Sugars, Salt, Saturated Fat and Fibre Purchased through Packaged Food and Soft Drinks in Europe 2015-2018: Are We Making Progress?

The availability, purchase and consumption of foods high in fat, sugars and salt and low in fibre are linked to the high health and economic burden of noncommunicable diseases, including cancer, in Europe. Therefore, assessing the quality of the food offer is key as feedback to decision makers, as well as to identify good practices and areas of the food supply still requiring urgent action. We combined detailed market share and sales data with nutrition composition data to evaluate the nutritional quality of 14 packaged food and soft drinks categories sold across 22 European countries over the 2015–2018 period. Our analysis shows great variability of the nutritional composition within and among packaged food and soft drinks categories across European countries. Our estimates of the market-share weighted mean, a measure that integrates possible changes in nutrient content with the amount of a product sold to consumers, as well as daily per capita nutrient sale estimates, suggest a small but statistically significant progress in certain food categories only. Overall, the amounts of sugars, saturated fat, salt and fibre being sold to European citizens through these products is not improving to an extent to meet public health objectives.

Water Researchers Do Not Have a Strategic Plan for Gathering Evidence to Inform Water Intake Recommendations to Prevent Chronic Disease

Confusion has persisted for decades in the United States (U.S.) over how much plain water to drink, despite national water intake recommendations which are based on high quality scientific evidence. This editorial summarizes the definition, alignment and coordination of evidence that informs the current U.S. adequate intake (AI) recommendations for water. It highlights gaps in the evidence that perpetuate confusion and opportunity to address the gaps through strategic planning.

Addressing Nutritional Gaps: Simple Steps for the Primary Care Provider

Identify common shortfalls in the typical American diet. Address the link between poor diet quality and chronic disease. Identify patients at risk for vitamin deficiency and potential vitamin-drug interactions. Recognize patients with vitamin and mineral deficiencies. Partner with patients regarding selection and appropriate use of vitamin and mineral supplements to achieve recommended dietary allowances.

Growing the Business of Whole Grain in the Australian Market: A 6-Year Impact Assessment

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition Council^™ (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers (“users”) and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content.

Differences in Dietary Intakes among Lebanese Adults over a Decade: Results from Two National Surveys 1997-2008/2009

Amidst the ongoing societal and economic shifts in the Eastern Mediterranean region (EMR), this study aims at investigating temporal trends in food consumption and nutrient intakes among Lebanese adults, by age and sex. Data were derived from two national cross-sectional surveys conducted in Lebanon during two time periods (1997; 2008/2009). In both surveys, dietary assessment was based on 24-h recalls. The results, expressed as % energy intake (%EI), revealed a significant decrease (p < 0.001) in the consumption of bread, fruits, fresh fruit juices, milk and eggs, whereas the consumption of added fats and oils, poultry, cereals and cereal-based products, chips and salty crackers, sweetened milk and hot beverages increased over time (p < 0.001). A significant increase in dietary energy (kcal/day) and fat intake (%EI) was observed, coupled with decreases in carbohydrate intake (%EI) and dietary density of vitamin A and vitamin C (per 1000 kcal) (p < 0.001). These changes were noted in both genders and across age groups, albeit there were some disparities between groups. In conclusion, based on national nutrition surveys, this study is the first to characterize the nutrition transition in a middle-income country of the EMR, shedding light on priority areas for nutrition policies and interventions.

The Decreasing Trend in Dietary Glycaemic Index and Glycaemic Load in Australian Children and Adolescents between 1995 and 2012

This study aims to examine whether there were changes between 1995⁻2012 in the dietary glycaemic index (dGI) and glycaemic load (dGL) in Australian children (<16 years) according to three national surveys in 1995 (1995NS), 2007 (2007NS), and 2011⁻2012 (2012NS). Glycaemic index (GI) values of foods were assigned using published methodology. Plausible 24-h recall data from the 1995NS, 2007NS and 2012NS (weighted n = 2475, 4373 and 1691 respectively) were compared for differences in dGI and dGL, and the contribution to dGL from different foods using one-way ANOVA with Bonferroni post hoc comparisons and linear regression. Decreasing trends across surveys were found in dGI and dGL (p < 0.001). Between 1995 and 2012, dGI and dGL per Megajoule (MJ) dropped by 2% and 6% respectively. The per capita dGL contribution from breads and bread rolls, fruit and vegetable juices, sweetened beverages and potatoes showed strong decreasing trends (R² > 0.7). Our findings suggest that dGI and dGL of Australian youths declined between 1995 to 2012, which may be due to increased awareness of the GI concept and healthy diet, widened food choices and immigrants with diverse dietary habits. This may lower the future risks of chronic degenerative diseases in Australian youths.

Novel Nutrition Profiling of New Zealanders' Varied Eating Patterns

There is increasing recognition that the relationship between nutrition and health is influenced by complex eating behaviors. The aims of this study were to develop novel nutrition profiles of New Zealanders and to describe the prevalence of these profiles. Observational, cross-sectional data from the Sovereign Wellbeing Index, 2014 was used to develop the profiles in an a-priori process. Descriptive prevalence for the total data (N = 10,012; 4797 males; 18+ years) and profiles were reported. Nutrition question responses were presented as: Includers (consumed few time a week or more), Avoiders (few time a month) and Limiters (not eaten). Fruit or non-starchy vegetables were Included (fruit: 83.4%, 95% confidence interval (CI: 82.7, 84.1); vegetables: 82.6% (81.8, 83.4)) by the majority of the sample. Also Included were confectionary (48.6% 95% CI (47.6, 49.6)) and full sugar drinks (34.3% (33.4, 35.2)). The derived nutrition profiles were: Junk Food (22.4% 95% CI (21.6, 23.3)), Moderator (43.0% (42.1, 44.0)), High-Carbohydrate (23.0% (22.2, 23.8)), Mediterranean (11.1% (10.5, 11.8)), Flexitarian (8.8% (8.2, 9.4)), and Low-Carbohydrate (5.4% (4.9, 5.8)). This study suggests that New Zealanders follow a number of different healthful eating patterns. Future work should consider how these alternate eating patterns impact on public health.

Changes in Consumer Attitudes toward Broad-Based and Environment-Specific Sodium Policies-SummerStyles 2012 and 2015

We examined temporal changes in consumer attitudes toward broad-based actions and environment-specific policies to limit sodium in restaurants, manufactured foods, and school and workplace cafeterias from the 2012 and 2015 SummerStyle surveys. We used two online, national research panel surveys to conduct a cross-sectional analysis of 7845 U.S. adults. Measures included self-reported agreement with broad-based actions and environment-specific policies to limit sodium in restaurants, manufactured foods, school cafeterias, workplace cafeterias, and quick-serve restaurants. Wald Chi-square tests were used to examine the difference between the two survey years and multivariate logistic regression was used to obtain odds ratios. Agreement with broad-based actions to limit sodium in restaurants (45.9% agreed in 2015) and manufactured foods (56.5% agreed in 2015) did not change between 2012 and 2015. From 2012 to 2015, there was a significant increase in respondents that supported environment-specific policies to lower sodium in school cafeterias (80.0% to 84.9%; p < 0.0001), workplace cafeterias (71.2% to 76.6%; p < 0.0001), and quick-serve restaurants (70.8% to 76.7%; p < 0.0001). Results suggest substantial agreement and support for actions to limit sodium in commercially-processed and prepared foods since 2012, with most consumers ready for actions to lower sodium in foods served in schools, workplaces, and quick-serve restaurants.

PUFAs, Bone Mineral Density, and Fragility Fracture: Findings from Human Studies

Osteoporosis is a global health problem that leads to an increased incidence of fragility fracture. Recent dietary patterns of Western populations include higher than recommended intakes of n-6 (ω-6) polyunsaturated fatty acids (PUFAs) relative to n-3 (ω-3) PUFAs that may result in a chronic state of sterile whole body inflammation. Findings from human bone cell culture experiments have revealed both benefits and detriments to bone-related outcomes depending on the quantity and source of PUFAs. Findings from observational and randomized controlled trials suggest that higher fatty fish intake is strongly linked with reduced risk of fragility fracture. Moreover, human studies largely support a greater intake of total PUFAs, total n-6 (ω-6) fatty acid, and total n-3 (ω-3) fatty acid for higher bone mineral density and reduced risk of fragility fracture. Less consistent evidence has been observed when investigating the role of long chain n-3 (ω-3) PUFAs or the ratio of n-6 (ω-6) PUFAs to n-3 (ω-3) PUFAs. Aspects to consider when interpreting the current literature involve participant characteristics, study duration, diet assessment tools, and the primary outcome measure.

[Bone and Nutrition. Vitamin D intake and bone]

Vitamin D insufficiency is one of the risk factors of osteoporosis. To know the vitamin D intake for the prevention of bone loss and fracture, it is necessary to evaluate the appropriate serum 25-hydroxyvitamin D (25-D) concentration for bone health, and the vitamin D intake to maintain its concentration. Although vitamin D intake 15 and 20 μg/d have been set as RDA (Recommended Dietary Allowance) in USA/Canada DRIs (Dietary reference intakes), 5.5 μg/d has been set as AI (adequate intake) in Japanese DRIs (2015). While reference values in Japan and USA/Canada were quite different, both DRIs are common in that it aim to maintain the serum 25-D concentration to more than 50 nmol/L. In the present review, vitamin D intakes and bone health, vitamin D status in Japanese people, DRIs for vitamin D and improvement of vitamin D insufficiency are reviewed.

German Nutrition Society (DGE). New Reference Values for Energy Intake

The reference values for energy intake of the German, Austrian and Swiss nutrition societies for children, adolescents and adults are derived using the factorial method. For adults, a mean BMI of 22 kg/m(2) is taken as a basis given the current mean body size for adults residing in Germany (taken from the German Health Interview and Examination Survey for Adults, DEGS1). The determination of the energy expenditure for infants is based on data obtained using the doubly labelled water (DLW) method. The energy storage in growing tissue will be added for the purpose of deriving reference values for this age group. For pregnant women, given an increase in body weight of 12 kg during pregnancy, guiding values for additional energy intake in the second trimester of 250 kcal/day and in the third trimester of 500 kcal/day are indicated using DLW data sets and taking energy storage in growing tissue into account. In case of overweight prior to pregnancy as well as in the case of reduced physical activity during pregnancy, the additional requirement is lower. For women exclusively breastfeeding during the first 4-6 months, the guiding value for additional energy intake is quoted as 500 kcal/day.

Ten-year trends in fiber and whole grain intakes and food sources for the United States population: National Health and Nutrition Examination Survey 2001-2010

Current U.S. dietary guidance includes recommendations to increase intakes of both dietary fiber and whole grain (WG). This study examines fiber and WG intakes, food sources and trends from 2001 to 2010 based on National Health and Nutrition Examination Survey (NHANES) data for children/adolescents (n = 14,973) and adults (n = 24,809). Mean fiber intake for children/adolescents was 13.2 (±0.1) g/day. Mean fiber intake for adults 19–50 years (y) was 16.1 (±0.2) g/day and for adults 51+ was 16.1 (±0.2) g/day. There were significant increases in fiber intake from 2001–2010 for children/adolescents and for adults 51+ y. Mean WG intake for children/adolescents was 0.52 (±0.01) oz eq/day. Mean WG intake for adults 19–50 y was 0.61 (±0.02) oz eq/day and for adults 51+ 0.86 (±0.02) oz eq/day. There were no significant changes in WG intake for any age group from 2001–2010. The main food groups contributing to dietary fiber intake for children/adolescents were vegetables (16.6%), grain mixtures (16.3%), other foods (15.8%) and fruits (11.3%). For adults 19+ y, the main sources of dietary fiber were vegetables (22.6%), other foods (14.3%), grain mixtures (12.0%) and fruits (11.1%). Major WG sources for children/adolescents included ready-to-eat cereals (RTEC) (31%), yeast breads/rolls (21%) and crackers and salty grain snacks (21%). The main sources of WG for adults 19+ were yeast breads/rolls (27%), RTEC (23%) and pastas/cooked cereals/rice (21%). Recommending cereals, breads and grain mixtures with higher contents of both dietary fiber and WG, along with consumer education, could increase intakes among the United States (U.S.) population.