Diet-related Non-communicable Disease Research Articles

Drivers of change: dietary change, food and nutrition security and agricultural practices in peripheral communities in Pacific Island countries and territories: A scoping review protocol

Pacific Island Countries and Territories (PICTs) are experiencing a Diet-Related Non-Communicable Disease (DR-NCD) health crisis(1). Increasing rates of DR-NCDs such as Type 2 diabetes and cardiovascular disease have been linked to dietary transitions and increasing food insecurity in the region(2). Anthropogenic climate change has also been identified as a significant threat to food security in PICTs(3). Additionally, the impacts of the COVID-19 Pandemic have been identified as both a contributor to food insecurity in the region and as an opportunity to transform PICT food systems and reduce rates of DR-NCDs(4). Yet, the drivers of dietary change, food security and agricultural practices in peripheral PICT communities are not well documented or understood. To determine how these drivers may change in the future and the impacts this may have on Pacific peoples, a deeper understanding of the historical and contemporary drivers of change is necessary. The aim of this scoping review was to collate existing information to improve this understanding, by mapping key factors evident in the literature that underpin the links between DR-NCDs and food security with a focus on women in PICT peripheral communities, to better clarify the challenges, working definitions and conceptual boundaries in the research area. The review maps where research has been conducted geographically and how the links between DR-NCDs and food security in PICTs have been investigated over time and identifies projections and suggestions for the future. The scoping review was conducted in accordance with a pre-defined protocol available online(5). A total of 476 peer-reviewed sources and 126 grey literature sources were identified by the initial search criteria. Two independent researchers completed title/abstract and full text screening using Covidence, and data extraction using a data extraction tool. The resulting data was quantified in table format, with common themes and ideas presented qualitatively. Sources spanned all sectors of PICT food systems with a heavy focus on production from fisheries and agriculture. Most PICTs were represented in the findings. Many drivers of change within food systems were identified, some of which included the impacts of anthropogenic climate change, the COVID-19 pandemic, and urbanisation. The drivers impacted all four pillars of food security, and many were directly or indirectly related to dietary and lifestyle changes associated with DR-NCD risk factors. This data is accompanied by an interpretation of results and a narrative summary. These results provide a useful platform to further explore the drivers of dietary change, food security, agricultural practices and DR-NCD’s in this region.

Trends in ultra-processed food availability and its association with diet-related non-communicable disease health indicators in the Portuguese population.

Broad variations in dietary and physical activity patterns are part of nutritional transition concept. An additional nutritional transition has as main characteristic the change of consumption of processed foods for ultra-processed foods (UPF). This study aims to evaluate trends of UPF availability in Portuguese population and its association with diet-related non-communicable diseases (NCD) health indicators. This ecological study used data from the Household Budget Surveys conducted by the National Statistics Institute each 5 years within a national representative sample of households. The percentage of UPF was calculated based on the total daily amount of food and beverages available per capita (in grams). Data from the years 1990, 1995, 2000 and 2005 were used, which were retrieved from DAFNE-Anemos Software. NCD age-standardised mortality, prevalence and incidence were obtained from the Global Burden of Disease database, for the years 2000, 2005, 2010 and 2015. Between 1990 and 2005, the UPF availability increased from 3·9 % to 13·8 %. Over the years, almost all food and beverages categories increased the UPF availability contribution, mainly noticeable for milk, sugar, cereal and meat products. Positive correlations were observed between UPF availability and digestive diseases both in prevalence (r = 0·062; P = 0·037) and incidence (r = 0·005; P = 0·010) measures. Neoplasms incidence also showed positive correlation with UPF availability (r = 0·002; P = 0·012). Trends in UPF availability in Portugal increased exponentially. At the same time, there is a trend towards a decrease in unprocessed and processed food availability. The Portuguese population should be made aware of the health risks resulting from excessive consumption of UPF.

Performance of the Global Diet Quality Score (GDQS) App in Predicting Nutrient Adequacy and Metabolic Risk Factors among Thai Adults

BackgroundThe Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related noncommunicable disease risk in diverse populations. A software application (GDQS app) was recently developed for the standardized collection of GDQS data. The application involves a simplified 24-h dietary recall (24HR) where foods are matched to GDQS-food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed. ObjectivesThe study aimed to estimate associations between GDQS scores collected using the GDQS app and nutrient adequacy and metabolic risks. MethodsIn this cross-sectional study of 600 Thai males and nonpregnant/nonlactating females (40–60 y), we collected 2 d of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between application scores and outcomes were estimated using multiple regression, and application performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity–Women, Alternative Healthy Eating Index–2010, and Global Dietary Recommendations score. ResultsIn covariate-adjusted models, application scores were significantly (P < 0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3%–44.5%) and FFQ (Q1–Q5: 40.6%–44.2%), and probability of protein adequacy from 24HR (Q1–Q5: 63%–72.5%). Application scores were inversely associated with BMI kg/m2 (Q1–Q5: 26.3–24.9), body fat percentage (Q1–Q5: 31.7%–29.1%), diastolic blood pressure (Q1–Q5: 84–81 mm Hg), and a locally-developed sodium intake score (Q1–Q5: 27.5–24.0 points out of 100); positively associated with high-density lipoprotein cholesterol (Q1–Q5: 49–53 mg/dL) and 24-h urinary potassium (Q1–Q5: 1385–1646 mg); and inversely associated with high midupper arm circumference (Q5/Q1 odds ratio: 0.52) and abdominal obesity (Q5/Q1 odds ratio: 0.51). Significant associations for the application outnumbered those for metrics computed using 24HR or FFQ. ConclusionsThe GDQS app effectively assesses nutrient adequacy and metabolic risk in population surveys.

Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: A Case Study of South Africa.

Complex interactions between political economy factors and corporate power are increasingly recognized to prevent transformative policy action on non-communicable disease (NCD) prevention. System science offers promising methods for analysing such causal complexity. This study uses qualitative system dynamics methods to map the political economy of diet-related NCD (DR-NCD) prevention policy-making aiming to better understand the policy inertia observed in this area globally. We interviewed 25 key policy actors. We analysed the interviews using purposive text analysis (PTA). We developed individual then combined casual loop diagrams to generate a shared model representing the DR-NCD prevention policy-making system. Key variables/linkages identified from the literature were also included in the model. We validated the model in several steps including through stakeholder validation interviews. We identified several inter-linked feedback processes related to political economy factors that may entrench different forms of corporate power (instrumental, structural, and discursive) in DR-NCD prevention policy-making in South Africa over time. We also identified a number of feedback processes that have the potential to limit corporate power in this setting. Using complex system methods can be useful for more deeply understanding DR-NCD policy inertia. It is also useful for identifying potential leverage points within the system which may shift the existing power dynamics to facilitate greater political commitment for healthy, equitable, and sustainable food system transformation.

The estimated dietary and health impact of implementing the recently approved 'high in' front-of-package nutrition symbol in Canada: a food substitution scenario modeling study.

Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy food environments and to help consumers make healthier food choices. Consumer surveys report that after implementation of mandatory 'high in' FOPL symbols between 30 and 70% of consumers choose or were willing to choose products with fewer 'high in' symbols. Health Canada has recently published FOPL regulations that will require prepackaged food and beverages that meet or exceed thresholds for sodium, total sugars, or saturated fat to display a 'high in' FOPL nutrition symbol. The aims were to estimate the potential (1) dietary impact of substituting foods with similar foods that would display at least one less 'high in' symbol, and (2) the number of diet-related noncommunicable disease (NCD) deaths that could be averted or delayed due to estimated dietary changes. Baseline and counterfactual intakes of sodium, total sugars, saturated fats, and energy were estimated among Canadian adults (n = 11,992) using both available days of 24 h-recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS). Similar foods to those reported in CCHS that would display at least one less 'high in' symbol (n = 239) were identified using a Canadian branded food composition database. Based on current FOPL consumer research, identified foods were substituted for 30, 50, and 70% of randomly selected CCHS-Nutrition adult participants and for all adult participants. Potential health impacts were estimated using the Preventable Risk Integrated ModEl. Mean dietary reductions of between 73 and 259 mg/day of sodium, 2.0 and 6.9 g/day of total sugars, 0.2 and 0.5 g/day of saturated fats, and 14 and 46 kcal/day of energy were estimated. Between 2,148 (95% UI 1,913-2,386) and 7,047 (95% UI 6,249-7,886) of deaths due to diet-related NCDs, primarily from cardiovascular diseases (70%), could potentially be averted or delayed if Canadians choose products with fewer 'high in' symbols. Results suggest that FOPL could significantly reduce sodium and total sugar intakes among Canadian adults, the consequences of which could avert or delay an important number of diet-related NCD deaths. These findings provide relevant data to support the importance of the impending FOPL regulations.

How Many Diet-Related Non-Communicable Disease Deaths Could Be Averted or Delayed If Canadians Reduced Their Consumption of Calories Derived from Free Sugars Intake? A Macrosimulation Modeling Study.

Free sugars are a major source of calories in diets and contribute to the burden of many non-communicable diseases (NCDs). The World Health Organization (WHO) recommends reducing free sugars intake to less than 10% of total energy. This study aimed to estimate the number of diet-related NCD deaths which could be averted or delayed if Canadian adults were to reduce their calorie intake due to a systematic 20% reduction in the free sugars content in foods and beverages in Canada. We used the Preventable Risk Integrated ModEl (PRIME) to estimate the potential health impact. An estimated 6770 (95% UI 6184-7333) deaths due to diet-related NCDs could be averted or delayed, mostly from cardiovascular diseases (66.3%). This estimation would represent 7.5% of diet-related NCD deaths observed in 2019 in Canada. A 20% reduction in the free sugars content in foods and beverages would lead to a 3.2% reduction in calorie intake, yet an important number of diet-related NCD deaths could be averted or delayed through this strategy. Our findings can inform future policy decisions to support Canadians' free sugars intake reduction, such as proposing target levels for the free sugars content in key food categories.

Estimating the dietary and health impact of implementing front-of-pack nutrition labeling in Canada: A macrosimulation modeling study.

Front-of-pack labeling (FOPL) has been identified as a cost-effective policy to promote healthy diets. Health Canada has recently published FOPL regulations that will require food and beverages that meet or exceed set thresholds for sodium, sugars, or saturated fat to display a 'high in' symbol on the front of the package. Although a promising measure, its potential impact on dietary intakes and health have not yet been estimated in Canada. This study aims to estimate (1) the potential dietary impact of implementing a mandatory FOPL among Canadian adults; and (2) the number of diet-related non-communicable disease (NCD) deaths that could be averted or delayed due to these estimated dietary changes. Baseline and counterfactual usual intakes of sodium, total sugars, saturated fats, and calories were estimated among Canadian adults (n = 11,992) using both available days of 24 h recalls from the 2015 Canadian Community Health Survey-Nutrition. The National Cancer Institute method was used to estimate usual intakes, and adjusted for age, sex, misreporting status, weekend/weekday, and sequence of recall. Estimated counterfactual dietary intakes were modeled from reductions observed in experimental and observational studies that examined changes in sodium, sugars, saturated fat, and calorie content of food purchases in the presence of a 'high in' FOPL (four counterfactual scenarios). The Preventable Risk Integrated ModEl was used to estimate potential health impacts. Estimated mean dietary reductions were between 31 and 212 mg/day of sodium, 2.3 and 8.7 g/day of total sugars, 0.8 and 3.7 g/day of saturated fats, and 16 and 59 kcal/day of calories. Between 2,183 (95% UI 2,008-2,361) and 8,907 (95% UI 8,095-9,667) deaths due to diet-related NCDs, mostly from cardiovascular diseases (~70%), could potentially be averted or delayed by implementing a 'high in' FOPL in Canada. This estimation represents between 2.4 and 9.6% of the total number of diet-related NCD deaths in Canada. Results suggest that implementing a FOPL could significantly reduce sodium, total sugar, and saturated fat intakes among Canadian adults and subsequently prevent or postpone a substantial number of diet-related NCD deaths in Canada. These results provide critical evidence to inform policy decisions related to implementing FOPL in Canada.

An umbrella review of the acceptability of fiscal and pricing policies to reduce diet-related noncommunicable disease.

Poor diet has been implicated in a range of noncommunicable diseases. Fiscal and pricing policies (FPs) may offer a means by which consumption of food and non-alcoholic beverages with links to such diseases can be influenced to improve public health. To examine the acceptability of FPs to reduce diet-related noncommunicable disease, based on systematic review evidence. MEDLINE, EMBASE, PsychInfo, SCI, SSCI, Web of Science, Scopus, EconLit, the Cochrane Library, Epistemonikos, and the Campbell Collaboration Library were searched for relevant studies published between January 1, 1990 and June 2021. The studies included systematic reviews of diet-related FPs and: used real-world evidence; examined real or perceived barriers/facilitators; targeted the price of food or non-alcoholic beverages; and applied to entire populations within a jurisdiction. A total of 9996 unique relevant records were identified, which were augmented by a search of bibliographies and recommendations from an external expert advisory panel. Following screening, 4 systematic reviews remained. Quality appraisal was conducted using the AMSTAR 2 tool. A narrative synthesis was undertaken, with outcomes grouped according to the WHO-INTEGRATE criteria. The findings indicated a paucity of high-quality systematic review evidence and limited public support for the use of FPs to change dietary habits. This lack of support was related to a number of factors that included: their perceived potential to be regressive; a lack of transparency, ie, there was mistrust around the use of revenues raised; a paucity of evidence around health benefits; the deliberate choice of rates that were lower than those considered necessary to affect diet; and concerns about the potential of such FPs to harm economic outcomes such as employment. The findings underscore the need for high-quality systematic review evidence on this topic, and the importance of responding to public concerns and putting in place mechanisms to address these when implementing FPs. This study was funded by Safefood [02A-2020]. PROSPERO registration no. CRD42021274454.

Strengthening implementation of diet-related non-communicable disease prevention strategies in Fiji: a qualitative policy landscape analysis

BackgroundNoncommunicable diseases (NCDs) are the leading cause of death globally, and the World Health Organization (WHO) has recommended a comprehensive policy package for their prevention and control. However, implementing robust, best-practice policies remains a global challenge. In Fiji, despite political commitment to reducing the health and economic costs of NCDs, prevalence of diabetes and cardiovascular disease remain the highest in the region. The objective of this study was to describe the political and policy context for preventing diet-related NCDs in Fiji and policy alignment with WHO recommendations and global targets. We used a case study methodology and conducted (1) semi-structured key informant interviews with stakeholders relevant to diet-related NCD policy in Fiji (n = 18), (2) documentary policy analysis using policy theoretical frameworks (n = 11), (3) documentary stakeholder analysis (n = 7), and (4) corporate political activity analysis of Fiji’s food and beverage industry (n = 12). Data were sourced through publicly available documents on government websites, internet searches and via in-country colleagues and analysed thematically.ResultsOpportunities to strengthen and scale-up NCD policies in Fiji in line with WHO recommendations included (1) strengthening multisectoral policy engagement, (2) ensuring a nutrition- and health-in-all policy approach, (3) using a whole-of-society approach to tighten political action across sectors, and (4) identifying and countering food industry influence.ConclusionDiet-related NCD policy in Fiji will be strengthened with clearly defined partner roles, responsibilities and accountability mechanisms, clear budget allocation and strong institutional governance structures that can support and counter industry influence. Such initiatives will be needed to reduce the NCD burden in Fiji.

Front-of-Package Labels on Unhealthy Packaged Foods in India: Evidence from a Randomized Field Experiment.

Policies to require front-of-package labels (FOPLs) on packaged foods may help Indian consumers to better identify foods high in nutrients of concern, including sugar, saturated fat, and sodium, and discourage their consumption, which are outcomes that are critical for preventing rises in diet-related non-communicable disease. The objective was to test whether FOPLs helped Indian consumers identify “high-in” packaged foods and reduce intentions to purchase them. We conducted an in-person randomized experiment (n = 2869 adults between ages 18 and 60 years old) in six states of India in 2022. Participants were randomized to one of five FOPLs: a control label (barcode), warning label (octagon with “High in [nutrient]”), Health Star Rating (HSR), Guideline Daily Amount (GDA), or traffic light label. Participants then viewed a series of packaged foods high in sugar, saturated fat, or sodium with the assigned FOPL, and rated product perceptions and label reactions. Fewer than half of participants in the control group (39.1%) correctly identified all products high in nutrient(s) of concern. All FOPLs led to an increase in this outcome, with the biggest differences observed for the warning label (60.8%, p < 0.001), followed by the traffic light label (54.8%, p < 0.001), GDA (55.0%, p < 0.001), and HSR (45.0%, p < 0.01). While no FOPLs led to a reduction in intentions to purchase the packaged foods, the overall pattern of results suggested that warning labels are the most effective FOPL to help Indian consumers identify unhealthy foods.

Realizing the Potential of Neglected and Underutilized Bananas in Improving Diets for Nutrition and Health Outcomes in the Pacific Islands

Pacific Island countries are undergoing rapid food system transformation. This has led to a deterioration in diet quality with decreased consumption of traditional, fresh foods, and increasing consumption of imported, ultra-processed foods. Consequently, the triple burden of malnutrition is a now a major issue in the region. It is estimated that Vitamin A deficiency (VAD) is widespread, particularly in Kiribati, Vanuatu, and Solomon Islands. Rates of overweight, obesity, and diet-related non-communicable disease (DR-NCD) are high. Increasing consumption of local, traditional fruits and vegetables, particularly those that have high nutritional value like Pacific Island bananas, could play an important role in improving diets and health outcomes of Pacific Islander populations. Many of the banana cultivars found in the Pacific Islands region are high in carotenoids, an important precursor to Vitamin A. Fe'i bananas, such as Utin Iap, have been shown to contain much higher amounts of carotenoids than that of the commonly consumed Cavendish banana. As a traditional, starchy staple food, bananas are a good source of carbohydrate, including resistant starch, with small amounts of protein and little fat. These characteristics also lend themselves to being part of a healthy diet. The promotion of neglected and underutilized banana cultivars in the Pacific region provides a food-based and low-cost solution that simultaneously supports healthy diets and good nutrition, local farming systems and livelihood opportunities. However, to realize this potential, more work is required to understand the availability of nutrient rich banana in the region, current consumption patterns and drivers of consumption.

Dietary Patterns and Changes in Weight Status Among Chinese Men and Women During the COVID-19 Pandemic.

Aims: To identify dietary patterns during the coronavirus disease-2019 (COVID-19) pandemic and to examine their association with changes in weight status in the Chinese population.Methods: The 2020 China COVID-19 cross-sectional survey is an anonymous 74-item survey administered via social media across 31 provinces in mainland China between April and May 2020. Dietary data were assessed by a Food Frequency Questionnaire and the changes in weight status were self-reported. Exploratory factor analysis using the principal component analysis method was applied to identify dietary patterns. The multinomial regression models were conducted, and forest plots were used to present the associations between dietary patterns and changes in weight status.Results: Of a total of 10,545 adults (aged ≥18 years), more than half of participants reported to have weight gain, with 18.6% of men and 16.3% of women having weight gain >2.5 kg. Approximately 8% of participants reported to have weight loss, with 2.1% of men and 2.5% women having weight loss >2.5 kg. Two dietary patterns, namely, the modern and prudent dietary patterns, were identified during the COVID-19 pandemic. The modern dietary pattern was loaded heavily with soft drinks, fried foods, pickles, and inversely with fresh vegetables. The prudent dietary pattern was characterized by high intake of fresh fruits, vegetables, and inversely with soft drinks and fried food. The modern dietary pattern was positively associated with weight gain in men and women, while the prudent dietary pattern was negatively associated with both weight gain and loss in men and women during the COVID-19 pandemic.Conclusion: Dietary patterns during COVID-19 are significantly associated with the changes in weight status, which may subsequently increase the risk of diet-related non-communicable disease among the Chinese population.

Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS)

BackgroundPoor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. ObjectivesWe aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. MethodsUsing cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. ResultsWe developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). ConclusionsThe simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application–based 24-h recall system developed as part of this project.

Climate change and socioeconomic determinants are structural constraints to agency in diet-related non-communicable disease prevention in Vanuatu: a qualitative study

BackgroundPacific Island countries, many of which are low- and middle-income countries, have some of the highest rates of diet-related non-communicable diseases (DR-NCDs) globally. These countries also face some of the earliest and most significant impacts of climate change. Several pathways between climate change and DR-NCDs have been described in the literature; however, the scope is broad and lacks context specificity. This paper uses a case study of one Pacific Island country, Vanuatu, to investigate links between climate change and DR-NCDs.MethodsAn ethnographic qualitative research approach was used to share the lived experiences of community participants and to explore and contrast these with the perspectives of key informants at the national level. Data collection comprised thirty-two semi-structured interviews and community fieldwork in two villages using a mix of methods, including group workshops, informal conversations, and observations. Reflexive thematic analysis was conducted on both data sets.ResultsThis study found that DR-NCDs are a prominent health concern for ni-Vanuatu people and that structural determinants, including climate change, are the main driving forces for increased DR-NCD risk in the country. However, there was a lack of understanding of the links between climate change and DR-NCDs both at the community and national levels. Structural factors, such as social determinants and climate change, constrained individual and community agency in making optimal food and health choices and promoted the nutrition transition in Vanuatu. Despite the critical role of social determinants and climate change in driving DR-NCD risk, the responsibility for prevention and treatment was considered to rest mainly with the individual. A systems approach is advocated to grasp the complexity and interrelatedness of the causes of DR-NCD risk.ConclusionsThe interaction of structural determinants creates food and health environments that amplify the risk, burden, and consequences of DR-NCDs. It is recommended that the DR-NCD narrative in Vanuatu be re-framed with an emphasis on the range of structural determinants of DR-NCD risk. This will serve to enhance individual and collective agency to not only make healthy food and other behavioural choices but also to exercise agency to transform the structures in a culturally appropriate way.

School Vegetable Gardens As a Site for Reciprocity in Food Systems Research: An Example from Cape Town, South Africa

In this snapshot, I discuss the potential value of gardening as a reciprocal research method. I draw on my experience of partnering with a school in establishing and supporting an ongoing primary school vegetable garden, as part of a long-term research project. I suggest that the garden creates a space in which to “talk around” the problem of diet-related non-communicable disease,1 rather than trying to define or address it directly, and therefore allows for the co-construction of our understanding of “food choice,” both in exploring the limitations of choice, and in discovering participatory opportunities to leverage for change in the food system. In this light, I discuss the value of slow research around a shared physical space, where reciprocity is derived from a negotiated give-and-take of learning to grow vegetables. Over time, locally relevant, relational and cumulative framing emerges. I argue that slow, reciprocal research involves embracing the full complexity of context, and adopting a posture of flexibility means that, rather than trying to control outcomes, we remain curious about the process itself.

A Review on Sustainable Eating and Eco-Friendly Diets

The world population is expected to be thousand crores by 2050, and it’s now a matter of hot debate that how global food system is going to meet future requirements of food. There is the biggest challenge to make it sure that every person will have access to enough as well as nutritive food produced in a socio-culturally and environmentally sustainable forms. The diets available now (mostly westernized diets) are also a big risk factor for the worldwide burden of disease and death. Diet-related non-communicable disease and rising obesity are increasingly prevalent, affecting most of population. Therefore, sustainable diets are proposed as a multidimensional framework to affect the need for nutritious and adequate food within the context of the varied challenges facing the earth today reducing poverty and hunger, improving environmental health, enhancing human health, and strengthening local food networks, sustainable livelihoods, and cultural heritage. This mini-review is on new advancements towards sustainable diets and their nutritional, cultural and environmental aspects.

Consumption of ultra-processed foods and non-communicable disease-related nutrient profile in Portuguese adults and elderly (2015–2016): the UPPER project

This study aims to investigate the dietary share of ultra-processed foods and its association with the non-communicable disease (NCD)-related nutrient profile of adult and elderly populations in Portugal. Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015-2016) of the Portuguese population were analysed. Dietary intake was assessed by two non-consecutive 24-h recalls, and food items were classified according to the NOVA system. We estimated the percentage of dietary energy provided by each of the NOVA food groups and assessed the NCD-related nutrient profile of the overall diet across quintiles of ultra-processed food consumption. Weighted t tests, besides crude and adjusted linear and Poisson regressions, were performed. Ultra-processed foods contributed to around 24 and 16 % of daily energy intake for adults and elderly, respectively. In both groups, as the consumption of ultra-processed foods increased, the dietary content of free sugars, total fats and saturated fats increased, while the dietary content of protein decreased. In adults, total energy intake, dietary energy density and content of carbohydrates also increased as the consumption of ultra-processed foods increased, while the dietary content of fibre, Na and K decreased. The prevalence of those exceeding the upper limits recommended for free sugars and saturated fats increased by 544 and 153 % in adults and 619 and 60 % in elderly, when comparing the lowest with the highest quintile of ultra-processed food consumption. Such a scenario demands for effective strategies addressing food processing in the Portuguese population to improve their diet quality and prevention against diet-related NCD.

Health care providers\u2019 perspectives of diet-related non-communicable disease in South Africa

BackgroundIn South Africa, diet-related non-communicable diseases (dr-NCDs) place a significant burden on individuals, households and the health system. In this article, we investigate the experiences of eight key informants within the public sector health care system (nurse, doctor and dietician), in order to reflect on their experiences treating dr-NCDs.MethodsWe interviewed eight key informants who were central to the primary care service for at least 40,000 people living in a low-income neighbourhood of Cape Town, South Africa. In previous work, we had interviewed and conducted ethnographic research focused on dr-NCDs in the same neighbourhood. We then conducted a thematic analysis of these interviews.ResultsThe perspectives of key informants within the public sector therefore offered insights into tensions and commonalities between individual, neighbourhood and health systems perspectives. In particular, the rising prevalence of dr-NCDs alarmed providers. They identified changing diet as an important factor driving diabetes and high blood pressure in particular. Health care practitioners focused primarily on patients’ individual responsibility to eat a healthy diet and adhere to treatment. A marked lack of connection between health and social services at the local level, and a shortage of dieticians, meant that doctors provided rapid, often anecdotal dietary advice. The single dietician for the district was ill-equipped to connect dr-NCDs with the upstream determinants of health. While providers often had empathy and understanding of patients’ circumstances, their training and context had not equipped them to translate that understanding into a clinical context. Providers seemingly could not reconcile their empathy with their perception of dr-NCDs as a failure of prudence or responsibility by patients. Significant shortcomings within health systems and social services make reflexive practice very difficult.ConclusionsSupporting health care providers in understanding context, through approaches such as translational competency, while strengthening both health and social services, are vital given the high burden of NCDs in South Africa.

The impact of proposed nutrient criteria for the display of mandatory front-of-package ‘high-in’ symbols in the Canadian prepackaged foods supply

AbstractBackground: Front-of-package (FOP) nutrition labelling has become a core component of policy recommendations to address the growing burden of diet-related non-communicable disease globally. The CODEX Committee on Food Labelling is in the process of establishing standardized criteria for the definition of “high-in” for use with FOP labels highlighting excessive amounts of fats, sugars and sodium in foods. Recently, as part of Health Canada's Healthy Eating Strategy, regulations requiring the mandatory display of high-in FOP symbols have been published. The aim of this study was to investigate the extent to which these symbols would appear on foods and beverages in the Canadian prepackaged food supply, both overall and by food category.Methods: Foods and beverages in the University of Toronto's Food Label Information Program database 2013 (n = 15,277) were assessed for the prevalence of products that would have to display a symbol based on criteria published in the draft Canadian regulations. The criteria include thresholds based on the % Daily Value (DV) for each nutrient, above which, products would be required to display a FOP symbol for that nutrient. Exemptions are provided for fruits and vegetables without added sodium, sugars, or saturated fats, non-flavoured whole or partly skimmed milk, eggs, sweetening agents (i.e. sugar, honey, syrups and molasses) and table salt.Results: 61.7% (n = 10,251) of products would be required to display at least one symbol. Of these, 52.3% (n = 5,358) would have a sodium symbol, 41.9% (n = 4,295) a saturated fats symbol and 41.0% (n = 4,207) a sugars symbol. Overall, 37% of products would display a symbol for more than one nutrient. The highest concentration of symbols were found on processed meats (93.8%), soups (93.0%), desserts (87.2%), sugars and sweets (82.3%), dairy (76.9%) and bakery products (71.0%).Discussion: This is the first study to evaluate the impact of proposed regulations for the mandatory display of FOP symbols on Canadian prepackaged foods. Findings identify a high concentration of symbols in categories contributing meaningfully to dietary sodium, sugars, and saturated fats intakes, but also in categories for which consumption is discouraged in national dietary guidelines (e.g. processed meats, desserts). The findings presented here will inform ongoing discussions on how best to optimize criteria underpinning the display of FOP “high-in” labels.

Processed Foods and Nutrition Transition in the Pacific: Regional Trends, Patterns and Food System Drivers

Background: The role of processed foods in nutrition transition in the Pacific is receiving some attention in the context of a significant obesity and diet-related noncommunicable disease health burden. However, trends, patterns and underlying drivers of processed food markets in the Pacific are not well understood. The aim of this study was to investigate recent trends and patterns of processed food markets in the region and interpret the findings by engaging key literature on relevant food systems drivers. Methods: We conducted a mixed-methods approach involving two steps; (1) We analysed Euromonitor market sales data for processed food and beverage products sold from 2004–2018 for 16 countries differentiated by income level, and (2) guided by a food systems conceptual framework, we drew upon key literature to understand the likely drivers of our observations. Results: We observed plateaus and declines in processed food sales in some high-income countries but increases in upper-middle and lower-middle income countries, and most rapidly in the latter. Beverage markets appear to be stagnating across all income groups. Carbonated soft drinks, baked goods, vegetable oils, processed meats, noodles and sweet biscuits made up the majority of sales in transitioning countries. These observations are likely a result of income growth, urbanising populations, trade and globalisation, and various policies implemented by Pacific governments. Conclusions: A processed foods nutrition transition is well underway in the Pacific region and accelerating most prominently in lower-middle income countries.