderly were calculated using an optimisation model. Foods high in saturated and trans-fatty acids, salt and sugar, and low in dietary fibre, were excluded. The dietary patterns resembled the current food consumption as closely as possible, while simultaneously meeting recommendations for food groups, nutrients, maximum limits for foods with a high environmental impact, and within 85 % of the energy requirement. Recommended daily amounts of food groups were based on the optimised dietary patterns and expert judgement.

Setting:

The Netherlands.

Participants:

FBDG were derived for Dutch people with different ages, genders, activity levels and food preferences.

Results:

For most target groups the optimisation model provided dietary patterns that complied with all requirements. For some food groups, the optimised amounts varied largely between target groups. For consistent messages to consumers, the optimised dietary patterns were adjusted to uniform recommendations per target group. Recommendations were visualised in the Wheel of Five. The advice is to eat the recommended amounts of foods according to the Wheel of Five and limit consumption of other foods.

Conclusions:

Based on an optimisation model, scientific evidence, information on dietary patterns and expert knowledge, we derived FBDG for different target groups. The Wheel of Five is a key food-counselling model that can help Dutch consumers to make their diets healthier and more environmentally sustainable.

Optimising healthy and safe fish intake recommendations: a trade-off between personal preference and cost

Individuals may perceive personalised dietary advice as more relevant and motivational than national guidelines. Personal preference and food cost are factors that can affect consumer decisions. The objective of this study was to present a method for modelling and analysing the trade-off between deviation from preference and food cost for optimised personalised dietary recommendations. Quadratic programming was applied to minimise deviation from fish preference and cost simultaneously with different weights on the cost for 3016 Danish adults (whose dietary intake and body weight were recorded in a national dietary survey). Model constraints included recommendations for EPA, DHA and vitamin D and tolerable levels for methyl mercury, dioxins and dioxin-like polychlorinated biphenyls. When only minimising deviation from preference, 50 % of the study population should be recommended to increase fish intake, 48 % should be suggested to maintain current consumption and 2 % should be suggested to decrease fish consumption. When only minimising cost, the vast majority (99 %) should be recommended to only consume herring, which is the least-expensive fish species. By minimising deviation from preference and cost simultaneously with different weights on the cost, personalised optimal trade-off curves between deviation from fish intake preference and fish cost could be generated for each individual in our study population, except for twenty-two individuals (0·7 %) whose contaminant background exposure was too high. In the future, the method of this paper could be applied in the personal communication of healthy and safe food recommendations that fit the preferences of individual consumers.

Improvement in Cognition Following Double-Blind Randomized Micronutrient Interventions in the General Population

The impact of poor nutrition on physiological health is well understood (Costarelli et al., 2013). Less is known about the effects of diet on brain function and cognition in the general population (Ames, 2010; Parletta et al., 2013; White et al., 2017) and we are still in the early stages of understanding the role of specific nutrients to normal and pathological neuronal functioning. In the present study, the putative effect of a multivitamin/mineral or vitamin D supplement on cognitive function over an 8-week period was compared with volunteers taking vitamin C. Healthy adults (N = 60) were recruited, age range 21-59 years ( x ¯ = 39.07 years, SD = 11.46), with participants randomly allocated to conditions in a double-blind protocol. Participants also completed a 14-day food diary to gather information on micronutrient intake. The cognitive test battery included measures from the Wechsler Adult Intelligence Scale-III (WAIS-III; Wechsler et al., 2008), Wechsler Memory Scale-IV (WMS-IV; Wechsler, 2009) and Delis-Kaplan Executive Function System (D-KEFS; Delis et al., 2001), along with the Doors and People (Baddeley et al., 1994) and a serial reaction time task. Analyses showed better performance on some tasks in all groups following the intervention period, notably on measures of verbal and visual memory and visuomotor processing speed. The Multivitamin group showed significant improvements on tasks of visual strategy generation (along with the Vitamin C group), motor planning, explicit and implicit learning, and working memory. This evidence suggests that sub-optimal micronutrient intake may have a negative effect on cognition across the lifespan.

Challenges following a personalised diet adhering to dietary guidelines in a sample of Australian university students

BACKGROUND

Food-based dietary guidelines are designed to support populations to adopt a healthy diet. University students studying nutrition related courses are typically en-route to professional roles that involve advocating a healthy diet.

AIM

The present study compared the dietary intake of university students enrolled in a foundation nutrition course against the Australian Dietary Guidelines (ADGs) and Nutrient Reference Values (NRVs), and explored students' experiences of following a 3-day self-determined diet plan adhering to the ADGs/NRVs.

METHODS

Students (n = 115) initially collected, and subsequently analysed a 3-day prospective diet record to determine food group/nutrient intake. Individuals then modified their diet to comply with recommendations (ADGs/NRVs) and attempted to implement the diet plan. Challenges associated with meeting the ADGs/NRVs were described in an online survey form.

RESULTS

Baseline food group and nutrient intakes deviated from the guidelines, with 'lean meats & alternatives' the only group consumed in recommended quantities. Students demonstrated the capacity to plan a modified personal diet adhering to the ADGs food group recommendations. However, when following this, several key challenges to dietary adherence were identified. Challenges were categorised as personal/behavioural factors (e.g. the quantity/type of food) and societal factors (e.g. time, cost, social factors).

CONCLUSION

Overall, this study highlights challenges influencing adherence to dietary guidelines in a sample of undergraduate university students. Understanding these factors may help tailor advice to facilitate improved dietary patterns in this population group.

Development and testing of a scale to evaluate diet according to the recommendations of the Dietary Guidelines for the Brazilian Population

OBJECTIVE

To develop and test a scale for healthy eating practices measurement according to the Dietary Guidelines for the Brazilian Population recommendations.

DESIGN

Methodological study. The current Brazilian food-based dietary guideline highlights the importance of choosing foods, combining foods to create meals and modes of eating. These recommendations formed the main domains of the scale and served as a basis for the development of ninety-six items, each with a 4-point Likert response option. Content and face validity were tested. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine construct validity. Internal consistency was determined using α and ω coefficients, and reproducibility was tested using test-retest.

SETTING

Brazil.ParticipantsA ten-member expert panel was used to assess content validity. Adults aged 18-60 years were included in the face validity (n 20), EFA (n 352), CFA and reliability tests (n 900).

RESULTS

Of the ninety-six initial items, twenty-four were excluded and fifty-five were reworded following the content and face validations. EFA detected a four-domain structure (Food choices, Modes of eating, Planning and Domestic organization), which explained 41 % of the variance. CFA led to a final twenty-four-item model with acceptable goodness-of-fit indices and good reliability measures (α=0·77; ω=0·83). Intraclass correlation coefficient for the total score (0·82) and analysis of the Bland-Altman plot suggested good reproducibility of the scale.

CONCLUSIONS

The scale presents good evidence of validity and reliability. This innovative study created a useful tool for evaluation of the impact of the Dietary Guidelines for the Brazilian Population.

Searching for a Measure Integrating Sustainable and Healthy Eating Behaviors

Sustainable and healthy food-related behavior is high on the public policy and research agenda due to its potential to cope with negative environmental and health outcomes. There are several measures related to sustainability in food choices but there have not been many attempts to integrate sustainable and healthy eating (SHE) behaviors into one measurement instrument so far. Therefore, the main aim of this study was to identify how young adults interpret the SHE concept and to develop an instrument that measures a self-reported consumer's SHE behavior. The process of scale development involved an exploratory qualitative study and two quantitative studies. As a result of 20 individual in depth interviews with Polish young adults, 50 items were generated reflecting their perspective on principles of SHE (Study 1). Two samples were used in the scale validation process: n = 217 (Study 2) and n = 220 (Study 3). Via principal component analysis, reliability analysis, and confirmatory factor analysis, the final form of the scale was derived. The proposed 34-item scale offers insights into the most relevant aspects of SHE behaviors, grouped in eight factors: "healthy and balanced diet", "certification and quality labels", "meat reduction", "selection of local food", "choice of low fat food products", "avoidance of food waste" and purchase and consumption of food products that are respecting "animal welfare" and finally choice of "seasonal food". Although the developed scale can benefit from further refinement and validity testing in different cultural and social background, it is clear that the scale, as developed, can be a useful tool for researchers who are interested in the study of SHE behaviors.

Food Reference Budgets as a Potential Policy Tool to Address Food Insecurity: Lessons Learned from a Pilot Study in 26 European Countries

The aim of this article is to present the development of cross-country comparable food reference budgets in 26 European countries, and to discuss their usefulness as an addition to food-based dietary guidelines (FBDG) for tackling food insecurity in low-income groups. Reference budgets are illustrative priced baskets containing the minimum goods and services necessary for well-described types of families to have an adequate social participation. This study was conducted starting from national FBDG, which were translated into monthly food baskets. Next, these baskets were validated in terms of their acceptability and feasibility through focus group discussions, and finally they were priced. Along the paper, we show how that food reference budgets hold interesting contributions to the promotion of healthy eating and prevention of food insecurity in low-income contexts in at least four ways: (1) they show how a healthy diet can be achieved with limited economic resources, (2) they bring closer to the citizen a detailed example of how to put FBDG recommendations into practice, (3) they ensure that food security is achieved in an integral way, by comprising the biological but also psychological and social functions of food, and (4) providing routes for further (comparative) research into food insecurity.

Consumer accounts of favourable dietary behaviour change and comparison with official dietary guidelines

OBJECTIVE

The current study aimed to assess Uruguayan consumers' accounts of their own need to change their dietary patterns, their intended changes and the barriers related to doing so, and to compare the intentions and barriers with the recommendations of the national dietary guidelines.

DESIGN

An online survey with 2381 Uruguayan employed adults, aged between 18 and 65 years, 65 % females, was conducted. Participants had to answer two open-ended questions related to changes they could make in the foods they eat and/or the way in which they eat to improve the quality of their diet and the reasons why they had not implemented those changes yet. Content analysis using inductive coding by two researchers was used to analyse the responses.

RESULTS

Consumers mainly intended to change consumption of types of foods, particularly eating more fruits, vegetables and legumes and consuming less flour, but also intended to alter their eating patterns. Lack of time and the fact that healthy foods are perceived as being more expensive than unhealthy foods were major barriers to behaviour change. Some of the recommendations of the dietary guidelines, particularly those related to enjoying cooking and meals and engaging in it as a social activity, were not represented in consumer accounts.

CONCLUSIONS

Accompanying policies to the dietary guidelines need to underline the importance of changes in dietary patterns, including greater enjoyment and sharing food preparation and meals in the company with others, address misconceptions about flour, and provide concrete, consumer-derived recommendations on how to enact the guidelines.