Disentangling nutrition facts from fiction : towards healthy and sustainable consumption in industrialized societies

Over the last centuries, in the context of industrialization, globalization, and urbanization, profound dietary changes have occurred. Ubiquitous access to cheap, readily available and highly palatable unhealthy products, together with aggressive marketing that significantly influences social norms, have led to overconsumption of energy-dense, nutrient-poor foods. This has not only been associated with a higher prevalence of obesity and diet-related non-communicable diseases, but also with detrimental effects on the world?s natural resources. Broader and braver public health measures favoring the availability and affordability of healthy, minimally processed foods should be implemented in conjunction with educational strategies to re-encourage a healthy and sustainable food consumption

Nutri-Score, alimentos ultraprocesados y salud

El exceso de peso con un índice de masa corporal (IMC) elevado es uno de los factores de riesgo que contribuye en mayor medida a la mortalidad y carga global de enfermedad a nivel mundial1. Se estima que, en el año 2016, el 39% de la población adulta de todo el mundo presentaba sobrepeso y el 13% obesidad2. España no es una excepción. Según los datos de una muestra representativa de la población adulta española, el 62,3% de la población sufre sobrepeso u obesidad3. Ambos son importantes factores de riesgo para el desarrollo de enfermedades crónicas no transmisibles como la enfermedad cardiovascular, la diabetes tipo 2 o determinados tipos de cáncer4 . Los mecanismos asociados al desarrollo de un exceso de peso son multifactoriales, por lo que las estrategias preventivas también deben serlo. En este contexto, en el actual número de la revista Anales del Sistema Sanitario de Navarra se publica el artículo “Influencia de hábitos saludables sobre el índice de masa corporal en la población de 12-14 años en un área de Murcia (España)”, en el que Jiménez Candel y col5 exploraron en un estudio transversal, mediante una encuesta sobre hábitos saludables, los diferentes estilos de vida –incluyendo la alimentación, la actividad física, el uso de nuevas tecnologías y las relaciones sociales– de adolescentes en función de su IMC

Corporations and Health: The Need to Combine Forces to Improve Population Health

The recent concerns raised about commercial determinants of health (CDoH) are not new. Numerous organizations around the world are working on these issues. These groups have emerged in response to specific issues and contexts and bring with them a diversity of interests, worldviews and strategies for change. In creating the 'Governance, Ethics and Conflicts of Interest in Public Health' network in 2018, our hope was to broaden our engagement with other actors advocating for change and strengthen our collective efforts. For academics, this requires moving further beyond the collective comfort zone of peer-reviewed publications, working with the media and those with political expertise, and learning from and supporting other stakeholders with a common vision. [Abstract copyright: © 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Associations Between the Modified Food Standard Agency Nutrient Profiling System Dietary Index and Cardiovascular Risk Factors in an Elderly Population

Background: Helping consumers to improve the nutritional quality of their diet is a key public health action to prevent cardiovascular diseases (CVDs). The modified version of the Food Standard Agency Nutrient Profiling System Dietary Index (FSAm-NPS DI) underpinning the Nutri-Score front-of-pack label has been used in public health strategies to address the deleterious consequences of poor diets. This study aimed to assess the association between the FSAm-NPS DI and some CVD risk factors including body mass index (BMI), waist circumference, plasma glucose levels, triglyceride levels, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and diastolic and systolic blood pressure. Materials and Methods: Dietary intake was assessed at baseline and after 1 year of follow-up using a 143-item validated semi-quantitative food-frequency questionnaire. Dietary indices based on FSAm-NPS applied at an individual level were computed to characterize the diet quality of 5,921 participants aged 55-75 years with overweight/obesity and metabolic syndrome from the PREDIMED-plus cohort. Associations between the FSAm-NPS DI and CVD risk factors were assessed using linear regression models. Results: Compared to participants with a higher nutritional quality of diet (measured by a lower FSAm-NPS DI at baseline or a decrease in FSAm-NPS DI after 1 year), those participants with a lower nutritional quality of diet (higher FSAm-NPS DI or an increase in score) showed a significant increase in the levels of plasma glucose, triglycerides, diastolic blood pressure, BMI, and waist circumference (beta coefficient [95% confidence interval]; P for trend) (1.67 [0.43, 2.90]; <0.001; 6.27 [2.46, 10.09]; <0.001; 0.56 [0.08, 1.05]; 0.001; 0.51 [0.41, 0.60]; <0.001; 1.19 [0.89, 1.50]; <0.001, respectively). No significant associations in relation to changes in HDL and LDL-cholesterol nor with systolic blood pressure were shown. Conclusion: This prospective cohort study suggests that the consumption of food items with a higher FSAm-NPS DI is associated with increased levels of several major risk factors for CVD including adiposity, fasting plasma glucose, triglycerides, and diastolic blood pressure. However, results must be cautiously interpreted because no significant prospective associations were identified for critical CVD risk factors, such as HDL and LDL-cholesterol, and systolic blood pressure

Associations Between the Modified Food Standard Agency Nutrient Profiling System Dietary Index and Cardiovascular Risk Factors in an Elderly Population

BackgroundHelping consumers to improve the nutritional quality of their diet is a key public health action to prevent cardiovascular diseases (CVDs). The modified version of the Food Standard Agency Nutrient Profiling System Dietary Index (FSAm-NPS DI) underpinning the Nutri-Score front-of-pack label has been used in public health strategies to address the deleterious consequences of poor diets. This study aimed to assess the association between the FSAm-NPS DI and some CVD risk factors including body mass index (BMI), waist circumference, plasma glucose levels, triglyceride levels, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and diastolic and systolic blood pressure.Materials and MethodsDietary intake was assessed at baseline and after 1 year of follow-up using a 143-item validated semi-quantitative food-frequency questionnaire. Dietary indices based on FSAm-NPS applied at an individual level were computed to characterize the diet quality of 5,921 participants aged 55–75 years with overweight/obesity and metabolic syndrome from the PREDIMED-plus cohort. Associations between the FSAm-NPS DI and CVD risk factors were assessed using linear regression models.ResultsCompared to participants with a higher nutritional quality of diet (measured by a lower FSAm-NPS DI at baseline or a decrease in FSAm-NPS DI after 1 year), those participants with a lower nutritional quality of diet (higher FSAm-NPS DI or an increase in score) showed a significant increase in the levels of plasma glucose, triglycerides, diastolic blood pressure, BMI, and waist circumference (β coefficient [95% confidence interval]; P for trend) (1.67 [0.43, 2.90]; &lt;0.001; 6.27 [2.46, 10.09]; &lt;0.001; 0.56 [0.08, 1.05]; 0.001; 0.51 [0.41, 0.60]; &lt;0.001; 1.19 [0.89, 1.50]; &lt;0.001, respectively). No significant associations in relation to changes in HDL and LDL-cholesterol nor with systolic blood pressure were shown.ConclusionThis prospective cohort study suggests that the consumption of food items with a higher FSAm-NPS DI is associated with increased levels of several major risk factors for CVD including adiposity, fasting plasma glucose, triglycerides, and diastolic blood pressure. However, results must be cautiously interpreted because no significant prospective associations were identified for critical CVD risk factors, such as HDL and LDL-cholesterol, and systolic blood pressure

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

A Provegetarian Food Pattern Emphasizing Preference for Healthy Plant-Derived Foods Reduces the Risk of Overweight/Obesity in the SUN Cohort

Provegetarian diets (i.e., preference for plant-derived foods but not exclusion of animal foods) have been associated with a reduced risk of long-term weight gain and could be more easily embraced than strict vegetarian diets. However, not all plant-derived foods are equally healthy. In the &ldquo;Seguimiento Universidad de Navarra&rdquo; (SUN) cohort, we prospectively evaluated the association between different provegetarian food patterns and the incidence of overweight/obesity in 11,554 participants with initial body mass index &lt;25 kg/m2. A provegetarian food pattern (FP) was built by assigning positive scores to plant foods and reverse scores to animal foods. A healthful and an unhealthful provegetarian FP, which distinguished between healthy (fruits/vegetables/whole grains/nuts/legumes/olive oil/coffee) and less-healthy plant foods (fruit juices/potatoes/refined grains/pastries/sugary beverages), were also built. A total of 2320 new cases of overweight or obesity were identified after a median follow-up of 10.3 years. Higher baseline conformity with the overall provegetarian FP was inversely associated with overweight/obesity (HR comparing extreme quintiles: 0.85; 95% CI: 0.75 to 0.96; p-trend: 0.014). This association was stronger for the healthful FP (HR: 0.78; 95% CI: 0.67 to 0.90; p-trend: &lt;0.001) and was not apparent for the unhealthful FP (HR: 1.07; 95% CI: 0.92 to 1.23; p-trend: 0.551). In a large prospective cohort of relatively young adults, better conformity with a healthy provegetarian diet was associated with a reduced long-term risk of overweight/obesity, whereas no consistent trend was found for a FP that emphasized less-healthy plant foods

Diet-related approaches for primary prevention of obesity and premature mortality

El exceso de peso es uno de los factores de riesgo que contribuye en mayor medida a la mortalidad y carga global de enfermedad a nivel mundial. Si bien las causas del sobrepeso son múltiples, los determinantes más influyentes son los ambientales (dieta y estilo de vida) que, a su vez, están determinados por factores socioculturales y del entorno. En España, existen diversas guías alimentarias con el objetivo de prevenir la obesidad. Sin embargo, no está claro que tales mensajes procedentes de opiniones de expertos, a veces con conocidos conflictos de interés, coincidan con las prioridades en salud pública. Por otro lado, las políticas alimentarias se han centrado mayoritariamente en la responsabilidad individual pero se ha demostrado que esto no es suficiente para mejorar los hábitos alimentarios a nivel poblacional. Es necesario actuar sobre factores estructurales, adoptando estrategias que favorezcan el seguimiento de patrones dietéticos saludables. Los objetivos de esta Tesis Doctoral han consistido en evaluar el efecto de distintos índices dietéticos sobre el riesgo de desarrollar sobrepeso/obesidad o mortalidad en una cohorte prospectiva de graduados universitarios de toda España. A raíz de una estancia en Deakin University (Australia), se propuso realizar un análisis transversal del International Food Policy Study para estudiar el nivel de apoyo para establecer iniciativas que promuevan compras más saludable en los supermercados. En los primeros tres estudios, se analizó la asociación entre 1) las guías alimentarias de la Sociedad Española de Nutrición Comunitaria (SENC), 2) patrones dietéticos pro-vegetarianos y 3) un índice específico para prevención de obesidad (Dietary Obesity-Prevention Score; DOS) en relación con el riesgo de desarrollar sobrepeso/obesidad en la cohorte SUN. En el primer estudio, los resultados mostraron que el quintil superior de la pirámide alimentaria de la SENC se asoció inversamente con el riesgo de desarrollar sobrepeso/obesidad respecto al quintil inferior, mientras que no se encontró asociación para la pirámide de hidratación. En el segundo estudio, el quintil superior de un patrón dietético pro-vegetariano definido a-priori se asoció inversamente con el riesgo de desarrollar sobrepeso/obesidad en comparación con el quintil inferior. Esta asociación se reforzó cuando el patrón dietético pro-vegetariano era saludable y dejó de ser evidente para la versión menos saludable. En el tercer estudio, el riesgo de desarrollar sobrepeso/obesidad disminuyó significativamente en todas las categorías del DOS. Dicho índice se basó en el consumo de verduras, frutas, legumbres, yogur, frutos secos, pescado, ratio de proteínas vegetales sobre animales, carne roja y procesada, grasa animal saturada, cereales refinados, productos ultra-procesados, bebidas azucaradas, cerveza y destilados. En el cuarto estudio, se evaluó la asociación entre el algoritmo nutricional en el que se basa el etiquetado frontal de alimentos Nutri-Score y el riesgo de mortalidad en la cohorte SUN. Se encontró que una mayor puntuación del índice dietético FSAm-NPS (modified Food Standards Agency Nutrient Profiling System), que refleja un consumo de alimentos con peor calidad nutricional de acuerdo a Nutri-Score, se asocia con un mayor riesgo de mortalidad por cualquier causa y mortalidad por cáncer, mientras que no se encontró asociación en el caso de mortalidad por causas cardiovasculares. En el quinto estudio, se investigó el nivel de apoyo para poner en práctica iniciativas saludables en los supermercados relacionadas con el posicionamiento y la disponibilidad de alimentos en cinco países. Se encontró que, generalmente, hay un amplio apoyo, sobre todo para incrementar el espacio dedicado a alimentos saludables. Estos resultados contribuyen al desarrollo y actualización de estrategias dietéticas de distinta naturaleza para prevenir la obesidad en España desde un enfoque de prevención primaria

Nutri-Score, alimentos ultraprocesados y salud

El exceso de peso con un índice de masa corporal (IMC) elevado es uno de los factores de riesgo que contribuye en mayor medida a la mortalidad y carga global de enfermedad a nivel mundial1. Se estima que, en el año 2016, el 39% de la población adulta de todo el mundo presentaba sobrepeso y el 13% obesidad2. España no es una excepción. Según los datos de una muestra representativa de la población adulta española, el 62,3% de la población sufre sobrepeso u obesidad3. Ambos son importantes factores de riesgo para el desarrollo de enfermedades crónicas no transmisibles como la enfermedad cardiovascular, la diabetes tipo 2 o determinados tipos de cáncer4 . Los mecanismos asociados al desarrollo de un exceso de peso son multifactoriales, por lo que las estrategias preventivas también deben serlo. En este contexto, en el actual número de la revista Anales del Sistema Sanitario de Navarra se publica el artículo “Influencia de hábitos saludables sobre el índice de masa corporal en la población de 12-14 años en un área de Murcia (España)”, en el que Jiménez Candel y col5 exploraron en un estudio transversal, mediante una encuesta sobre hábitos saludables, los diferentes estilos de vida –incluyendo la alimentación, la actividad física, el uso de nuevas tecnologías y las relaciones sociales– de adolescentes en función de su IMC