National dietary surveys in the WHO European Region: a review of provision, results and challenges

Background The World Health Organisation (WHO) encourages countries to conduct national dietary surveys to inform preventative policies targeting malnutrition and noncommunicable diseases. This research reviews the provision of national dietary surveys across the 53 countries of the WHO European Region and uses intake data from these surveys to assess selected topics that are of concern to WHO. Methods National dietary surveys were gathered, survey characteristics were collated and survey-reported energy and selected nutrient intakes were examined in relation to recommended intakes for adults and children. Raw datasets were gathered from 12 countries and age-standardised weighted mean nutrient intakes presented by individual education level and Gross Domestic Product (GDP). Socio-economic and food consumption characteristics of high trans fatty acid (TFA) consumers were compared in the Dutch and UK surveys. The impact of body mass index (BMI) on consumed portion size was investigated in the French and UK surveys. Means and nutritional content of commercial UK serving-sizes were compared to consumed portion sizes in the UK survey in popular energy-dense foods. Results Less than two thirds of WHO European Member States conducted national dietary surveys; the main survey gaps lie in Central & Eastern European countries, where nutrition policies may lack an evidence base. Nutritional issues appeared widespread, particularly in females and Central & Eastern Europe, but differences in age group, methodology, under-reporting and nutrient composition databases hinder inter-country comparisons. Lower income countries and lower education groups had poorer diet, particularly for micronutrients. Higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. Although voluntary national reduction programmes may successfully reduce average TFA intakes, as shown in the Dutch and UK national dietary surveys, inequalities in TFA consumption may be hidden. Limited evidence of associations between portion size and BMI was found. UK consumed portion sizes were greater than on-pack serving sizes, suggesting that portion size guidance may need updating. Conclusion This project produced the first review of national dietary survey provision across the lifecourse, within the whole WHO European region, with reference to disadvantaged groups, obesity and nutrients of concern. All European countries should be encouraged to conduct harmonised national dietary surveys, which could facilitate effective, coordinated policy development to deliver dietary improvement across Europe

Corporate political activity in the context of sugar-sweetened beverage tax policy in the WHO European Region

BACKGROUND: Sugar-sweetened beverage (SSB) taxes have emerged as an effective and increasingly popular tool to reduce added sugar intake, an important contributor to obesity and non-communicable diseases. A common barrier to the implementation of well-designed SSB taxes is the opposition of commercial actors. Focusing on the WHO European Region, this study seeks to map if and how key stakeholders have experienced industry efforts to influence SSB taxes. METHODS: We identified 11 countries in the WHO European Region which have implemented SSB taxes or attempted to do so. Using an online survey informed by the global literature on industry interference with SSB taxation, we approached 70 in-country policymakers, advocates and academics. The data were analysed using an existing framework of corporate political activity. RESULTS: Twenty-three experts from nine countries responded to the survey. Transnational SSB producers and their business associations were identified as the most active opponents of SSB taxation. Industry claims that the policy would have negative economic effects were identified as the most common and powerful arguments. Direct lobbying was reported in all study countries. Shifts in political activity were recognisable across stages of the policy process, moving from outright opposition to attempts to delay or weaken the policy after its announcement. CONCLUSION: Those seeking to introduce effective SSB taxation can use our findings to pre-empt and counter industry opposition. We identify several measures for preventing and mitigating industry interference with SSB tax policy

Projecting Cardiovascular Deaths Averted due to Trans Fat Policies in the Eurasian Economic Union

Objective: To demonstrate the potential impact on population health if policies designed to reduce population trans fatty acid (TFA) intake are successfully implemented in the Eurasian Economic Union (EAEU) in line with the World Health Organization's (WHO) guidelines to lower intake of TFA as a percent of total energy intake to less than 1%. Design: A projection exercise was conducted to estimate reductions in CVD-related deaths in countries of the EAEU if TFA policies are implemented in the EAEU. Plausibly causal, annual effects (in %) of Denmark's TFA policy on the evolution of CVD mortality rates were applied to project the potential effects of recently announced TFA policies in Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation under three TFA exposure scenarios. Settings: Member States of the EAEU; Armenia, Belarus, Kazakhstan, Kyrgyzstan and the Russian Federation. Participants: Data used for the projection exercise were based on estimates from natural experimental evidence from Denmark. National CVD mortality rates used were from WHO and OECD datasets. Results: In all countries in all scenarios deaths averted were ≤5 deaths/100,000 in year 1 and rose in years 2 and 3. The highest projected impacts in the high exposure scenario were seen in Kyrgyzstan (39 deaths/100,000), with the lowest occurring in Armenia (24 deaths/100,000). Conclusion: This study demonstrates the potential population health gains that can be derived from effective policies to reduce TFAs in line with WHO guidance. Monitoring and surveillance systems are needed to evaluate the effectiveness of the TFA-reduction policies in a national context.</p

Trans fatty acid elimination policy in member states of the Eurasian Economic Union: implementation challenges and capacity for enforcement

Removing trans fatty acids (TFAs) from the food supply in the Eurasian Economic Union (EAEU) are one of the most effective public health interventions for reducing the risk of noncommunicable diseases. EAEU Member States have taken important steps to reduce TFA in oil and fat products to &lt;2% of the total fat content. The authors summarize existing policies in the region, identify challenges in implementation, and suggest measures to strengthen regulation to achieve compliance with WHO guidelines. Documents published between 2011 and 2019 in Russian and English were reviewed, including EAEU and Member State restrictions on TFA in food products, data on TFA content in foods, and food labeling policies. The EAEU has established TFA limits in oil and fat products; however, Member States are currently not achieving the WHO guideline of &lt;2% of total fat content in food products. A lack of harmonized monitoring systems and sanctions create challenges in monitoring compliance. The authors recommend developing an EAEU‐wide monitoring system to test TFA content and organize population intake surveys. Discrepancies exist within regulatory frameworks that allow higher levels of TFAs in dairy products and infant formula. The authors recommend extending the current regulation to mandate TFA limits for all food products. Research found that strengthening regulation to meet the WHO guidelines should be prioritized. Member States should implement actions to replace TFAs with healthier fats, develop standardized surveillance methods, and scale‐up strategic communication to ensure the food industry and the public follow public health recommendations to protect the health of the EAEU population

Systems Thinking and Complexity Science Methods and the Policy Process in Non-Communicable Disease Prevention: A Systematic Scoping Review

Background: Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy. Methods: Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS. Results: 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use. Conclusion: This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.</jats:p

Nutritional Quality of Plant-Based Cheese Available in Spanish Supermarkets: How Do They Compare to Dairy Cheese?

Plant-based cheese is one of the most increasingly consumed dairy alternatives. Evidence is lacking on their nutritional quality. We aimed to evaluate the nutritional composition of the plant-based cheese options available in Spanish supermarkets, and how they compare with dairy cheese. An audit of plant-based cheese alternatives has been conducted in seven of the most common supermarkets. For each product, the nutritional content per 100 g and ingredients were collected. Data on generic dairy cheese were retrieved from the BEDCA website. Descriptive statistics (median, minimum and maximum) were used to characterize the plant-based cheese products, for both all the products and grouped by main ingredients (i.e., coconut oil, cashew nuts and tofu). Mann–Whitney U tests were used for comparisons between dairy and different types of plant-based cheese. The coconut oil-based products (the large majority of plant-based cheese products, n = 34) could not be considered as healthy foods. Their major ingredients were refined coconut oil and starches and were high in saturated fats and salt. The other smaller groups, cashew nut- (n = 4) and tofu-based (n = 2), showed a healthier nutritional profile. Replacing dairy cheese with these groups could be nutritionally beneficial. Future investigations should address the health effects of substituting dairy cheese with these products

The development and potential of a digital Out Of Home food environment monitoring platform

The rapidly growing field of digital meal delivery platforms has transformed the out of home (OOH) food environment, presenting both opportunities and challenges for public health. This paper introduces the development and potential of a novel digital platform designed for monitoring the OOH food environment. Drawing on publicly available data from meal delivery applications, this platform provides valuable insights into the landscape of digital food offerings, such as the most common restaurants per region, average caloric content per meal type, and energy value per monetary unit. This research addresses the current void in regulations for this digital environment, particularly around food labeling and provision of nutrition information. Even though the platform has significantly improved our understanding of the digital food ecosystem, it highlights gaps, primarily due to the lack of publicly available individual data and inconsistencies in provided information. Despite these challenges, the proposed digital platform holds considerable promise for better understanding the digital food environment, supporting healthier food choices, and informing future policy interventions aimed at regulating the online food environment. This research advocates for mandatory regulations in the digital food sector to ensure comprehensive, comparable, and transparent nutrition information and equality in access to nutritious foods