Healthful Food Choices Research Articles

Supporting healthful eating through retail environmental change: communities putting prevention to work.

More healthful eating patterns can help people achieve recommended nutrient intakes, control calorie intake, and reduce the risk of some of the leading causes of chronic illness and death in the United States such as cardiovascular disease, diabetes, and certain types of cancer (1). Making more healthful choices easily accessible may help people start and maintain more healthful eating patterns (2,3). Although research and programs dedicated to improving access to more healthful food choices are under way (4), there is little empirical evidence to identify what aspects of the retail environment require intervention to improve access (5). It is unclear whether efforts should focus on improving proximity to stores, improving the selection of healthful options within stores with limited stock, making more healthful items more affordable, improving the quality of goods within stores, introducing more healthful options to an area via other retail models like farmers markets, or some combination of the above. One recent initiative that may elucidate what aspects of the environments to change to improve the diet and health of community members is Communities Putting Prevention to Work (CPPW). During the 2-year funding period beginning in 2010, 39 of the 50 CPPW communities committed to enhancing access to healthful food and evaluating the effect of this increased access on behavior (6). CPPW presented an opportunity to evaluate changes to the environment that may support people in making more healthful dietary choices.

Flavonoids from Fruit and Vegetables: A Focus on Cardiovascular Risk Factors

Epidemiological studies suggest that high intakes of dietary flavonoids are associated with decreased cardiovascular disease mortality and risk factors. Less is known about the cardioprotective effects of flavonoids from fruit and vegetables. This review summarizes data from studies which examine the effects of commonly consumed fruit and vegetables on cardiovascular disease risk biomarkers in healthy volunteers or at-risk individuals. Although flavonoids from apples, berries, and onions appear to impact positively on blood pressure, vascular function, and serum lipid levels, further research is required to find out the optimal quantity and food matrix for conferring substantial clinical benefit. The benefits from citrus flavonoids are still inconclusive. Further robust, longer-term dietary intervention studies, with the inclusion of placebo or control arms, are required to improve the credibility of the findings and confirm current observations. An improved understanding of the impact of flavonoids from fruit and vegetables can help one make discerning food choices for optimal cardiovascular health.

Behavioural effects of directive cues on front-of-package nutrition information: the combination matters!

Nutrition information aims to reduce information asymmetries between manufacturers and consumers. To date, however, it remains unclear how nutrition information that is shown on the front of the packaging should be designed in order to increase both visual attention and the tendency to make healthful food choices. The present study aimed to address this gap in research. An experimental laboratory study applying mobile eye-tracking technology manipulated the presence of two directive cues, i.e. health marks and traffic light colour-coding, as part of front-of-package nutrition information on actual food packages. Participants wore mobile eye-tracking glasses during a simulated shopping trip. After the ostensible study had finished, they chose one snack (from an assortment of fifteen snacks) as a thank you for participation. All products were labelled with nutrition information according to the experimental condition. Consumers (n 160) who were mainly responsible for grocery shopping in their household participated in the study. The results showed that, in the absence of traffic light colouring, health marks reduced attention to the snack food packaging. This effect did not occur when the colouring was present. The combination of the two directive cues (v. presenting traffic light colours only) made consumers choose more healthful snacks, according to the nutrient profile. Public policy makers may recommend retailers and manufacturers implement consistent front-of-pack nutrition labelling that contains both health marks and traffic light colouring as directive cues. The combination of the cues may increase the likelihood of healthful decision making.

Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study

To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs. Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone. Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status. Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children's ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.

Supermarket and grocery store-based interventions to promote healthful food choices and eating practices: a systematic review.

IntroductionIncreasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices.MethodsWe searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category.ResultsWe identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. ConclusionMore rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed.

Nutrition in Pain Modulation

Diet and nutrition issues are common themes in the practice of integrative medicine. Some of these have become more familiar and even more mainstream during the past several years. Examples include the effects of dietary trans fatty acids on heart disease and carbohydrates on diabetes, as well as the protective effects of fish oil in several conditions. In recent years there has been more basic research and clinical information about anti-inflammatory diets, how to prevent diabetes, and how to make better food choices for health and antiaging. With this information, integrative physicians have been able to effectively manage and treat the conditions of many patients who have a variety of chronic illnesses, thereby improving the efficacy of conventional medical treatment and medication. More recently, the condition of chronic pain has come to the forefront of medical and social discussion. According to the United Nations World Drug Report, 2008, 0.6% of Americans between the ages of 15 and 64 use opiates, tying the United States for seventeenth in the world. 1 A Drug Enforcement Ad

Dietary guidance for people wearing removable prostheses

The authors identified and described dietary strategies appropriate for dental patients who receive dental care that includes the placement and maintenance of dental prostheses. Identification of a patient's perception of food choices associated with placement of a dental prosthesis can lead to delivery of patient-focused dietary guidance for the promotion of targeted food choices to improve oral health and systemic health. An interview guide for assessment of patient satisfaction and a guide for suggested dietary choices and modifications are provided. Dental professionals can tailor food modification strategies and promote healthful food choices, enhance patient satisfaction and improve health outcomes.

Single-Larger-Portion-Size and Dual-Column Nutrition Labeling May Help Consumers Make More Healthful Food Choices

The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices. To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container, but are reasonably consumed at a single eating occasion. Participants were randomly assigned to study conditions that varied on label format, product, and nutrition profile. Data were collected via an online consumer panel. Adults aged 18 years and older were recruited from Synovate's online household panel. Data were collected during August 2011. A total of 32,897 invitations were sent for a final sample of 9,493 interviews. Participants were randomly assigned to one of 10 label formats classified into three groups: listing 2 servings per container with a single column, listing 2 servings per container with a dual column, and listing a single serving per container. Within these groups there were versions that enlarged the font size for "calories," removed "calories from fat," and changed the wording for serving size declaration. The single product task measured product healthfulness, the amount of calories and various nutrients per serving and per container, and label perceptions. The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving. Analysis of covariance models with Tukey-Kramer tests were used. Covariates included general label use, age, sex, level of education, and race/ethnicity. Single-serving and dual-column formats performed better and scored higher on most outcome measures. For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices.

15B. The Seven Questions for Symptomatic Vegans and Vegetarians

Focus Area: Experiential WorkshopNot all who adhere to vegetarian, vegan, or other special diets have nutritionally sound eating habits. The clinical consequences of an insufficiently mindful vegetarian or vegan diet include many common symptoms such as anxiety, brain fog, depression, fatigue, insomnia, neuropathies, and other neurologic dysfunction. Patients with such symptoms who report having a vegetarian or vegan diet or a diet that severely restricts meat consumption require a slightly expanded differential diagnosis. The clinical challenge is to identify which patients require closer attention. This workshop introduces 7 questions for all clinicians for rapid assessment of potential dietary drivers of clinical symptoms. This approach supports patient insights on mindful eating practices including optimal food choices for optimal health.

Capacity analysis of health food choice by reference to consumers in two models of nutritional labeling; crossover study

The aim of this study was to compare two models of nutrition labeling front-of-pack, in reference to the ability of consumers to choose a diet closer to nutritional recommendations. Randomized crossover design in 32 adults (18-65 years) of both sexes. Participants were randomly exposed to two experimental conditions using nutritional traffic light system (S-SN) or monochrome system (SM). Participants had to choose options from a closed menu for five days on the basis of the experimental front-of-pack labelling. For each meal, three food options with different nutritional compositions were given to the participants. The total energy and fat, saturated fat, sugar and salt of the chosen options were calculated. No significant differences at baseline sociodemographic and anthropometric characteristics were shown between individuals regardless of the experimental condition in which they started. The subjects tended to choose a diet with a lower, but not significant energy content of 23.0 ± 67.5 (P = 0.063) and a significantly lower sugar content of 3.5 ± 9.2 g, P < 0.001 and 0.6 ± 1 g, P < 0.003 for salt. Compared to the to the monochrome system, the multiple traffic-light system probably can help make food choices with less sugar and salt in a situation similar to the usual purchase in which there is a time limitation.

Awareness and use of MyPlate Guidelines in Making Food Choices

Background/ObjectiveOver the past decades, the USDA created several guidelines to assist the public in making healthful food choices. In June 2011, the popular pyramid symbols (Food Guide Pyramid and MyPyramid) were replaced with MyPlate – a simple and practical guideline for making healthful food choices. This study aims to 1) assess consumers’ awareness of the replacement of MyPyramid with MyPlate, and 2) determine whether MyPlate influenced people's dietary choices 4 months after the MyPlate symbol's release. MethodsFifty-one male and female participants, ages 18-34 years, with high school, associate's and bachelor's degree diplomas, were selected by convenience sampling. Participants manually completed an 11-question survey using yes/no or degree of liking rating. The relationship between participants’ backgrounds, familiarity with MyPlate and MyPyramid guidelines, and the likelihood of use and influence on food selection was compared with participants’ demographics. ResultsEighty percent of the 51 participants were familiar with MyPyramid while 59% reported they had visited the website. About 50% of the participants reported they were aware that MyPlate replaced MyPyramid; but they were unfamiliar with MyPlate guidelines. About 50% of the participants would likely visit the MyPlate website. And, over half of the participants were unsure if MyPlate would influence their food choices while 43% thought it would. SignificanceMyPlate guidelines have been available to the public since June 2011 and findings of this study show that MyPlate guidelines influenced the food choices of at least 40% of the participants. It could be inferred that public awareness and use of MyPlate guidelines will grow over time.

Explaining and predicting individually experienced liking of berry fractions by the hTAS2R38 taste receptor genotype

The roles of taste and astringent properties, food choice motives and health concerns in liking of bilberry and crowberry samples were studied using a sensory panel prescreened for the hTAS2R38 taste receptor genotype. The subjects rated the intensity of sourness, bitterness and two astringent properties (soft, velvety and rough, puckering) of all berry samples. They also scored the liking of juice fractions and completed a food choice motive and health concern questionnaire. Regression models were used to combine different data sets and to predict liking of the extracts. Sourness contributed positively to the liking of berry fractions, and bitterness and rough astringency were negative factors. The hTAS2R38 genotype affected the liking of polyphenol-rich extracts, which were significantly bitter and astringent. Based on the genotype grouping of subjects, PAV homozygotes gave lower ratings to the attributes than AVI homozygotes. In contrast, PAV homozygotes were predicted to dislike the extracts notably more than AVI homozygotes. Health concern and food choice motives related to health and weight control had significant roles in individual liking of juice fractions. Our results indicate that mood was more important to the PAV homozygotes than to the AVI homozygotes.

Effects of Potato Fiber and Potato‐Resistant Starch on Biomarkers of Colonic Health in Rats Fed Diets Containing Red Meat

The effects of red meat consumption with and without fermentable carbohydrates on indices of large bowel health in rats were examined. Sprague-Dawley rats were fed cellulose, potato fiber, or potato-resistant starch diets containing 12% casein for 2 wk, then similar diets containing 25% cooked beef for 6 wk. After week 8, cecal and colonic microbiota composition, fermentation end-products, colon structure, and colonocyte DNA damage were analyzed. Rats fed potato fiber had lower Bacteroides-Prevotella-Porphyromonas group compared to other diet groups. Colonic Bifidobacterium spp. and/or Lactobacillus spp. were higher in potato fiber and potato-resistant starch diets than in the cellulose diet. Beneficial changes were observed in short-chain fatty acid concentrations (acetic, butyric, and propionic acids) in rats fed potato fiber compared with rats fed cellulose. Phenol and p-cresol concentrations were lower in the cecum and colon of rats fed potato fiber. An increase in goblet cells per crypt and longer crypts were found in the colon of rats fed potato fiber and potato-resistant starch diets. Fermentable carbohydrates had no effect on colonic DNA damage. Dietary combinations of red meat with potato fiber or potato-resistant starch have distinctive effects in the large bowel. Future studies are essential to examine the efficacy of different types of nondigestible carbohydrates in maintaining colonic health during long-term consumption of high-protein diets. Improved understanding of interactions between the food consumed and gut microbiota provides knowledge needed to make healthier food choices for large bowel health. The impact of red meat on large bowel health may be ameliorated by consuming with fermentable dietary fiber, a colonic energy source that produces less harmful by-products than the microbial breakdown of colonic protein for energy. Developing functional red meat products with fermentable dietary fiber could be one way to promote a healthy and balanced macronutrient diet.

Updated US Department of Agriculture Food Patterns Meet Goals of the 2010 Dietary Guidelines

The US Department of Agriculture Food Patterns were updated for the 2010 Dietary Guidelines for Americans to meet new nutrition goals and incorporate results of food pattern modeling requested by the Dietary Guidelines Advisory Committee. The purpose of this article is to describe the process used and changes in the updated patterns. Changes include renaming the Meat and Beans and Milk Groups to the Protein Foods and Dairy Groups, respectively, to be more encompassing of foods in each. Vegetable subgroups now provide more achievable intake recommendations. Calcium-fortified soymilk is now included in the Dairy Group because of its similarity to foods in that group. Increased amounts of seafoods are recommended in the Protein Foods Group, balanced by decreased amounts of meat and poultry. A limit on calories from solid fats and added sugars is included, replacing the previous discretionary calorie allowance and emphasizing the need to choose nutrient-dense forms of foods. Lacto-ovo vegetarian and vegan patterns that meet nutrition goals were created by making substitutions in the Protein Foods Group, and for vegan patterns, in the Dairy Group. Patterns identify food choices that meet nutritional needs within energy allowances and encourage choosing a variety of foods. They rely on foods in nutrient-dense forms, including a limited amount of calories from solid fats and added sugars. The Food Patterns provide a useful template for educating consumers about healthful food choices while highlighting a large gap between choices many Americans make and healthy eating patterns.

Nutrition Labeling to Prevent Obesity: Reviewing the Evidence from Europe

Overweight and obesity are major public health problems in the European Union (EU). Providing nutrition information on foods and menus is considered a relevant means to guide consumers toward more healthful food choices, in part characterized by adequate energy intakes to achieve and maintain a healthy body weight. Various formats of back-of-pack and front-of-pack nutrition labeling can currently be found across the EU, with varying levels of penetration. Experimental studies show that consumers are reasonably able to understand and use the different systems to identify more healthful food products from given choice sets. However, European studies assessing the impact of nutrition labeling on actual dietary intake are scarce, and no real-life evidence exists linking nutrition label use with measured changes in body weight. This review summarizes how European consumers respond to nutrition labels when shopping for food or eating out of home, considering evidence published between 2007 and mid-March 2012.

Diet and Body Composition Outcomes of an Environmental and Educational Intervention among Men in Treatment for Substance Addiction

To determine the effect of an educational and environmental intervention on diet, body mass index, and waist circumference of men in substance addiction treatment. One hundred three racially/ethnically diverse men in 6 urban substance addiction residential treatment facilities in Upstate New York participated in weekly nutrition and food classes and food environment changes to increase healthful food choices. The main outcomes of this controlled, quasi-experimental, pre-post evaluation study were diet, body mass index, and waist circumference. Forty-three (42%) participants with complete data reported significantly greater intakes of fruits and vegetables, lower intakes of calories from sweets and desserts, and a reduction in waist circumference (P≤ .05) following the intervention, compared to the control period. An educational and environmental intervention can be effective in promoting positive dietary behavior and reducing waist circumference among men in residential treatment. These results need to be confirmed in a larger, randomized trial.

Promoting Healthful Eating Patterns Among Patients With Diabetes

There is a quote attributed to Hippocrates that reads, “Let food be thy medicine, thy medicine shall be thy food.” It is easy to recognize the significance of this advice when working with patients with diabetes. Nutrition therapy has been recognized as a crucial component of diabetes management since the discovery of the disease. General goals of diabetes nutrition therapy are to achieve and sustain blood glucose and blood pressure as near to normal as possible, as well as a lipid profile that decreases the risk for cardiovascular disease; to prevent chronic complications; to address individual nutrition needs; and to maintain the pleasure of eating.1 Although it is recommended that a registered dietitian (RD) experienced in diabetes medical nutrition therapy (MNT) take the lead role in providing nutrition care for individuals with diabetes,1 all health care professionals who see patients with diabetes play a contributing role in promoting healthful eating. For busy clinicians, messages about healthful eating and physical activity often go unsaid because of the short duration of time actually spent face to face with patients. Health care professionals encountering patients with diabetes throughout their course of care can make a difference by reinforcing positive messages about healthful food choices and physical activity and sharing the belief that it is possible to make changes. These brief messages may be more important than clinicians realize. Controversy surrounded the recent revelation from celebrity chef Paula Deen that she had been diagnosed with type …

Diabetes Cooking Schools Improve Knowledge and Skills in Making Healthful Food Choices

Rates of type 2 diabetes are increasing nationally and in New Mexico, particularly in ethnic minorities. A key self-care area with challenging barriers is healthy eating. The New Mexico Cooperative Extension Service conducts diabetes cooking schools statewide together with community health providers. The study reported here determined if this education was effective in people with type 2 diabetes and their family members. Self-report surveys showed that knowledge and behaviors significantly improved (p&lt;0.05) following participation in cooking schools in all ethnic groups, both genders, and a wide range of ages. Hands-on cooking schools are an effective method for diabetes education.

Personal Food Systems of Male Collegiate Football Players: A Grounded Theory Investigation

Factors that affect food choices include the physical and social environments, quality, quantity, perceived healthfulness, and convenience. The personal food choice process was defined as the procedures used by athletes for making food choices, including the weighing and balancing of activities of daily life, physical well-being, convenience, monetary resources, and social relationships. To develop a theoretical model explaining the personal food choice processes of collegiate football players. Qualitative study. National Collegiate Athletic Association Division II football program. Fifteen football players were purposefully sampled to represent various positions, years of athletic eligibility, and ethnic backgrounds. For text data collection, we used predetermined, open-ended questions. Data were analyzed using the constant comparison method. The athletes' words were used to label and describe their interactions and experiences with the food choice process. Member checks and an external audit were conducted by a qualitative methodologist and a nutrition specialist, and the findings were triangulated with the current literature to ensure trustworthiness of the text data. Time was the core category and yielded a cyclic graphic of a theoretical model for the food choice system. Planning hydration, macronutrient strategies, snacks, and healthful food choices emerged as themes. The athletes planned meals and snacks around their academic and athletic schedules while attempting to consume foods identified as healthful. Healthful foods were generally lower in fat but high in preferred macronutrients. High-protein foods were the players' primary goal; carbohydrate consumption was secondary. The athletes had established plans to maintain hydration. Professionals may use these findings to implement educational programs on food choices for football players.

Strategies to Promote High School Students’ Healthful Food Choices

The purpose of this study was to evaluate the efficacy of a nutrition education curriculum that was developed to inspire new, more healthful dietary habits among adolescents, in order to address the growing public health problem of overweight in youth. Previous garden-based interventions improved attitudes or behaviors related to increased fruit and vegetable intake in pre-adolescent student populations.1-3 In the present garden-to-table curriculum pilot, the authors focus on improving adolescent dietary behavior and attitudes toward healthful food choices by promoting cooking with fresh ingredients and enjoying meals with friends and family.