Modelling of Usual Nutrient Intakes: Potential Impact of the Choices Programme on Nutrient Intakes in Young Dutch Adults

Introduction The Choices Programme is an internationally applicable nutrient profiling system with nutrition criteria for trans fatty acids (TFA), saturated fatty acids, sodium, added sugar and for some product groups energy and fibre. These criteria determine whether foods are eligible to carry a “healthier option” stamp. In this paper a nutrient intake modelling method is described to evaluate these nutritional criteria by investigating the potential effect on nutrient intakes. Methods Data were combined from the 2003 Dutch food consumption survey in young adults (aged 19–30) and the Dutch food composition table into the Monte Carlo Risk Assessment model. Three scenarios were calculated: the “actual intakes” (scenario 1) were compared to scenario 2, where all foods that did not comply were replaced by similar foods that did comply with the Choices criteria. Scenario 3 was the same as scenario 2 adjusted for the difference in energy density between the original and replacement food. Additional scenarios were calculated where snacks were not or partially replaced and stratified analyses for gender, age, Body Mass Index (BMI) and education. Results Calculated intake distributions showed that median energy intake was reduced by 16% by replacing normally consumed foods with Choices compliant foods. Intakes of nutrients with a maximal intake limit were also reduced (ranging from -23% for sodium and -62% for TFA). Effects on intakes of beneficial nutrients varied from an unintentional reduction in fat soluble vitamin intakes (-15 to -28%) to an increase of 28% for fibre and 17% calcium. Stratified analyses in this homogeneous study population showed only small differences across gender, age, BMI and education. Conclusions This intake modelling method showed that with consumption of Choices compliant foods, nutrient intakes shift towards population intake goals for the nutrients for which nutrition criteria were defined, while effects on beneficial nutrients were diverse

The virtual supermarket: An innovative research tool to study consumer food purchasing behaviour

<p>Abstract</p> <p>Background</p> <p>Economic interventions in the food environment are expected to effectively promote healthier food choices. However, before introducing them on a large scale, it is important to gain insight into the effectiveness of economic interventions and peoples' genuine reactions to price changes. Nonetheless, because of complex implementation issues, studies on price interventions are virtually non-existent. This is especially true for experiments undertaken in a retail setting. We have developed a research tool to study the effects of retail price interventions in a virtual-reality setting: the Virtual Supermarket. This paper aims to inform researchers about the features and utilization of this new software application.</p> <p>Results</p> <p>The Virtual Supermarket is a Dutch-developed three-dimensional software application in which study participants can shop in a manner comparable to a real supermarket. The tool can be used to study several food pricing and labelling strategies. The application base can be used to build future extensions and could be translated into, for example, an English-language version. The Virtual Supermarket contains a front-end which is seen by the participants, and a back-end that enables researchers to easily manipulate research conditions. The application keeps track of time spent shopping, number of products purchased, shopping budget, total expenditures and answers on configurable questionnaires. All data is digitally stored and automatically sent to a web server. A pilot study among Dutch consumers (n = 66) revealed that the application accurately collected and stored all data. Results from participant feedback revealed that 83% of the respondents considered the Virtual Supermarket easy to understand and 79% found that their virtual grocery purchases resembled their regular groceries.</p> <p>Conclusions</p> <p>The Virtual Supermarket is an innovative research tool with a great potential to assist in gaining insight into food purchasing behaviour. The application can be obtained via an URL and is freely available for academic use. The unique features of the tool include the fact that it enables researchers to easily modify research conditions and in this way study different types of interventions in a retail environment without a complex implementation process. Finally, it also maintains researcher independence and avoids conflicts of interest that may arise from industry collaboration.</p

What do screening tools measure? Lessons learned from SCREEN II and SNAQ(65+)

Background: Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice. Methods: Dutch community-dwelling older adults (n = 200, 78.2 +/- 6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ(65+) (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score <54 out of 64). Chi-square tests were used to test associations between demographic, health, physical and social factors and outcome of SNAQ(65+) and SCREEN II. Results: Of all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQ(65+)). Agreement between the two tools was poor (kappa < 0.20). Gender, BMI, living status, income, activity level and protein/energy intake were associated with SCREEN II; age, BMI, comorbidities, medication use, help at home, activity level and low basic mobility were associated with SNAQ(65+). Conclusion: SCREEN II and SNAQ(65+) measure different concepts of malnutrition and therefore identify different persons at risk. SCREEN II is more inclusive and comprises both undernutrition and overnutrition as well as different determinants that can impact on food intake, while SNAQ(65+) is solely focused on protein-energy malnutrition. (C) 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved

The protein gap-increasing protein intake in the diet of community-dwelling older adults: a simulation study.

OBJECTIVE: Approximately 50 % of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on the protein intake of Dutch community-dwelling older adults. DESIGN: The Dutch National Food Consumption Survey-Older Adults 2010-2012 (DNFCS-OA) was used for scenario modelling. Dietary intake was estimated based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2) and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was &lt; 1•0 g/kg BW/d (n 391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-d intake data. SETTING: A simulation study based on the DNFCS-OA. PARTICIPANTS: 727 Dutch community-dwelling older adults aged 70+. RESULTS: Mean protein intake of the total population increased from 1•0 to 1•2 g/kg BW/d (scenarios 1 and 2) and to 1•3 g/kg BW/d (scenario 3). The percentage of participants with intakes of ≥ 1•0 g/kg BW/d increased from 47•1 % to 91•4 %, 90•2 % and 94•6 %, respectively, in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups: yoghurt, cream desserts and pudding, potatoes, vegetables and legumes and non-alcoholic beverages and milk in scenario 1 and bread; yoghurt, cream desserts and pudding and soups in scenario 2. CONCLUSIONS: This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counselling

Protein Intake among Community-Dwelling Older Adults: The Influence of (Pre-) Motivational Determinants.

An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019-October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (&lt;1.0 g/kg body weight/day). The behavioral determinants of cognizance, knowledge, risk perception, perceived cues, attitude, social support, self-efficacy and intention were assessed by evaluating statements on a 7-point Likert scale. A total of 824 Dutch community-dwelling older adults were included, recruited via online newsletters, newspapers and by personal approach. Poisson regression was performed to calculate quartile-based prevalence ratios (PRs). Almost 40% of 824 respondents had a high chance of a low protein intake. Univariate analyses indicated that lower scores for all different behavioral determinants were associated with a higher chance of a low protein intake. Independent associations were observed for knowledge (Q4 OR = 0.71) and social support (Q4 OR = 0.71). Results of this study can be used in future interventions aiming to increase protein intake in which focus should lie on increasing knowledge and social support

Towards an integrated system for product improvement in the Netherlands : Advice of the Committee Criteria Product Improvement

In Nederland kennen we verschillende systemen die de samenstelling van levensmiddelen kunnen helpen verbeteren: het Akkoord Verbetering Productsamenstelling tussen de overheid en het bedrijfsleven, het Vinkje op verpakkingen dat wordt uitgefaseerd, en de Schijf van Vijf. Ze bevatten afspraken of criteria voor de gehalten zout, verzadigd vet en suiker in producten. De systemen vertonen weinig samenhang: ze gebruiken verschillende productgroepen, voedingsstoffen en criteria. Er is een nieuw integraal systeem gewenst met één samenhangende set criteria die voor alle producten in de productgroepen geldt. Dat adviseert de onafhankelijke Commissie Criteria Productverbetering. Volgens de commissie is het mogelijk om een getrapt systeem voor productverbetering te ontwikkelen. Dit houdt in dat per productgroep minimale eisen voor productverbetering (ten aanzien van zout, verzadigd vet, suiker, calorieën en vezel) worden bepaald die voor alle producten in die productgroep gelden. Daarnaast worden er extra criteria gedefinieerd voor producten die hier de beste resultaten in behalen ('koplopers'). De commissie adviseert om een werkgroep van deskundigen de opdracht te geven het voorgestelde systeem technisch verder uit te werken. Om dit systeem te laten slagen is het belangrijk om draagvlak te creëren door maatschappelijke organisaties en de industrie intensief te betrekken. Daarnaast is het van belang dat de criteria vanuit de rijksoverheid worden vastgesteld en regelmatig worden aangescherpt. Ten slotte moet een onafhankelijke organisatie bijhouden of producten aan de criteria voldoen. Ervaringen uit het buitenland leren dat een set met criteria alleen niet voldoende is. Fabrikanten dienen continu gestimuleerd te worden om de samenstelling van hun producten stapsgewijs aan te passen. Het is belangrijk uit te zoeken welke prikkels hierbij werken, van wettelijke of financiële maatregelen tot communicatie naar de consument bijvoorbeeld via een nieuw voedselkeuzelogo. De onafhankelijke Commissie Criteria Productverbetering werd ingesteld door het ministerie van VWS en bestond uit wetenschappers uit de Wetenschappelijke Adviescommissie van het voormalige Vinkje (Wecom), de Wetenschappelijke adviescommissie van het Akkoord Verbetering Productsamenstelling (WAC) en het Voedingscentrum. De commissie werd voorgezeten en begeleid door het RIVM. Various systems have been established in the Netherlands aimed at improving the composition of food products. They include the National Agreement to Improve Product Composition between the government and industry, a front-of-pack logo called "het Vinkje" which is currently being phased out, and the Wheel of Five. They contain agreements on the amount of salt, saturated fat and sugar in products. There is little coherence between the systems as they use different product classifications, nutrients and criteria. A new integrated system is needed with a coherent set of criteria that applies to all products in all product groups. This is the advice of the independent Criteria Committee for Product Improvement. According to the committee, it will be possible to develop a multi-stage system for product improvement. This means that per product group minimum standards for product reformulation are set for salt, saturated fat, sugar, calories and fibre for all products. In addition, criteria for products that achieve the best results per group ('frontrunners') will be set. The committee recommends that a working group of experts be assigned to carry out the technical development of the proposed system. To increase this system's chances of success it is important to mobilize support by closely involving social organizations and industry. In addition, it is important that criteria are set by the central government and are regularly refined. Finally, an independent organization should monitor whether or not the products meet the criteria. We know from other countries that a set of criteria alone is insufficient. Producers must be constantly encouraged to steadily improve the composition of their products. It is important to identify the most effective incentives, ranging from legal or financial measures to communication to the consumer (for example via a new logo on the packaging). The independent Criteria Committee was appointed by the Ministry of Health, Welfare and Sport and consisted of scientists from the Scientific Advisory Committee of the (previous) Vinkje (Wecom), the scientific advisory committee of the National Agreement to Improve Product Composition (WAC) and the Dutch Nutrition Centre. It was chaired and supported by the National Institute for Public Health and the Environment (RIVM). Ministerie van VW

Consuming a diet complying with front-of-pack label criteria may reduce cholesterol levels: a modeling study.

Background/Objectives:Front-of-pack nutrition labels can help consumers to make healthier choices and stimulate healthier product development. This is the first modeling study to investigate the potential impact on cholesterol levels of consuming a diet consisting of products that comply with the criteria for a healthier choice logo.Subjects/Methods:National food consumption and food composition data were used to estimate the nutrient intake of the Dutch adult population (18-70 years) before and after replacing foods that did not comply with the Choices front-of-pack label criteria. Different scenarios were established. The difference in cholesterol levels in the Dutch population was assessed before and after replacement by means of equations from meta-analyses that calculate how blood lipids change when diet composition changes.Results:After replacing non-complying products with products, which comply with the label's criteria (maximum scenario), saturated fatty acids median intake reduced from 14.5 to 9.8 en%. Trans-fatty acids reduced from 0.95 to 0.57 en%. The average predicted changes in low-density lipoprotein and total cholesterol levels were 0.25 and 0.31 mmol/l, respectively. Because high-density lipoprotein (HDL) cholesterol levels reduced as well (0.05 mmol/l), overall, the result was a slightly positive change in the total cholesterol/HDL ratio (0.03).Conclusions:Our findings suggest that the consumption of foods complying with the criteria for a front-of-pack label could contribute moderately to cardiovascular risk reduction via influencing blood lipids. These findings were independent of other potential effects on related health outcomes. © 2012 Macmillan Publishers Limited. All rights reserved