A Consensus Proposal for Nutritional Indicators to Assess the Sustainability of a Healthy Diet: The Mediterranean Diet as a Case Study

BACKGROUND: There is increasing evidence of the multiple effects of diets on public health nutrition, society, and environment. Sustainability and food security are closely interrelated. The traditional Mediterranean Diet (MD) is recognized as a healthier dietary pattern with a lower environmental impact. As a case study, the MD may guide innovative inter-sectorial efforts to counteract the degradation of ecosystems, loss of biodiversity, and homogeneity of diets due to globalization through the improvement of sustainable healthy dietary patterns. This consensus position paper defines a suite of the most appropriate nutrition and health indicators for assessing the sustainability of diets based on the MD. METHODS: In 2011, an informal International Working Group from different national and international institutions was convened. Through online and face-to-face brainstorming meetings over 4 years, a set of nutrition and health indicators for sustainability was identified and refined. RESULTS: Thirteen nutrition indicators of sustainability relating were identified in five areas. Biochemical characteristics of food (A1. Vegetable/animal protein consumption ratios; A2. Average dietary energy adequacy; A3. Dietary Energy Density Score; A4. Nutrient density of diet), Food Quality (A5. Fruit and vegetable consumption/intakes; A6. Dietary Diversity Score), Environment (A7. Food biodiversity composition and consumption; A8. Rate of Local/regional foods and seasonality; A9. Rate of eco-friendly food production and/or consumption), Lifestyle (A10. Physical activity/physical inactivity prevalence; A11. Adherence to the Mediterranean dietary pattern), Clinical Aspects (A12. Diet-related morbidity/mortality statistics; A13. Nutritional Anthropometry). A standardized set of information was provided for each indicator: definition, methodology, background, data sources, limitations of the indicator, and references. CONCLUSION: The selection and analysis of these indicators has been performed (where possible) with specific reference to the MD. Sustainability of food systems is an urgent priority for governments and international organizations to address the serious socioeconomic and environmental implications of short-sighted and short-term practices for agricultural land and rural communities. These proposed nutrition indicators will be a useful methodological framework for designing health, education, and agricultural policies in order, not only to conserve the traditional diets of the Mediterranean area as a common cultural heritage and lifestyle but also to enhance the sustainability of diets in general

Edible leafy vegetables from West Africa (Guinea-Bissau): consumption, trade and food potential

Wild Edible Plants are common in the diet of rural communities of sub-Saharan Africa. In Guinea-Bissau, West Africa, wild plant resources are widely used in human diet, but very few studies have addressed them. The aim of this study is to reveal: (1) the wild and semi-cultivated leafy vegetables consumed in Guinea-Bissau; and (2) the nutritional composition of those plants traded at the largest country market in Bissau. Our results revealed that 24 native or naturalized species with edible leaves are currently consumed by Guinea-Bissau population. Five of them were found at the market: dried leaves of Adansonia digitata, Bombax costatum and Sesamum radiatum, and fresh leaves and shoots of Amaranthus hybridus and Hibiscus sabdari a. The analysis of the nutritional properties revealed that leaves contain a significant amount of protein (10.1–21.0 g/100 g, dry basis), high values of macronutrients and micronutrients, as well as of phenolic compounds (13.1–40.3 mg GAE/g) and a considerable antioxidant capacity (DPPH 111.5–681.9 mg Eq Trolox). Although price and availability vary among the leafy vegetables analyzed, these traditional foods appear to be a good dietary component that can contribute to food security in Guinea-Bissau and in other West African countries, as these species are widely distributed in this regioninfo:eu-repo/semantics/publishedVersio

Findings from the Nutrition Challenge Program

Obesity is an epidemic in the United States. Over 61% of U.S. adults and 58% of Nevada adults have Body Mass Index’s (BMI) that classify them as either overweight or obese (Behavioral Risk Factor Surveillance System [BRFSS], 2005). According to a recent article published in the Journal of the American Medical Association, obesity was the second leading cause of preventable death in the United States behind tobacco use (Mokdad, Marks, Stroup & Gerberding, 2004). While obesity and overweight are complex, multi-factorial health conditions, an important contributor to the overweight and obesity epidemic is poor dietary habits. One of the major public health nutrition education efforts in the past few years has been to encourage Americans to eat more fruits and vegetables. Current dietary guidelines recommend consuming between 5 and 9 servings of fruits and vegetables each day depending on age and gender. A person’s physical activity level and age determine how many calories they need each day and their calorie needs determine how many servings of fruits and vegetables they should eat each day. Only 23% of adults nationwide and 22% of Nevada adults are currently meeting that recommendation, most at the low end (BRFSS, 2005)

School Food Environments and Policies in U.S. Public Schools

Examines food environments in elementary, middle, and high schools based on seventeen factors, including foods and beverages offered, the availability of vending machines, and how they vary by grade level, location, and other school characteristics

Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative.

BackgroundWomen without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), whereas results in women with hypertension or prior CVD could have been confounded by postrandomization use of statins.ObjectivesIntervention participants reported various self-selected changes to achieve the 20% total fat goals. Reviewed are intervention compared with comparison group HRs for CHD, stroke, and total CVD in relation to specific dietary changes in normotensive participants.MethodsDietary change was assessed by comparing baseline with year 1 FFQ data in women (n = 10,371) without hypertension or CVD at baseline with intake of total fat above the median to minimize biases due to use of the FFQ in trial eligibility screening.ResultsIntervention participants self-reported compensating reduced energy intake from total fat by increasing carbohydrate and protein. Specifically they increased plant protein, with those in the upper quartile (increased total protein by ≥3.3% of energy) having a CHD HR of 0.39 (95% CI: 0.22, 0.71), compared with 0.92 (95% CI: 0.57, 1.48) for those in the lower quartile of change (decreased total protein ≥0.6% of energy), with P-trend of 0.04. CHD HR did not vary significantly with change in percentage energy from carbohydrate, and stroke HR did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension Trial and the Healthy Eating Index showed favorable changes in the intervention group.ConclusionsIntervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk in normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol: https://www.whi.org/about/SitePages/Dietary%20Trial.aspx

Capturing health and eating status through a nutritional perception screening questionnaire (NPSQ9) in a randomised internet-based personalised nutrition intervention : the Food4Me study

BACKGROUND: National guidelines emphasize healthy eating to promote wellbeing and prevention of non-communicable diseases. The perceived healthiness of food is determined by many factors affecting food intake. A positive perception of healthy eating has been shown to be associated with greater diet quality. Internet-based methodologies allow contact with large populations. Our present study aims to design and evaluate a short nutritional perception questionnaire, to be used as a screening tool for assessing nutritional status, and to predict an optimal level of personalisation in nutritional advice delivered via the Internet. METHODS: Data from all participants who were screened and then enrolled into the Food4Me proof-of-principle study (n = 2369) were used to determine the optimal items for inclusion in a novel screening tool, the Nutritional Perception Screening Questionnaire-9 (NPSQ9). Exploratory and confirmatory factor analyses were performed on anthropometric and biochemical data and on dietary indices acquired from participants who had completed the Food4Me dietary intervention (n = 1153). Baseline and intervention data were analysed using linear regression and linear mixed regression, respectively. RESULTS: A final model with 9 NPSQ items was validated against the dietary intervention data. NPSQ9 scores were inversely associated with BMI (β = -0.181, p < 0.001) and waist circumference (Β = -0.155, p < 0.001), and positively associated with total carotenoids (β = 0.198, p < 0.001), omega-3 fatty acid index (β = 0.155, p < 0.001), Healthy Eating Index (HEI) (β = 0.299, p < 0.001) and Mediterranean Diet Score (MDS) (β = 0. 279, p < 0.001). Findings from the longitudinal intervention study showed a greater reduction in BMI and improved dietary indices among participants with lower NPSQ9 scores. CONCLUSIONS: Healthy eating perceptions and dietary habits captured by the NPSQ9 score, based on nine questionnaire items, were associated with reduced body weight and improved diet quality. Likewise, participants with a lower score achieved greater health improvements than those with higher scores, in response to personalised advice, suggesting that NPSQ9 may be used for early evaluation of nutritional status and to tailor nutritional advice. TRIAL REGISTRATION: NCT01530139 .Peer reviewedFinal Published versio

Perceived eating norms and vegetable consumption in children

open access articleBackground Beliefs about the eating behaviour of others (perceived eating norms) have been shown to influence eating behaviour in adults, but no research has examined whether young children are motivated by perceived eating norms. Findings Here we investigated the effect on vegetable intake of exposing children to information about the vegetable intake of other children. One hundred and forty three children aged 6–11 years old took part in a between-subjects experiment. Children were exposed to information suggesting that other children had eaten a large amount of carrots, no carrots, or control information. Children ate more carrots when they believed that other children had eaten a large amount of carrots, compared to all other conditions. Conclusions Perceived eating norms can influence vegetable intake in young children and making use of eating norms to promote healthier eating in children warrants investigation

The school food environment and student body mass index and food consumption: 2004 to 2007 national data

PURPOSE: This study identifies trends in the availability of various food choices in United States' middle and high schools from 2004 to 2007, and examines the potential associations between such food availability and students' self-reported eating habits and body mass index (BMI)-related outcomes. METHODS: Data are based on nationally representative samples of 78,442 students in 684 secondary schools surveyed from 2004 to 2007 as part of the Youth, Education, and Society (YES) study and the Monitoring the Future (MTF) study. In the YES study, school administrators and food service managers completed self-administered questionnaires on their school's food environment. In the MTF study, students in the same schools completed self-administered questionnaires, providing data used to construct BMI and food consumption measures. RESULTS: Overall, there was a decrease in the availability of regular-sugar/fat food items in both middle and high schools, and some indication of an increase in high school availability of reduced-fat food items through school lunch or a la carte. Some minimal evidence was found for relationships between the school food environment and student BMI-related outcomes and food consumption measures. CONCLUSIONS: United States secondary schools are making progress in the types of foods offered to students, with food items of lower nutritional value becoming less prevalent in recent years. Continued monitoring of food environment trends may help clarify whether and how such factors relate to youth health outcomes.The Youth, Education, and Society (YES) project (part of a larger research initiative, entitled Bridging the Gap: Research Informing Policy and Practice for Healthy Youth Behavior) is funded by the Robert Wood Johnson Foundation. The Monitoring the Future study is funded by the National Institute on Drug Abuse (DA01411). The views expressed in this article are those of the authors and do not necessarily reflect the views of the funders. (Robert Wood Johnson Foundation; DA01411 - National Institute on Drug Abuse

Home availability of vegetables, barriers to purchasing and preparing vegetables, and vegetable intake in a sample of primarily low-income, Hispanic children

Background: Obesity prevalence in American children disproportionately affects low-income children. Consumption of vegetables is a dietary factor that is often targeted to promote weight loss and decrease risk of obesity, and has shown a relationship with home vegetable availability, though no studies have examined this relationship in a large, predominantly low-income, Hispanic sample. Objective: To examine the association between availability of different types of vegetables in the home, perceived parental barriers to vegetable purchase and preparation, and child vegetable intake in a low-income, Hispanic sample. Design: Secondary cross-sectional analysis of TX Sprouts. Participants: 1925 students from twelve elementary schools who have >50% Hispanic enrollment and >50% of children receiving free and reduced lunches in the Greater Austin area. Main Outcomes Measures: Parents/guardians completed a questionnaire packet that included information about free/reduced lunch program (FRL) participation, availability of fresh, canned, frozen, and cut-up vegetables and salad in the home, and perceived barriers to purchasing/preparing vegetables. Child-reported dietary intake data was collected via 14-item validated dietary screener. Statistical Analyses Performed: Negative binomial regression was used to examine the relationship between home vegetable availability and vegetable intake. Chi-square analyses were conducted to assess the relationship between barriers to purchasing/preparing vegetables and home vegetable availability. Results: Children who had fresh vegetables, cut-up vegetables, and salad available in the home “all of the time” consumed more vegetables than those who had them in the home “never”, “sometimes”, or “most of the time” (p<0.05). Participants were less likely to have vegetables in the home “all of the time” if they perceived them as expensive, inaccessible, or perishable, or if they did not have the time, skills, or family assistance to prepare/cook vegetables (p<0.01). Conclusions: Addressing barriers to the purchase and preparation of vegetables in the home may be a cost-effective policy target to promote vegetable intake for children of all socioeconomic backgrounds.Nutritional Science