Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data

Frailty-free life expectancy and its association with socio-economic characteristics: an analysis of the English Longitudinal Study of Ageing cohort study

BACKGROUND

Frailty is more prevalent in socio-economically disadvantaged groups; however, little is known about how this translates to differences in the number of years people live with and without frailty. We investigate differences in frailty-free and frail life expectancies among population groups stratified by wealth, area deprivation, education and marital status.

METHODS

The English Longitudinal Study of Ageing cohort study was used to follow the frailty trajectories of 15,003 individuals over 18 years. A multi-state model assessed the risk of transitioning between frailty states and death based on socio-economic characteristics. These risks were translated into state-specific life expectancies.

RESULTS

Wealth had the strongest association with frailty-free and frail life expectancies. Increased wealth, reduced deprivation, higher educational attainment and marriage all correlate with increased frailty-free life expectancies and reduced frail life expectancies. At age 50, the wealthiest population quintile can expect to live 11.1 [10.1-12.1] years (women) and 9.8 [8.8-10.8] years (men) longer frailty-free than the poorest population quintile. The wealthiest quintile live less than half the number of years with frailty than the poorest quintile. There is no difference in frailty-free life expectancy between the poorest men and women; however, the wealthiest women have longer frailty-free life expectancies than the wealthiest men.

CONCLUSIONS

Large inequalities in frailty-free and frail life expectancies exist across socio-economic groups, with wealth and area deprivation the most important socio-economic determinants. Narrowing these inequalities may extend frailty-free life expectancies more for women than men, suggesting strategies to reduce disparities should consider both socio-economic factors and gender. Care policies should account for the geographical clustering of socio-economically disadvantaged populations. Reducing socio-economic inequalities could increase frailty-free life expectancies and reduce health and social care costs.

Comparative determination of factors affecting attitude level towards healthy nutrition

Healthy eating habits are critical to the health and well-being of future generations. Many people worldwide do not receive enough vitamins and minerals due to malnutrition To eliminate these, it is necessary to determine the factors that support people's healthy eating habits. This study was conducted to determine the factors that affect healthy eating habits. There are three external factors to the study: (1) being an expert in food and drink, (2) having received formal education in health, and (3) receiving professional support (dietician support) in nutrition. The level of healthy eating was evaluated based on nutritional knowledge, feelings about nutrition, positive eating habits, and poor eating habits. In this context, an online survey was applied to 425 employees in the health sector (202 people) and the food and beverage sector (223 people). The data obtained were analyzed comparatively. The study results showed that the level of nutritional knowledge was equal in both groups. However, it was concluded that food and beverage sector employees were more sensitive to feelings about nutrition, positive eating, and poor eating habits than healthcare sector employees. While food and beverage sector employees are expected to constantly deal with food, which causes desensitization, it has been observed that they are stable and resistant to healthy eating. It has been concluded that although they have not received any formal health training, the information they have obtained through professional support (dietician) accelerates the process of developing healthy eating behaviors. This result has strengthened the power of the education variable affecting healthy nutrition. In addition, sensitivity to healthy nutrition is catalyzed by the professional profession. Dietician support indirectly reinforces this attitude. Thus, it has contributed to the development of healthy nutrition literature.

Early adulthood socioeconomic trajectories contribute to inequalities in adult diet quality, independent of childhood and adulthood socioeconomic position

BACKGROUND

Diet is an important risk factor for cardiovascular disease and shows well-established socioeconomic patterning among adults. However, less clear is how socioeconomic inequalities in diet develop across the life course. This study assessed the associations of early adulthood socioeconomic trajectories (SETs) with adult diet quality, adjusting for childhood socioeconomic position (SEP) and testing for mediation by adulthood SEP.

METHODS

Participants from the 1970 British Cohort Study with socioeconomic data in early adulthood were included (n=12 434). Diet quality at age 46 years, evaluated using the Mediterranean diet pyramid, was regressed on six previously identified classes of early adulthood SETs between ages 16 and 24 years including a continued education class, four occupation-defined classes and an economically inactive class. Causal mediation analyses tested the mediation of the association via household income and neighbourhood deprivation at age 46 years separately. Models were adjusted for sex, childhood SEP, adolescent diet quality and adolescent health.

RESULTS

The continued education class showed the best diet quality at age 46 years while little difference in diet quality was found among the remaining SET classes. The association between the continued education class and adult diet quality was independent of parental SEP in childhood and was largely not mediated by household income or neighbourhood deprivation (0.7% and 3.7% of the total effect mediated, respectively) in mid-adulthood.

CONCLUSIONS

Early adulthood SETs independently contribute to adult diet quality with continuing education associated with better adherence to the Mediterranean diet. Early adulthood therefore represents a sensitive period for intervention to alleviate dietary inequalities in later life.

Changes in food habits during the transition to retirement: the Whitehall II cohort study

BACKGROUND

The transition to retirement is a significant turning point in life, which may lead to changes in food habits.

OBJECTIVE

To examine changes in red meat, fish, vegetables and fruit consumption during the retirement transition and whether these changes vary between sociodemographic groups.

METHODS

The data were from the Whitehall II study, a cohort of 10 308 British civil servants aged 35-55 years at study induction (1985-1988). Data collection has taken place every 2-3 years. Food consumption (n=2484-2491) was assessed with the Food Frequency Questionnaire in the periods before (max. 16 years) and after retirement (max. 16 years). Changes in preretirement and postretirement consumption were compared in the total cohort and subgroups by sex, marital status, preretirement occupation status and financial hardship using linear regression analyses with generalised estimating equations.

RESULTS

Weekly red meat consumption was stable before retirement but increased after retirement (p=0.02), especially among women, single and lower occupational status participants. Fish consumption increased during the follow-up and the increase was steeper before retirement than postretirement period (p=0.02). Vegetable and fruit consumption also increased during the entire follow-up, but more strongly during preretirement than postretirement period (p<0.001 for both).

CONCLUSION

The transition to retirement is accompanied by favourable (increase in fruit, vegetable and fish) and unfavourable (increase in red meat) dietary changes, varied to some extent by sex, marital status and preretirement occupational status. Our findings suggest that attention should be paid to this transitional phase to promote eating habits in accordance with the recommendations for retirement.

Inequalities in diet quality by socio-demographic characteristics, smoking, and weight status in a large UK-based cohort using a new UK diet quality questionnaire-UKDQQ

The aim of this study was to explore the associations between diet quality, socio-demographic measures, smoking, and weight status in a large, cross-sectional cohort of adults living in Yorkshire and Humber, UK. Data from 43, 023 participants aged over 16 years in the Yorkshire Health Survey, 2nd wave (2013-2015) were collected on diet quality, socio-demographic measures, smoking, and weight status. Diet quality was assessed using a brief, validated tool. Associations between these variables were assessed using multiple regression methods. Split-sample cross-validation was utilised to establish model portability. Observed patterns in the sample showed that the greatest substantive differences in diet quality were between females and males (3.94 points; P < 0.001) and non-smokers vs smokers (4.24 points; P < 0.001), with higher diet quality scores observed in females and non-smokers. Deprivation, employment status, age, and weight status categories were also associated with diet quality. Greater diet quality scores were observed in those with lower levels of deprivation, those engaged in sedentary occupations, older people, and those in a healthy weight category. Cross-validation procedures revealed that the model exhibited good transferability properties. Inequalities in patterns of diet quality in the cohort were consistent with those indicated by the findings of other observational studies. The findings indicate population subgroups that are at higher risk of dietary-related ill health due to poor quality diet and provide evidence for the design of targeted national policy and interventions to prevent dietary-related ill health in these groups. The findings support further research exploring inequalities in diet quality in the population.

Who likes meat, fish, and seafood? Influence of sex, age, body mass index, smoking, and olfactory efficiency on meat product preferences

Meat, fish, and seafood are animal products that can be found in various forms in the human diet. In Western culture, there are trends to reduce meat consumption. This work was created to assess how various factors influence the fact that we like to eat meat, fish, and seafood. Exploring these relationships will contribute to our understanding of why dietary interventions for the above foods may be so difficult to implement in some groups of people. Two hundred eighty-three people living in Poland took part in the study. An interview and olfactory tests were conducted together with assessments of food preferences from 25 types of food products. The extent to which sex, age, body mass index, tobacco addiction, and sense of smell influence 'meat, fish and seafood' consumption was assessed. Using the factor analysis, a coherent group of 'meat, fish and seafood' products was selected: beef, pork, veal, cured meats, poultry, fish dishes, and seafood. 'Meat, fish and seafood' was liked more by men, compared to women (B = .85; CI = .60, 1.10; t = 6.66, η 2 = .14; p < .001), whereas other factors did not affect the preference of dishes from this group as a whole. A detailed analysis of each type of food separately showed, however, that not only is gender important, but fish is liked more by older people, and cured meats by people who identify odors more efficiently. When planning a diet change, including the products mentioned above, we should consider the sex and age of the person to whom the diet is addressed, because men declare a higher derived pleasure from eating various types of meat, fish, and seafood than women, while older people like fish more.

Engaging with 'less affluent' communities for food system transformation: a community food researcher model (FoodSEqual project)

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with socio-demographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet are often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project is a research consortium that aims to 'co-produce healthy and sustainable food systems for disadvantaged communities'. The project focusses on innovating food products, supply chains and policies, placing communities at the centre of the change. Tackling the above issues requires new ways of working. Creative approaches in food research are known to empower a wider range of individuals to share their 'lived food experience' narratives, building relationships and corroborating co-production philosophies, thus promoting social justice, and challenging more traditional positivist/reductionist 'biomedical' approaches for nutrition and food studies. This review paper critiques the use of community-centric approaches for food system transformation, focusing on one, a community food researcher model() as an exemplar, to highlight their utility in advocating with rather than for less affluent communities. The potential for creative methods to lead to more equitable and lasting solutions for food system transformation is appraised, consolidating the need for community-driven systemic change to foster more progressive and inclusive approaches to strengthen social capital. The paper closes with practice insights and critical considerations offering recommendations for readers, researchers, and practitioners, enabling them to better understand and apply similar approaches.

Ethnic differences in meat consumption attitudes, norms and behaviors: A survey of White, South Asian and Black ethnic groups in the UK

A reduction in meat consumption is necessary to mitigate negative impacts of climate change and adverse health outcomes. The UK has an increasingly multi-ethnic population, yet there is little research on meat consumption habits and attitudes among ethnic groups in the UK. We ran a survey (N = 1014) with quota samples for ethnic groups and analyzed attitudes, behaviors and norm perceptions of White, South Asian and Black British respondents. Most respondents believe overconsumption of red and processed meat has negative impacts on health (73.3%) and the environment (64.3%).South Asian respondents were statistically significantly less likely to be meat eaters than White respondents (OR = 0.44, 95% CIs: 0.30-0.65, t = -4.15, p = 0.000), while there was no significant difference between White and Black respondents (OR = 1.06, 95% CIs: 0.63-1.76, t = 0.21, p = 0.834). Both South Asian (OR = 2.76, 95% CIs: 1.89-4.03 t = 5.25, p = 0.000) and Black respondents (OR = 2.09, 95% CIs: 0.1.30-3.35, t = 3.06, p = 0.002) were significantly more likely to express being influenced by friends and family in their food choices than White respondents. South Asian (OR = 3.24,95% CIs: 2.17-4.84, t = 5.74, p = 0.000) and Black (OR = 2.02,95% CIs: 1.21-3.39, t = 2.69, p = 0.007) respondents were also both significantly more likely to report they would want to eat similarly to their friends and family than White respondents. Statistical analyses suggested some gender and socioeconomic differences across and among ethnic groups, which are reported and discussed. The differences in meat consumption behaviors and norm conformity between ethnic groups raises the prospect that interventions that leverage social norms may be more effective in South Asian groups than Black and White groups in the UK.

Red and Red Processed Meat Consumption Behaviors in Scottish Adults

In 2021, 32% of adult meat consumers in Scotland exceeded the 70 g/d recommended limit of red and red processed meat (RPM) intake. We analyzed RPM consumption behaviors among adults in the Scottish Health Survey (2021) to better understand this consumer group. Consumers were categorized into low, medium, and high consumers, and overall, mean intake was 66 g/d. Males and individuals living in the most deprived areas were most likely to be high consumers (45% compared with 30% for males compared with females, respectively, and 44% compared with 32% for those in the most compared with least deprived areas, respectively). Dinners accounted for the majority of intake among high (55%) and medium (52%) consumers, whereas low consumers distributed intake between lunch (40%) and dinner (48%). Across all groups, consumption was highest on Sundays, and majority of RPM was purchased at supermarkets. Beef dishes and sandwiches were primary contributors among high and medium consumers. These insights can inform the design of effective strategies and policies aligned with meat reduction targets. For instance, strategies focusing on modifying traditional meat-centric dishes and sandwiches could be impactful.

Living with obesity in Ireland: determinants, policy and future perspectives

Globally, the prevalence of those living with obesity (≥30 kg/m2) is rising, with this trend expected to continue if firm and decisive policy interventions are not introduced. Across Europe, despite many consecutive policies aiming to reverse rising trends in weight status over recent decades, no country is currently on track to halt and reverse current trends in the coming years. This is evident in Ireland too, whereby the reporting of nationally representative weight status data show that targets have not been achieved since reporting began. The aim of this review is to critically appraise recent evidence relating to the key determinants of obesity including weight status, diet quality and physical activity with an emphasis on socioeconomic inequalities. And to consider these in the context of respective policy measures and propose future-focused recommendations. Furthermore, as with the complex nature of obesity, multifaceted approaches that shift the focus from the individual and place responsibility at a societal level will be reviewed.

Adherence to dietary recommendations by socioeconomic status in the United Kingdom biobank cohort study

Introduction

Understanding how socioeconomic markers interact could inform future policies aimed at increasing adherence to a healthy diet.

Methods

This cross-sectional study included 437,860 participants from the UK Biobank. Dietary intake was self-reported. Were used as measures socioeconomic education level, income and Townsend deprivation index. A healthy diet score was defined using current dietary recommendations for nine food items and one point was assigned for meeting the recommendation for each. Good adherence to a healthy diet was defined as the top 75th percentile, while poor adherence was defined as the lowest 25th percentile. Poisson regression was used to investigate adherence to dietary recommendations.

Results

There were significant trends whereby diet scores tended to be less healthy as deprivation markers increased. The diet score trends were greater for education compared to area deprivation and income. Compared to participants with the highest level of education, those with the lowest education were found to be 48% less likely to adhere to a healthy diet (95% Confidence Interval [CI]: 0.60-0.64). Additionally, participants with the lowest income level were 33% less likely to maintain a healthy diet (95% CI: 0.73-0.81), and those in the most deprived areas were 13% less likely (95% CI: 0.84-0.91).

Discussion/conclussion

Among the three measured proxies of socioeconomic status - education, income, and area deprivation - low education emerged as the strongest factor associated with lower adherence to a healthy diet.

A systematic scoping review of health-promoting interventions for contact centre employees examined through a behaviour change wheel lens

PURPOSE

Social determinants of health and poor working conditions contribute to excessive sickness absence and attrition in contact centre advisors. With no recent review conducted, the current scoping review is needed to investigate the volume, effectiveness, acceptability, and feasibility of health-promoting interventions for contact centre advisors. This will inform the adoption and implementation of evidence-based practice, and future research.

METHODS

Searches conducted across four databases (MEDLINE, PsycInfo, CINAHL, Web of Science) and reference checking in February 2023 identified health-promoting interventions for contact centre advisors. Extracted and coded data from eligible interventions were systematically synthesised using the nine intervention functions of the Behaviour Change Wheel and behaviour change technique taxonomy.

RESULTS

This scoping review identified a low number of high quality and peer-reviewed health-promoting intervention studies for contact centre advisors (28 studies since 2002). Most interventions were conducted in high-income countries with office-based advisors, predominantly using environmental restructuring and training strategies to improve health. Most interventions reported positive effectiveness results for the primary intended outcomes, which were broadly organised into: i) health behaviours (sedentary behaviour, physical activity, smoking); ii) physical health outcomes (musculoskeletal health, visual health, vocal health, sick building syndrome); iii) mental health outcomes (stress, job control, job satisfaction, wellbeing). Few interventions evaluated acceptability and feasibility.

CONCLUSION

There is little evidence on the effectiveness, acceptability, and feasibility of health-promoting interventions for contact centre advisors. Evidence is especially needed in low-to-middle income countries, and for remote/hybrid, nightshift, older and disabled advisors.

Time Trends in Income-related Differences in Food Group Intakes: The National Health and Nutrition Survey, Japan in 2010, 2014, and 2018

BACKGROUND

We aimed to clarify whether differences in food group intake according to household income have changed over the last decade in Japanese people aged 20 years or older.

METHODS

This cross-sectional study was based on the 2010, 2014, and 2018 National Health and Nutrition Surveys in Japan. Food intake was assessed using a 1-day semi-weighed household dietary record. The participants were categorized into three groups based on their income. The mean of each food intake according to the income group was estimated by adjusting for age, occupation, and number of participants from the same household. The significance of the interaction terms between income and survey year was evaluated to assess the change in income-related differences in food intake over time.

RESULTS

Cereal intake was lower in the middle- and the highest-income groups than in the lowest-income group, regardless of sex, and the interaction between income and year was nonsignificant for cereal intake. In the former two surveys, vegetable intake was higher among the highest-income women, while in the 2018 survey, the vegetable intake decreased in the women in the middle- and the highest-income groups. The interaction between income and year was significant for vegetable intake among the women. For other foods, the differences in intake among the income groups did not significantly change over time.

CONCLUSION

The tendency for lower cereal intake in the higher-income groups was consistent over time in both the sexes, and the tendency for higher vegetable intake in the highest income women disappeared over time.

Consumption of foods with the highest nutritional quality, and the lowest greenhouse gas emissions and price, differs between socio-economic groups in the UK population

OBJECTIVE

To establish a baseline understanding of whether consuming food with the highest nutritional quality, lowest greenhouse gas emissions (GHGE) and cost differs between different UK demographic and socio-economic population groups.

DESIGN

Multiple linear regression models were fitted to evaluate the relationship between predictor socio-demographic variables in this study (i.e. sex, ethnic group, age, BMI and level of deprivation) and the response variables (i.e. consumption of items considered most nutritious, with a low GHGE and price, as a proportion of total items consumed).

SETTING

The UK.

PARTICIPANTS

1374 adult (18-65 years) participants from the National Diet and Nutrition Survey latest waves 9-11 (2016-2017 and 2018-2019).

RESULTS

Based on the total energy consumption in a day, the average diet-based GHGE was significantly higher for participants with a higher BMI. Non-white and most deprived participants spent significantly (P < 0·001) less money per total energy consumption. Participants with a BMI between 18·6 and 39·9 kg/m2 and those living in the least deprived areas consumed a significantly (P < 0·001) higher amount of those items considered the most nutritious, with the lowest GHGE and cost per 100 kcal.

CONCLUSIONS

Consumption of food with the highest nutritional quality, lowest GHGE and cost in the UK varies among those with different socio-demographic characteristics, especially the deprivation level of participants. Our analysis endorses the consideration of environmental sustainability and affordability, in addition to the consideration of nutritional quality from a health perspective, to make current dietary guidelines more encompassing and equitable.

"Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank

For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.

A critical exploration of the diets of UK disadvantaged communities to inform food systems transformation: a scoping review of qualitative literature using a social practice theory lens

The UK food system affects social, economic and natural environments and features escalating risk of food insecurity. Yet it should provide access to safe, nutritious, affordable food for all citizens. Disadvantaged UK communities [individuals and families at risk of food and housing insecurity, often culturally diverse] have often been conceptualised in terms of individual behaviour which may lead to findings and conclusions based on the need for individual change. Such communities face public health challenges and are often treated as powerless recipients of dietary and health initiatives or as 'choiceless' consumers within food supply chains. As transforming the UK food system has become a national priority, it is important a diverse range of evidence is used to support understanding of the diets of disadvantaged communities to inform food systems transformation research.A scoping review of UK peer reviewed qualitative literature published in MEDLINE, CINAHL Plus with Full Text, EMBASE, PsycINFO and Web of Science between January 2010 and May 2021 in English. Eligibility criteria were applied, a data extraction table summarised data from included studies, and synthesis using social practice theory was undertaken.Forty-five qualitative studies were reviewed, which included the views of 2,434 community members aged between 5 and 83. Studies used different measures to define disadvantage. Synthesis using social practice theory identified themes of food and dietary practices shaped by interactions between 'material factors' (e.g. transport, housing and money), 'meanings' (e.g. autonomy and independence), and 'competencies' (e.g. strategies to maximise food intake). These concepts are analysed and critiqued in the context of the wider literature to inform food systems transformation research.This review suggests to date, qualitative research into diets of UK disadvantaged communities provides diverse findings that mainly conceptualise disadvantage at an individual level. Whilst several studies provide excellent characterisations of individual experience, links to 'macro' processes such as supply chains are largely missing. Recommendations are made for future research to embrace transdisciplinary perspectives and utilise new tools (e.g., creative methods and good practice guides), and theories (e.g., assemblage) to better facilitate food systems transformation for disadvantaged communities.

Factors Affecting Inequality in the Quality Diets: A Scoping Review

OBJECTIVES

the current dietary pattern is found increasingly unsafe, unstable, and unequal for a huge part of the populations. Disadvantaged populations were usually known by less healthy diets and were at a higher risk of disease in comparison with high socioeconomic groups. The current scoping review study aims at indicating the effective factors on inequality in the quality of diets.

METHODS

the academic databases, including Scopus, Web of science, PubMed, Scientific Information Database, Islamic World Science Citation Center, Google scholar search engine, World Health Organization, and the website of the European Union, until April 2021, were systematically reviewed. We used vote counting technique to identify the effective factors causing inequality in the quality of diets.

RESULTS

The factors that have caused inequality in the quality of diets were divided into 3 categories of demographic, lifestyle, and socioeconomic. It was found that any increase in age, income, education, different ethnic groups, smoking, and occupational statues increased inequality in diet quality. Also, as a factor physical activity, could reduce inequality in diet quality. Moreover, type of residence in terms of access to food, dominant available food, and culture of the area could cause inequality in diet quality.

CONCLUSIONS

According to the results of this study, the effective factors on inequality in the quality of diet are demographic and socioeconomic factors that cannot be manipulated by policy makers. Nevertheless, increasing the knowledge of individuals, improving their lifestyle, and providing subsidies to poorer individuals reduce inequality in the quality of the diets.

The impact of price promotions on confectionery and snacks on the energy content of shopping baskets: A randomised controlled trial in an experimental online supermarket

Overconsumption of foods high in fat, sugars, and salt (HFSS) poses a significant risk to health. The government in England has passed legislation that would limit some price promotions of HFSS foods within supermarkets, but evidence regarding likely impacts of these policies, especially in online settings, is limited. This study aimed to determine whether there were any differences in the energy and nutrient content of shopping baskets after removing promotions on HFSS foods in an online experimental supermarket. UK adults (n = 511) were asked to select food from four categories with a £10 budget in an online experimental supermarket: confectionery; biscuits and crackers; crisps, nuts and snacking fruit; cakes and tarts. They were randomly allocated to one of two trial arms: (1) promotions present (matched to promotion frequency seen in a major UK retailer) (n = 257), or (2) all promotions removed from all products within the target food categories (n = 254). The primary outcome analysis used linear regression to compare total energy (kcal) of items placed in shopping baskets when promotions were present vs. absent, while secondary analyses investigated differences in nutrients and energy purchased from individual food categories. Mean energy in food selected without promotions was 5156 kcal per basket (SD 1620), compared to 5536 kcal (SD 1819) with promotions, a difference of -552kcal (95%CIs: -866, -238), equivalent to 10%. There were no significant differences in energy purchased for any individual category between groups. No evidence was found of other changes in nutritional composition of baskets or of significant interactions between the impact of promotions and participant characteristics (gender, age, ethnicity) on energy purchased. Removing promotions on HFSS foods resulted in significantly less total energy selected in an online experimental supermarket study.

Impact of the Family Environment on the Frequency of Animal-Based Product Consumption in School-Aged Children in Central Poland

Animal-sourced foods (ASFs) have a high nutritional value, which makes them important elements of young people's diets. Several environmental factors might affect the dietary habits of children and adolescents, and their identification seems to be a principal reason to maintain their healthy eating practice. Thus, we aimed to investigate selected environmental factors (a place of residence, net income, mother's education level, number of siblings, and mother's BMI), which may be linked to the consumption frequency of ASFs among school-aged children. In total, 892 mothers of primary school children aged 7-14 years from central Poland took part in the anonymous and voluntary survey. The frequency of meat and meat product consumption was affected by the mother's education level, place of residence, and net income. Generally, meat was eaten more often by the city children (G = 0.178, p < 0.01) of better-educated mothers (G = 0.268, p < 0.001) and higher-income families (G = 0.209, p < 0.001). A higher level of education was linked to more frequent fish consumption but only in the younger group (G = 0.130, p < 0.05). The frequency of egg intake was positively associated with the maternal level of education (G = 0.185, p < 0.001), children's gender (girls > boys, G = 0.123, p < 0.05), and place of residence (city > village, G = 0.214, p < 0.001). In turn, the frequency of milk and dairy intake was related only to the place of residence (village > city, G = 0.97, p <0.05). It can be concluded that the mother's level of education is a key factor linked to the selected children's dietary habits. Thus, we believe that successful health education programs designed for young people should include the maternal capacity to interpret and adapt information into daily practice.

Widening mismatch between UK seafood production and consumer demand: a 120-year perspective

Developed countries are increasingly dependent on international trade to meet seafood requirements, which has important social, environmental, and economic implications. After becoming an independent coastal state following Brexit, the UK faces increased trade barriers and changes in seafood availability and cost. We compiled a long-term (120-year) dataset of UK seafood production (landings and aquaculture), imports, and exports, and assessed the influence of policy change and consumer preference on domestic production and consumption. In the early twentieth century, distant-water fisheries met an increasing demand for large, flaky fish such as cod and haddock that are more abundant in northerly waters. Accordingly, from 1900 to 1975, the UK fleet supplied almost 90% of these fish. However, policy changes in the mid-1970s such as the widespread establishment of Exclusive Economic Zones and the UK joining the European Union resulted in large declines in distant-water fisheries and a growing mismatch between seafood production versus consumption in the UK. While in 1975, UK landings and aquaculture accounted for 89% of seafood consumed by the British public, by 2019 this was only 40%. The combination of policy changes and staunch consumer preferences for non-local species has resulted in today's situation, where the vast majority of seafood consumed in the UK is imported, and most seafood produced domestically is exported. There are also health considerations. The UK public currently consumes 31% less seafood than is recommended by government guidelines, and even if local species were more popular, total domestic production would still be 73% below recommended levels. In the face of climate change, global overfishing and potentially restrictive trade barriers, promoting locally sourced seafood and non-seafood alternatives would be prudent to help meet national food security demands, and health and environmental targets..

Supplementary Information

The online version contains supplementary material available at 10.1007/s11160-023-09776-5.

Intakes of major food groups in China and UK: results from 100,000 adults in the China Kadoorie biobank and UK biobank

PURPOSE

Different populations may exhibit differences in dietary intakes, which may result in heterogeneities in diet-disease associations. We compared intakes of major food groups overall, by sex, and by socio-economic status (SES) (defined as both education and income), between participants in the China Kadoorie Biobank (CKB) and the UK Biobank (UKB).

METHODS

Data were from ~ 25,000 CKB participants who completed a validated interviewer-administered computer-based questionnaire (2013-2014) and ~ 74,000 UKB participants who completed ≥ 3 web-based 24-h dietary assessments (2009-2012). Intakes of 12 major food groups and five beverages were harmonized and compared between the cohorts overall, by sex and by SES. Multivariable-adjusted linear regression examined the associations between dietary intakes and body mass index (BMI) in each cohort.

RESULTS

CKB participants reported consuming more rice, eggs, vegetables, soya products, and less wheat, other staple foods (other than rice and wheat), fish, poultry, all dairy products, fruit, and beverages compared to UKB participants. Red meat intake was similar in both cohorts. Having a higher SES was generally associated with a higher consumption of foods and beverages in CKB, whereas in UKB dietary intakes differed more by education and income, with a positive association observed for meat and income in both UKB and CKB but an inverse association observed for education in UKB. Associations of dietary intakes with BMI varied between the two cohorts.

CONCLUSION

The large differences in dietary intakes and their associations with SES and BMI could provide insight into the interpretation of potentially different diet-disease associations between CKB and UKB.

The Food4Years Ageing Network: Improving foods and diets as a strategy for supporting quality of life, independence and healthspan in older adults

By 2050, it is predicted that one in four people in the United Kingdom will be aged 65 years and over. Increases in lifespan are not always translated into years spent in good health. Incidence rates for chronic diseases are increasing, with treatments allowing people to live longer with their disease. There is good evidence to support changes to lifestyle to maintain or improve body composition, cognitive health, musculoskeletal health, immune function and vascular health in older adults. Much research has been done in this area, which has produced significant support for foods and nutrients that contribute to improved healthspan. Yet two major barriers remain: firstly, older adult consumers are not meeting current UK recommendations for macro- and micronutrients that could benefit health and quality of life and secondly, the UK-specific recommendations may not be sufficient to support the ageing population, particularly for nutrients with key physiological roles. More work is needed to improve intakes of specific foods, diets and nutrients by older adults, through a variety of mechanisms including (i) development of specific food products; (ii) improved clarity of information and (iii) appropriate marketing, and policy changes to enable incentives. The Food4Years Ageing Network aims to build a wide-reaching and multidisciplinary community that is committed to the development, integration and communication of healthy, affordable foods and specific diets for all older adults across the UK food landscape. The Network will identify evidence-based strategies for improving food intake and nutrition in older adults, paving the way to "living well while living longer."

Fruit and vegetable consumption as a preventative strategy for non-communicable diseases

A high intake of fruit and vegetables (FV) has consistently been associated with a reduced risk of a number of non-communicable diseases. This evidence base is largely from prospective cohort studies, with meta-analyses demonstrating an association between increased FV intake and reduced risk of both CHD and stroke, although the evidence is less certain for cancer and diabetes. Controlled intervention trials examining either clinical or intermediate risk factor endpoints are more scarce. Therefore, evidence that FV consumption reduces the risk of disease is so far largely confined to observational epidemiology, which is hampered by some methodological uncertainties. Although increased FV intake is promoted across all dietary guidelines, national surveys confirm that dietary intakes are suboptimal and are not increasing over time. A range of barriers to increasing FV intake exist, including economic, physical and behavioural barriers that must be considered when exploring potential opportunities to change this, considering the feasibility of different approaches to encourage increased FV consumption. Such interventions must include consideration of context, for example, challenges and uncertainties which exist with the whole food system.

The visual basis of reading and reading difficulties

Most of our knowledge about the neural networks mediating reading has derived from studies of developmental dyslexia (DD). For much of the 20th C. this was diagnosed on the basis of finding a discrepancy between children's unexpectedly low reading and spelling scores compared with their normal or high oral and non-verbal reasoning ability. This discrepancy criterion has now been replaced by the claim that the main feature of dyslexia is a phonological deficit, and it is now argued that we should test for this to identify dyslexia. However, grasping the phonological principle is essential for all learning to read; so every poor reader will show a phonological deficit. The phonological theory does not explain why dyslexic people, in particular, fail; so this phonological criterion makes it impossible to distinguish DD from any of the many other causes of reading failure. Currently therefore, there is no agreement about precisely how we should identify it. Yet, if we understood the specific neural pathways that underlie failure to acquire phonological skills specifically in people with dyslexia, we should be able to develop reliable means of identifying it. An important, though not the only, cause in people with dyslexia is impaired development of the brain's rapid visual temporal processing systems; these are required for sequencing the order of the letters in a word accurately. Such temporal, "transient," processing is carried out primarily by a distinct set of "magnocellular" (M-) neurones in the visual system; and the development of these has been found to be impaired in many people with dyslexia. Likewise, auditory sequencing of the sounds in a word is mediated by the auditory temporal processing system whose development is impaired in many dyslexics. Together these two deficits can therefore explain their problems with acquiring the phonological principle. Assessing poor readers' visual and auditory temporal processing skills should enable dyslexia to be reliably distinguished from other causes of reading failure and this will suggest principled ways of helping these children to learn to read, such as sensory training, yellow or blue filters or omega 3 fatty acid supplements. This will enable us to diagnose DD with confidence, and thus to develop educational plans targeted to exploit each individual child's strengths and compensate for his weaknesses.

Self-Reported Purchasing Behaviour, Sociodemographic Predictors of Plant-Based Protein Purchasing and Knowledge about Protein in Scotland and England

Plant-based diets are seen as a food-based strategy to address both the impact of dietary patterns on the environment, to reduce climate change impact, and also to reduce rates of diet-related disease. This study investigated self-reported consumer purchasing behaviour of plant-based alternative foods (PBAF) and wholefood plant protein foods (legumes) with a cross-sectional online survey. We identified the sociodemographic factors associated with purchasing behaviour and examined knowledge about protein and plant-based diets. We recruited and obtained consent from n = 1177 adults aged >18 from England and Scotland (mean age (± standard deviation (SD)) 44 (16.4) years), across different areas of social deprivation, based on postcode. Descriptive statistics were conducted, and sociodemographic factors were examined by computing covariate-adjusted models with binary logistic regression analysis. A total of 47.4% (n = 561) consumers purchased PBAF and 88.2% (n = 1038) wholefood plant-proteins. The most frequently purchased PBAF were plant-based burgers, sausages, and mince/meatballs. Individuals from low deprivation areas were significantly more likely than individuals from high deprivation areas to purchase wholefood plant-proteins (odds ratio (OR) 3.46, p = 0.001). People from low deprivation areas were also more likely to recognise lentils as good source of protein (OR 1.94, p = 0.003) and more likely to recognise plant-based diets as healthy (OR 1.79, p = 0.004) than those from high deprived areas. These results support current trends of increasing popularity of PBAF, which is positive for the environment, but also highlights these products as being ultra-processed, which may negatively impact on health. The study also re-enforces the link between deprivation, reduced purchasing of wholefood plant-proteins and knowledge of plant-based protein and diets. Further research is needed to examine healthfulness of PBAF and how sociodemographic factors, especially deprivation, affect both food choice and consumption of wholefood plant-proteins.

The partner in the plate: the association between changes in partnership status and protein consumption among older people in Europe

Experiencing a change in partnership status at older ages might have detrimental effects on an individual's habits, including eating behaviours. Prior studies presented evidence that widowhood is related to altered diets with a decrease in the amount of protein consumed, which is considered to be an important risk factor of frailty among older people. Using data from Waves 4–8 of the Survey of Health, Ageing and Retirement in Europe (N = 134,313), we investigate the association between stability and changes in partnership status and changes in the frequency of protein consumption at older ages. We also explore the potential moderating role played by changes in economic resources. Having never been married, being divorced and being widowed were significantly associated with a lower frequency of protein consumption among both men and women. The transition to widowhood was significantly associated with a reduction in the frequency of protein consumption, while this same association was not found in the transition to divorce. Subjective evaluation of economic resources did not moderate the relationship between changes in partnership status and frequency of protein consumption. In short, changes in eating behaviours after having experienced the loss of a partner due to widowhood might contribute to accounting for health differentials between those ageing alone and those with a partner.

Is altering the availability of healthier vs. less-healthy options effective across socioeconomic groups? A mega-analysis

Background

Availability interventions have been hypothesised to make limited demands on conscious processes and, as a result, to be less likely to generate health inequalities than cognitively-oriented interventions. Here we synthesise existing evidence to examine whether the impact of altering the availability of healthier vs. less-healthy options differs by socioeconomic position.

Methods

Individual-level data (21,360 observations from 7,375 participants) from six studies (conducted online (n = 4) and in laboratories (n = 2)) were pooled for mega-analysis. Multilevel logistic regressions analysed the impact of altering the availability of healthier options on selection of a healthier (rather than a less-healthy) option by socioeconomic position, assessed by (a) education and (b) income.

Results

Participants had over threefold higher odds of selecting a healthier option when the available range was predominantly healthier compared to selections when the range offered was predominantly less-healthy (odds ratio (OR): 3.8; 95%CIs: 3.5, 4.1). Less educated participants were less likely to select healthier options in each availability condition (ORs: 0.75–0.85; all p < 0.005), but there was no evidence of differences in healthier option selection by income. Compared to selections when the range offered was predominantly less-healthy, when predominantly healthier options were available there was a 31% increase in selecting healthier options for the most educated group vs 27% for the least educated. This modest degree of increased responsiveness in the most educated group appeared only to occur when healthier options were predominant. There was no evidence of any differential response to the intervention by income.

Conclusion

Increasing the proportion of healthier options available increases the selection of healthier options across socioeconomic positions. Availability interventions may have a slightly larger beneficial effect on those with the highest levels of education in settings when healthier options predominate.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01315-y.

Associations between childhood to adulthood socio-economic mobility and adult diet quality

The impact of change in socio-economic status (SES) from childhood to adulthood (SES mobility) on adult diet is not well understood. This study examined associations between three SES mobility variables (area disadvantage, education, occupation) and adult diet quality. 1482 Australian participants reported childhood area-level SES in 1985 (aged 10-15 years) and retrospectively reported highest parental education and main occupation (until participant age 12) and own area-level SES, education, occupation and dietary intake in 2004-2006 (aged 26-36 years). A Dietary Guidelines Index (DGI) was calculated from food frequency and habit questionnaires. A higher score (range 0-100) indicated better diet quality. Sex-stratified linear regression models adjusted for confounders. Area-level SES mobility was not associated with diet quality. Compared with stable high (university) education, stable low (school only) was associated with lower DGI scores (males: β = -5·5, 95 % CI: -8·9, -2·1; females: β = -6·3, 95 % CI: -9·3, -3·4), as was downward educational mobility (participant's education lower than their parents) (males: β = -5·3, 95 % CI: -8·5, -2·0; females: β = -4·5, 95 % CI: -7·2, -1·7) and stable intermediate (vocational) education among males (β = -3·9, 95 % CI: -7·0, -0·7). Compared with stable high (professional/managerial) occupation, stable low (manual/out of workforce) males (β = -4·9, 95 % CI: -7·6, -2·2), and participants with downward occupation mobility (males: β = -3·2, 95 % CI: -5·3, -1·1; females: β = -2·8, 95 % CI: -4·8, -0·8) had lower DGI scores. In this cohort, intergenerational low education and occupation, and downward educational and occupational mobility, were associated with poor adult diet quality.

Socio-economic inequalities in dietary intake in Chile: a systematic review

OBJECTIVE

Understanding the socio-economic inequalities in dietary intake is crucial when addressing the socio-economic gradient in obesity rates and non-communicable diseases. We aimed to systematically assess the association between socio-economic position (SEP) and dietary intake in Chile.

DESIGN

We searched for peer-reviewed and grey literature from inception until 31 December 2019 in PubMed, Scopus, PsycINFO, Web of Sciences and LILACS databases. Observational studies published in English and Spanish, reporting the comparison of at least one dietary factor between at least two groups of different SEP in the general Chilean population, were selected. Two researchers independently conducted data searches, screening and extraction and assessed study quality using an adaptation of the Newcastle Ottawa Quality Assessment Scale.

RESULTS

Twenty-one articles (from eighteen studies) were included. Study quality was considered low, medium and high for 24, 52 and 24 % of articles, respectively. Moderate-to-large associations indicated lower intake of fruit and vegetables, dairy products and fish/seafood and higher pulses consumption among adults of lower SEP. Variable evidence of association was found for energy intake and macronutrients, in both children and adults.

CONCLUSIONS

Our findings highlight some socio-economic inequalities in diets in Chile, evidencing an overall less healthy food consumption among the lower SEP groups. New policies to reduce these inequalities should tackle the unequal distribution of factors affecting healthy eating among the lower SEP groups. These findings also provide important insights for developing strategies to reduce dietary inequalities in Chile and other countries that have undergone similar nutritional transitions.

Sociodemographic and Lifestyle Determinants of Adherence to Current Dietary Recommendations and Diet Quality in Middle-Aged Spanish Premenopausal Women

Background

A healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors.

Methods

This is a cross-sectional study based on 1251 premenopausal women, aged 39–50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model.

Results

Regarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0–7.0). Former smokers (OR: 1.38; 95%CI: 1.08–1.78), as well as those with higher educational level (OR_SSecondary:1.68; 95%CI: 0.97–2.93, OR_University:1.82; 95%IC: 1.05–3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR_{>2188.2kcal/day}: 8.22; 95%CI: 6.19–10.92) and with greater physical activity (OR_{≥21METS−h/week}: 1.29; 95%CI: 0.95-1.76) showed greater adherence.

Conclusions

Almost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.

Explaining the effect on food selection of altering availability: two experimental studies on the role of relative preferences

BACKGROUND

Increasing the availability of healthier or plant-based foods increases their selection. The current studies aimed to examine the extent to which relative preferences account for food selections following availability interventions. In particular, (a) whether increasing the availability of lower-energy options increases the likelihood that individuals' highest-ranked option is lower-energy, and (b) the extent to which selections reflect individuals' highest-ranked option from the available range.

METHODS

UK adults (Study 1: n = 1976; Study 2: n = 1078) took part in within-subjects online studies. In both studies, the order of preference between food options was established by participants choosing the option that they would prefer "to eat right now" from every possible pairing within a pool of eight options. Then, participants were shown either predominantly higher-energy options (three higher- and one lower-energy) or predominantly lower-energy options (vice versa), presented in a random order.

RESULTS

When predominantly lower-energy options were presented, the odds of the highest-ranked option being a lower-energy option increased ten-fold (Study 1: odds ratio: 10.1; 95%CI: 8.9,11.4; Study 2: odds ratio: 10.4; 95%CI: 7.4,14.7), compared to when predominantly higher-energy options were available. In both studies, around 90% of selections reflected the highest-ranked option in the range offered in the studied availability conditions (range 88-92%).

CONCLUSIONS

These studies suggest that increased availability of lower-energy options increases the likelihood of an individual's highest-ranked option being lower-energy, and that the highest-ranked option has the greatest likelihood of selection. As such, preferences may be a key contributor to the effects of altering availability on food selections.

TRIAL REGISTRATION

ISRCTN ( http://www.isrctn.com/ISRCTN27598623 ; 3/12/19 [Study 1]; http://www.isrctn.com/ISRCTN61010183 ; 20/4/20 [Study 2]).

Testing availability, positioning, promotions, and signage of healthier food options and purchasing behaviour within major UK supermarkets: Evaluation of 6 nonrandomised controlled intervention studies

BACKGROUND

Governments are increasingly looking for policies to change supermarket environments to support healthier food purchasing. We evaluated 6 interventions within major United Kingdom grocery stores, including availability, positioning, promotions, and signage strategies to encourage selection of healthier products.

METHODS AND FINDINGS

Nonrandomised controlled study designs were used, except for one intervention that was rolled out nationwide using a pre/post within-store design. Store-level weekly sales (units, weight (g), and value (£)) of products targeted in the interventions were used in primary analyses using multivariable hierarchical models and interrupted time series (ITS) analyses. Stocking low fat chips next to regular chips was associated with decreases in sales of regular chips (units) in intervention versus control stores (-23% versus -4%; P = 0.001) with a significant level change in ITS models (P = 0.001). Increasing availability of lower energy packs of biscuits was associated with increased sales but reduced sales of regular biscuits in intervention versus control stores (lower energy biscuits +18% versus -2%; P = 0.245; regular biscuits -4% versus +7%; P = 0.386), although not significantly, though there was a significant level change in ITS models (P = 0.004 for regular biscuits). There was no evidence that a positioning intervention, placing higher fibre breakfast cereals at eye level was associated with increased sales of healthier cereal or reduced sales of regular cereal. A price promotion on seasonal fruits and vegetables showed no evidence of any greater increases in sales of items on promotion in intervention versus control stores (+10% versus +8%; P = 0.101) but a significant level change in ITS models (P < 0.001). A nationwide promotion using Disney characters was associated with increased sales of nonsugar baked beans (+54%) and selected fruits (+305%), with a significant level change in ITS models (P < 0.001 for both). Shelf labels to highlight lower sugar beverages showed no evidence of changes in purchasing of lower or higher sugar drinks. These were all retailer-led interventions that present limitations regarding the lack of randomisation, residual confounding from unmeasured variables, absolute differences in trends and sales between intervention versus control stores, and no independent measures of intervention fidelity.

CONCLUSIONS

Increasing availability and promotions of healthier alternatives in grocery stores may be promising interventions to encourage purchasing of healthier products instead of less healthy ones. There was no evidence that altering positioning within an aisle or adding shelf edge labelling is associated with changes in purchasing behaviours.

TRIAL REGISTRATION

https://osf.io/br96f/.

Impact of increasing the relative availability of meat-free options on food selection: two natural field experiments and an online randomised trial

BACKGROUND

Increasing the availability of lower energy-density foods is a promising intervention to encourage healthier food purchasing but few studies have examined the effect of increasing availability of meat-free meals to promote more sustainable purchasing. We report three studies, all examining the impact of altering the availability of meat-free meals on meal selection.

METHODS

Study 1 (a natural experiment in one university cafeteria) examined the impact of altering the ratio of meat-free meals (one meat-free and two meat, to two meat-free and one meat) on weekly sales of meals containing meat. Study 2 (a natural experiment in 18 worksite cafeterias) examined the impact on meat-free meal sales of a menu change designed to increase the availability of meat-free meals. Study 3 (an online study of 2205 UK-representative adults) compared meal selections when participants were randomised to ranges comprised of (a) one meat-free, three meat options; (b) two meat-free, two meat; or (c) three meat-free, one meat.

RESULTS

Study 1 suggested a significant decrease in the proportion of sales of meat options when the availability of meat-free options increased (- 19.9 percentage points; 95%CIs:-25.2,-14.6), with no evidence of changes to meat-based meal sales in other university cafeterias during the same period. Findings from Study 2 were mixed: multilevel regressions found no evidence of an increase in meat-free meals following the menu change (2.3 percentage points; 95%CIs: - 1.3,5.9), while interrupted time-series analyses suggested sales did increase (2.3; 95%CIs: 0.4,4.2), but implementation of the planned change was limited. In Study 3 reducing meat-free options from 50 to 25% reduced participants' selection of meat-free options (odds ratio 0.35; 95%CIs: 0.26,0.46), while increasing meat-free options from 50 to 75% increased meat-free selections (odds ratio 2.43; 95%CIs: 1.94,3.04). There was no evidence effects were moderated by gender, socioeconomic status or usual meat consumption.

CONCLUSION

Increasing the availability of meat-free options is effective at reducing meat selection and purchasing for different ratios of meat to meat-free options. The magnitude of the effect is uncertain, but with no evidence of differences in response by demographic groups when directly tested.

TRIAL REGISTRATION

Study 3: Open Science Framework; https://osf.io/ze9c6 ; 6/8/2020.

Exploring the Geographic Variation in Fruit and Vegetable Purchasing Behaviour Using Supermarket Transaction Data

The existence of dietary inequalities is well-known. Dietary behaviours are impacted by the food environment and are thus likely to follow a spatial pattern. Using 12 months of transaction records for around 50,000 ‘primary’ supermarket loyalty card holders, this study explores fruit and vegetable purchasing at the neighbourhood level across the city of Leeds, England. Determinants of small-area-level fruit and vegetable purchasing were identified using multiple linear regression. Results show that fruit and vegetable purchasing is spatially clustered. Areas purchasing fewer fruit and vegetable portions typically had younger residents, were less affluent, and spent less per month with the retailer.

Population group differences in subjective importance of meat in diet and red and processed meat consumption

Red and processed meat (RPM) consumption associates directly with several unfavorable health outcomes and with environmental impact of diet. RPM consumption differs between certain population groups, and moreover, encompasses various subjective meanings. Literature on determinants of subjective importance of meat in diet (SIM), however, is scarce. Aims of this study were to determine which sociodemographic and -economic characteristics associate with SIM and RPM consumption. The study was based on the FinHealth 2017 Study. The sample comprised 4671 participants aged 18-74 years. SIM was asked with a question including five response options from "not important at all" to "very important". Habitual dietary intake including RPM consumption was studied with a food frequency questionnaire. RPM consumption level grew in parallel with SIM categories. RPM consumption was high and SIM prevailing in men, those living in rural areas, and those with low education. Women living in household with children consumed more RPM than other women but did not find meat more important. Conversely, men living in household with children found meat more important but did not consume it more than other men. Domain analyses considering individuals within the highest RPM consumption quintile revealed that the oldest age group found meat significantly less important than the youngest group. In order to be able to lower RPM consumption at population level and to move towards healthier and climate-wiser diets, it is important to identify subgroups that consume much meat but also subgroups that find meat especially important. Such dietary transition may be especially challenging to subgroups that consume much meat and also consider it important. Actions to support the dietary transition in different population groups should be developed.

Trends in UK meat consumption: analysis of data from years 1-11 (2008-09 to 2018-19) of the National Diet and Nutrition Survey rolling programme

BACKGROUND

High meat consumption, particularly red meat and processed meat, negatively affects our health, while meat production is one of the largest contributors to global warming and environmental degradation. The aim of our study was to explore trends in meat consumption within the UK and the associated changes in environmental impact. We also aimed to identify any differences in intake associated with gender, ethnicity, socioeconomic status, and year of birth.

METHODS

Our study aimed to describe consumption of red, white, and processed meat within the UK, using data from the National Diet and Nutrition Survey rolling programme (2008-09 to 2018-19), and the associated changes in environmental impact. Meat consumption was based on disaggregated meat data, from 4 day food diaries that excluded all non-meat components of composite dishes. For each year surveyed, trends for meat intake were reported as mean grams per capita per day and linear-regression models were used to test for trends. We used multivariable linear-regression models to examine differences among consumers, as a percentage of food energy, by gender, ethnicity, equivalised household income, and year of birth.

FINDINGS

From 2008 to 2019, average meat consumption per capita per day decreased from 103·7 g (SE 2·3) to 86·3 g (2·9) per day (ptrend<0·0001), including an absolute reduction in red-meat consumption of 13·7 g (ptrend<0·0001), an absolute reduction in processed meat consumption of 7·0 g (ptrend<0·0001), and a 3·2 g increase (ptrend=0·0027) in white-meat consumption. Collectively, these changes were associated with a significant reduction in all six environmental indicators over the whole period. The two middle birth-year groups (people born in 1960-79 and 1980-99) and White individuals were the highest meat consumers. Meat intake increased over time among people born after 1999, was unchanged among Asian and Asian British populations, and decreased in all other population subgroups. We found no difference in intake with gender or household income.

INTERPRETATION

Despite the overall reduction in meat intake, reaching meat-consumption targets that align with sustainable diets will require a substantial acceleration of this trend.

FUNDING

The Wellcome Trust, Our Planet Our Health programme (Livestock, Environment, and People).

Healthy eating strategies for socioeconomically disadvantaged populations: a meta-ethnography

Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success.

Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK.

Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants’ attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants’ engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants.

Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs.

The CASSIOPEA Study (Economic Crisis and Adherence to the Mediterranean diet: poSSIble impact on biOmarkers of inflammation and metabolic PhEnotypes in the cohort of the Moli-sAni Study): Rationale, design and characteristics of participants

BACKGROUND AND AIMS

The CASSIOPEA Study was designed to evaluate whether the economic downturn during the late 2000s was a contributing factor to the observed decrease in adherence to Mediterranean diet (MD).

METHODS AND RESULTS

The study protocol consists of two steps: A) recall of 7406 men and women who, between 2005 and 2006, had been randomly recruited in the Moli-sani Study from the general population of Molise, to assess possible economic hardship (EH) related to the economic crisis initiated in 2007; B) re-examination, between 2017 and 2020, of available subjects identified in Step 1 as poorly or harder hit by EH to test the hypothesis that EH is associated with a decrease in MD adherence, possibly resulting in increased inflammation. The results of Step 1 are reported here. From the initial sample of individuals re-examined after 12.6 years (median; IQR = 12.1-13.0 y), 3646 were finally analysed. An Economic Hardship Score (EHS; range 0-14) was obtained by scoring three domains: 1) change in employment status; 2) financial hardship and 3) financial hardship for health expenditures. Overall, 37.8% of the sample reported high EHS (≥3), whilst 32% scored 0 (no EH). Those with high EHS were prevalently women and younger, with low socioeconomic status.

CONCLUSIONS

High economic hardship was prevalently reported by weaker socioeconomic groups. Longitudinal analysis (step 2) will examine whether the economic crisis had an effect on adherence to Mediterranean diet with consequent potential impact on inflammation, one of the main biological pathways linking MD to health outcomes. CLINICALTRIALS.

GOV IDENTIFIER

NCT03119142.

Impact of increasing the availability of healthier vs. less-healthy food on food selection: a randomised laboratory experiment

Background

Environmental cues shape behaviour, but few studies compare the impact of targeting healthier vs. less-healthy cues. One online study suggested greater impact on selection from increasing the number of less-healthy (vs. healthier) snacks. The current study aimed to: (1) extend the previous study by using physically-present snacks for immediate consumption; (2) explore responsiveness by socio-economic position; (3) investigate possible mediators (response inhibition, food appeal) of any socio-economic differences in selection.

Methods

In a between-subjects laboratory experiment UK adults (n = 417) were randomised according to their ID number (without blinding) to one of three ranges of options: Two healthier, two less-healthy [“Equal”] (n = 136); Six healthier, two less-healthy [“Increased Healthier”] (n = 143); Two healthier, six less-healthy [“Increased Less-Healthy”] (n = 138). Participants completed measures of response inhibition and food appeal, and selected a snack for immediate consumption from their allocated range. The primary outcome was selection of a healthier (over less-healthy) snack.

Results

The odds of selecting a less-healthy snack were 2.9 times higher (95%CIs:1.7,5.1) in the Increased Less-Healthy condition compared to the Equal condition. The odds of selecting a healthier snack were 2.5 times higher (95%CIs:1.5,4.1) in the Increased Healthier (vs. Equal) condition. There was no significant difference in the size of these effects (− 0.2; 95%CIs:-1.1,0.7). Findings were inconclusive with regard to interactions by education, but the direction of effects was consistent with potentially larger impact of the Increased Healthier condition on selection for higher-educated participants, and potentially larger impact of the Increased Less-Healthy condition for less-educated participants.

Conclusions

A greater impact from increasing the number of less-healthy (over healthier) foods was not replicated when selecting snacks for immediate consumption: both increased selections of the targeted foods with no evidence of a difference in effectiveness. The observed pattern of results suggested possible differential impact by education, albeit not statistically significant. If replicated in larger studies, this could suggest that removing less-healthy options has the potential to reduce health inequalities due to unhealthier diets. Conversely, adding healthier options could have the potential to increase these inequalities.

Trial registration

ISRCTN: ISRCTN34626166; 11/06/2018; Retrospectively registered.

Perspective: Application of N-of-1 Methods in Personalized Nutrition Research

Personalized and precision nutrition aim to examine and improve health on an individual level, and this requires reconsideration of traditional dietary interventions or behavioral study designs. The limited frequency of measurements in group-level human nutrition trials cannot be used to infer individual responses to interventions, while in behavioral studies, retrospective data collection does not provide an accurate measure of how everyday behaviors affect individual health. This review introduces the concept of N-of-1 study designs, which involve the repeated measurement of a health outcome or behavior on an individual level. Observational designs can be used to monitor a participant's usual health or behavior in a naturalistic setting, with repeated measurements conducted in real time using an Ecological Momentary Assessment. Interventional designs can introduce a dietary or behavioral intervention with predictors and outcomes of interest measured repeatedly either during or after 1 or more intervention and control periods. Due to their flexibility, N-of-1 designs can be applied to both short-term physiological studies and longer-term studies of eating behaviors. As a growing number of disease markers can be measured outside of the clinic, with self-reported data delivered via electronic devices, it is now easier than ever to generate large amounts of data on an individual level. Statistical techniques can be utilized to analyze changes in an individual or to aggregate data from sets of N-of-1 trials, enabling hypotheses to be tested on a small number of heterogeneous individuals. Although their designs necessitate extra methodological and statistical considerations, N-of-1 studies could be used to investigate complex research questions and to study underrepresented groups. This may help to reveal novel associations between participant characteristics and health outcomes, with repeated measures providing power and precision to accurately determine an individual's health status.

[Poverty as a determinant of food quality in Argentina. Results of the Argentine Study of Nutrition and Health (EANS)]

Introduction

Introduction: socio-economic differences lead to food and nutritional inequalities. Diet is a modifiable risk factor by public health activities, on the way to the prevention of chronic non-communicable diseases. Objective: to estimate food inequalities in Argentina based on the socioeconomic level of the population, analyzing the consumption of different food groups. Methods: Argentine data from the Latin American Study of Nutrition and Health. Sample: 1,266 individuals stratified by gender, socioeconomic level and geographic region. Intake: 2 24-hour reminders with the multi-step technique. Analysis: with the NDS Software average consumption values of 11 food groups were analyzed by socioeconomic level and country region. Results: the population with lower socioeconomic status consumes significantly less fruits, vegetables and dairy products than the population with medium to high socioeconomic level. Fruits: 59 vs. 79.1 and 106.3 g/d, respectively; p = 0.000. Vegetables: 82.3 g/d vs. 112 and 118 g/d; p = 0.000. Dairy products: 114 g/d vs. 165 and 137 g/d; p = 0.000). On the contrary, it consumes a greater volume of soft drinks and industrial juices (680 mL/d vs. 527 and 590 mL/d, respectively; p = 0.000), infusions with added sugar (568 mL/d vs. 385 and 309 mL/d; p = 0.000), bread (85 g/d vs. 75.5 and 66.7 g/d; p = 0.012) and pastries (159 g/d vs. 147 and 122 g/d; p = 0.008). Conclusions: Social vulnerability is an important determinant for diet quality. Interventions designed to reduce social inequalities as linked to nutrition and health are essential.

Have socio-economic inequalities in sugar purchasing widened? A longitudinal analysis of food and beverage consumer data from British households, 2014-2017

OBJECTIVE

To examine socio-economic inequalities in decreases in household sugar purchasing in Great Britain (GB).

DESIGN

Longitudinal, population-based study.

SETTING

Data were obtained from the GB Kantar Fast-Moving Consumer Goods (FMCG) panel (2014-2017), a nationally representative panel study of food and beverages bought and brought into the home. We estimated changes in daily sugar purchases by occupational social grade from twenty-three food groups, using generalised estimating equations (household-level clustering).

PARTICIPANTS

British households who regularly reported food and beverages to the GB Kantar FMCG (n 28 033).

RESULTS

We found that lower social grades obtained a lower proportion of sugar from healthier foods and a greater proportion of sugar from less healthy foods and beverages. In 2014, differences in daily sugar purchased between the lowest and the highest social grades were 3·9 g/capita/d (95 % CI 2·9, 4·8) for table sugar, 2·4 g (95 % CI 1·8, 3·1) for sugar-sweetened beverages, 2·2 g (95 % CI 1·5, 2·8) for chocolate and confectionery and 1·0 g (95 % CI 0·7, 1·3) for biscuits. Conversely, the lowest social grade purchased less sugar from fruits (2·1 g (95 % CI 1·5, 2·8)) and vegetables (0·7 g (95 % CI 0·5, 0·8)) than the highest social grade. We found little evidence of change in social grade differences between 2014 and 2017. These results suggest that recent overall declines in sugar purchases are largely equally distributed across socio-economic groups.

CONCLUSIONS

This suggests that recent population-level policy activity to reduce sugar consumption in GB does not appear to exacerbate or reduce existing socio-economic inequalities in sugar purchasing. Low agency, population-level policies may be the best solution to improving population diet without increasing inequalities.

Dietary Approaches to Stop Hypertension (DASH) diet and associated socio-economic inequalities in the UK

The Dietary Approaches to Stop Hypertension (DASH) diet is an effective measure in the prevention and treatment of CVD. We evaluated recent trends in socio-economic differences in the DASH score in the UK population, using education, occupation and income as proxies of socio-economic position (SEP). We analysed data on 6416 subjects aged 18 years and older collected in the National Diet and Nutrition Survey (2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. Multiple linear regression and quantile regression models were used to evaluate the trend in DASH score according to SEP. The mean DASH score was 24 (sd 5). The estimated mean difference between people with no qualification and those having the highest level of education was -3·61 (95 % CI -4·00, -3·22) points. The mean difference between subjects engaged in routine occupations and those engaged in high managerial and professional occupations was -3·41 (95 % CI -3·89, -2·93) points and for those in the first fifth and last fifth of the household income distribution was -2·71 (95 % CI -3·15, -2·28) points. DASH score improved over time, and no significant differences in the trend were observed across SEP. The widest socio-economic differences emerged for consumption of fruit, vegetables, whole grains, nuts, seeds and legumes. Despite an overall increase in the DASH score, a persisting SEP gap was observed. This is an important limiting factor in reducing the high socio-economic inequality in CVD observed in the UK.

The association between family structure and children's BMI over time-the mediating role of income

PURPOSE

Although both family structure and income have previously been indicated as being associated with body mass index (BMI), the extent to which the effect of family structure on BMI is mediated through income is incompletely understood. Taking the case of the United Kingdom, this study aims to investigate the association between family structure, defined in this study as whether children live in a one- or two-adult household, and childhood BMI, and whether this varies by child sex and with increased age. Second, the study aims to examine whether family equivalised income, as a proxy for socioeconomic status, mediates the association between family structure and childhood BMI.

METHODS

This study uses data from the Millennium Cohort Study. Data from 7478 children born between 2000 and 2001 in the UK at the ages of 3, 5, 7, 11, and 14 were used. Mediation analysis was used to consider, at each age, the extent to which the association between living in a one- or two-adult household and BMI was mediated through income overall and stratified by sex. To assess the robustness of the mediation analysis estimates, we used both E-values and multiple confounder adjustment.

RESULTS

At ages 3 and 5, there was no direct or indirect effect of family structure mediated by income on BMI. Between the ages of 7 and 11, the overall proportion of the association mediated vastly increased, from 19.70% at age 7 up to 42.70% at the age of 11. The E-values show that substantial unmeasured confounder associations would be needed to fully explain away the conclusions from the mediation analysis. Results remained significant when models were additionally adjusted for geographic region, the main respondent's (usually the mother's) highest educational attainment, and ethnicity.

CONCLUSIONS

An increasing proportion of the association between family structure and BMI is mediated by income as children grow older. The study focuses on the mediating role of income between family structure and BMI using the available data as an empirical application of the potential impact of income as mediator in the causal pathway.

A systematic review of the determinants of seafood consumption

Although seafood is considered to be an important part of a balanced diet, many national food consumption surveys suggest that seafood is not consumed in sufficient amounts. As consumers are moving to diversify their diet from animal-based protein, it is important to understand the factors influencing consumption of marine foods. This review aims to assess the characteristics of seafood consumers as well as the influences on seafood consumption in Europe, USA, Canada, Australia and New Zealand. Systematic search strategies were used to identify relevant journal articles from three electronic databases (PubMed, Web of Science and Embase). Three searches were carried out and identified 4405 unique publications from which 121 met the criteria for the review process. The reviewed studies revealed that seafood consumers were more likely to be older, more affluent and more physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a directional association with seafood consumption. The most commonly reported barriers to seafood consumption were cost, followed by sensory or physical barriers, health and nutritional beliefs, habits, availability and cooking skills. The most commonly reported influences were beliefs about the contribution of seafood to health, environmental influences and personal preferences. Based on the findings of this review, future intervention strategies to increase seafood consumption may need to consider affordability and education in terms of health, nutrition and cooking skills. More research is needed to explore the effectiveness of specific interventions at increasing the consumption of seafood.

Understanding the role of diet in adult constipation

Constipation is a common condition in adults and symptoms such as straining and the sensation of incomplete bowel emptying can be distressing for patients. The nurse's role includes preventing, monitoring and managing the condition. Fibre and fluid intake have an important role in prevention, while first-line treatments include increased consumption of wholegrain carbohydrates, fruit and vegetables. This article outlines the role of diet in preventing and managing constipation in adults and offers practical advice for nurses caring for this group of patients.

Altering the availability of products within physical micro-environments: a conceptual framework

Altering the availability of products (e.g. food, alcohol or tobacco products) is one potential intervention to change behaviours to help reduce preventable premature deaths worldwide. However, research on these interventions lacks consistent conceptualisation, hindering clear reporting and cumulative synthesis. This paper proposes a conceptual framework – categorising intervention types and summarising constituent components – with which interventions can be reliably described and evidence synthesised. Three principal distinctions are proposed: interventions altering: (i) Absolute Availability (changing the overall number of options, while keeping the proportions comprised by any subsets of options constant); (ii) Relative Availability (changing the proportion comprised by a subset of options, yet keeping the overall number of options constant); (iii) Absolute and Relative Availability (changing both the overall number of options and the proportions comprised by subsets of options). These are subdivided into those targeting (a) a product or (b) a category of products. Mechanisms that might underlie each of these intervention types are discussed, and implications for future research highlighted. The proposed framework aims to facilitate study of a set of interventions that could contribute significantly to healthier behaviour across populations.

What features of a nutrition resource are important to adolescents of a low socioeconomic status?

OBJECTIVE

To identify the key features of a nutrition resource that are important to adolescents of a low socioeconomic status (SES).

DESIGN

Structured interviews were conducted to explore participants' preferences relating to the features of a nutrition resource. Thematic framework analysis was used to determine key themes, subthemes and concepts from the data.

SETTING

Streetsport activity sessions, north-east of Scotland.

PARTICIPANTS

Eighteen adolescents aged 12-17 years from a low socioeconomic background.

RESULTS

The overarching themes identified were barriers and facilitators to engagement with a nutrition resource. Adolescents expressed a preference for an app, and this was mainly attributed to convenience and low cost. There was also an emphasis on the integral role social media has in their lives. Aesthetics was a facilitator for both male and female participants, with a particular focus on weight loss. Behaviour change support, including reminders, access to simple recipes and adopting a 'small change approach', were identified as possible facilitators, whereas cost, environmental influences, and existing eating habits were identified as possible barriers to engaging with a nutrition resource.

CONCLUSIONS

A number of subthemes, including aesthetics, cost and convenience, which have previously been reported in adolescents with a higher SES, were prominent in our research. The present study contributes to insights relating to behaviour change tools that should be considered when developing a nutrition resource targeting disadvantaged adolescents. Further research focusing on how mobile phone technology and social media can be utilised to support dietary behaviour change in low SES adolescents is recommended.