Food Substitution Research Articles

Renal-Friendly Interactive Cooking Demonstration for Hemodialysis Patients

Description: Following a renal diet in the hemodialysis population has unique challenges. Patients often have complex dietary restrictions, lack adequate cooking skills and have limited financial resources. Consequently, they rely on processed meals that are high in sodium and/or phosphorus. The aim of a renal-friendly cooking demonstration is to help increase patient's confidence in managing a renal diet, to improve self-management and encourage peer support. The class was an interactive cooking demonstration of a 3-course meal led by a chef and an optional 30-minute grocery store tour. The recipes were chosen by the chef, who was given the dietary restrictions (low phosphorus, low sodium), and approved by the Registered Dietitians (RDs). The RDs provided additional food substitution suggestions throughout the class to accommodate high- or low-potassium and diabetic diets. The tour focused on reading nutritional information on labels and was led by RDs. The participants had the opportunity to eat the meal and socialize with their peers.

Substitution of red meat with poultry or fish and risk of type 2 diabetes: a Danish cohort study.

We examined associations between substitution of red meat (total, processed and unprocessed, low fat and high fat) with poultry or fish and substitution of processed red meat with unprocessed red meat and the risk of type 2 diabetes. A cohort of 53,163 participants from the Danish Diet, Cancer and Health study were followed for incident type 2 diabetes (6879 cases; median follow-up time 15.4years). Diet was assessed by a validated 192-item food frequency questionnaire at baseline. Adjusted Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for type 2 diabetes associated with specified food substitutions of 150g/week. Replacing total red meat with fish was associated with a lower risk of type 2 diabetes [HR 0.96 (95% CI 0.94, 0.99)] as was replacement of processed red meat with poultry or fish [HR poultry 0.96 (95% CI 0.93, 0.99)]; HR fish 0.94 [(95% CI 0.91, 0.97)]. Replacing low fat red meat or high fat red meat with fish was associated with a lower risk of type 2 diabetes whereas similar substitutions, with poultry, were not. Replacing processed red meat with unprocessed red meat was also associated with a lower risk of type 2 diabetes [HR 0.96 (95% CI 0.93, 0.99)]. Replacing processed red meat with poultry, replacing total or processed red meat with fish, and replacing processed red meat with unprocessed red meat were all associated with a lower risk of type 2 diabetes.

The effect of substitution of regular foods by protein enriched foods on protein intake in hospitalized: Patients independent of malnutrition risk; A pilot study

Rationale: All hospitalized patients have higher protein needs because of their acute or chronic illnesses, but a study in Bernhoven (Uden, The Netherlands) has shown that patients WITH a risk of malnutrition have a higher protein intake because of dietary interventions (extra protein enriched snacks), which are not used in patients without risk of malnutrition. The aim of this study was to examine whether it is possible to reach higher protein intake in ALL hospital patients by substitution of standard bread and fruit drinks by protein enriched bread and fruit drinks.

Examining the influence of perceived and objective time constraints on the quality of household food purchases

BackgroundObesity is a major public health concern in the United States. From the late 1970s through the mid-1990s, the reduction in the amount of time individuals spent preparing food coincided with changes in the food environment. This led to increased consumption of energy and contributed to the dramatic rise in obesity rates over the same period. Research and policy aimed at improving American diets has largely focused on ensuring that healthy foods are accessible and affordable. Although these are important determinants of food choice, time constraints also factors into purchasing decisions. PurposeTo examine the relationship between time constraints, both perceived and objective, and the quality of Americans' food purchases by income level. MethodsUSDA's National Household Food Acquisition and Purchase Survey was used to examine the relationship between time constraints (objective and perceived) and HEI-2010 score of food purchases and examines this relationship by income. It estimates an econometric model that controls for other factors that influence time resources and food choice. ResultsThe relationship between the perceived time constraint and estimated HEI score of food purchases varied by income level, though the relationship was only significant for higher-income households, or those between 400% and 600% of the poverty line. There was no significant relationship between the objective time constraint and HEI score of food purchases. ConclusionsNutrition education and interventions aimed at improving household food purchasing decisions may benefit from focusing on improving time management skills and emphasizing healthier convenience food substitutions when consumers feel time-constrained. Higher-income consumers eat out more frequently than lower-income consumers, so menu labeling aimed at nudging higher-income individuals to purchase healthier options could help improve food choice in these settings.

Nutrient intake disparities in the US: modeling the effect of food substitutions

BackgroundDiet quality among federal food assistance program participants remains low, and little research has assessed the diet quality of food insecure non-participants. Further research is needed to assess the extent to which food substitutions can improve the nutritional status of these vulnerable populations. Substituting egg dishes for other commonly consumed dishes at certain eating occasions may be an effective strategy for improving the daily nutrient intake among these groups. Eggs are rich in many important nutrients, and are low-cost and part of a wide range of cultural food menus, which are important considerations for low-income and ethnically diverse populations. To help guide the focus of targeted nutrition interventions and education campaigns for vulnerable populations, the present work begins by 1) estimating the prevalence of nutrient inadequacy among these groups, and then models the effect of consuming egg dishes instead of commonly consumed dishes at each eating occasion on 2) the prevalence of nutrient inadequacy, and 3) the mean intake of nutrients.MethodsDietary data from 34,741 adults ≥ 20 y were acquired from the National Health and Nutrition Examination Survey, 2001–2014. Diet pattern modeling was used to substitute commonly consumed egg dishes for commonly consumed main dishes at breakfast, lunch, and dinner. National Cancer Institute usual intake methods were used to estimate the prevalence of inadequate intake of 31 nutrients pre- and post-substitution, and a novel index was used to estimate change in intake of all nutrients collectively.ResultsSubstituting eggs for commonly consumed main dishes at lunch or dinner did not change total daily nutrient intake for each group (P > 0.05), but decreased the prevalence of vitamin D inadequacy by 1–4 percentage points (P < 0.01). Substituting eggs for commonly consumed foods at breakfast increased the prevalence of folate inadequacy by 8–12 percentage points among each group (P < 0.01).ConclusionsWhen making food substitutions to increase nutrient intake, eating occasion should be an important consideration. Further research is needed to better understand how food substitutions affect diet costs, which may be an important driver of food purchasing decisions among low income individuals with limited food budgets.

Assessing the role of market integration in the consumption of traditional foods in Benin: a joint price instability coefficient and diet composition approach

Globalization-driven food trade policies and the transformations of food regimes have led to modernizing food habits and the growing substitution of traditional foods by introduced/industrialized foods in the diets of urban people in sub-Saharan Africa. Such changes in food consumption habits are suspected to be associated with the increasing prevalence of some non-transmittable food-related diseases in the region. The role food markets play in food substitution in the diets needs to be understood. This study analyzes the effects of differential market integration on the consumption of the two types of foods in Southern Benin. Market integration was assessed using the reciprocal of the gap in price instability coefficients between markets (G) and calculated using monthly prices series over the “July 2009–July 2011” period. The findings indicate that markets in the Allada market cluster are more integrated for introduced foods (G = 5.3) than traditional foods (G = 4.3). The integration of primary, assembly, and rural consumer markets with the Bohicon regional market is by far higher for introduced foods (G = 5.3) than traditional foods (G = 1.2). The results in Toffo market cluster were comparable, in spite of less reliable data. The district-level rural markets are more integrated among themselves than with the regional market, either for traditional foods or introduced foods. Considering that most of the latter are processed foods, the result tends to indicate that food processing would trigger greater market integration. Therefore, policies that promote processing and trade of locally produced traditional foods should be implemented. Indeed, processing is key among the factors that increase urban consumers’ preferences for introduced foods against traditional foods. On the contrary, the hypothesis which asserts that low levels of market integration among traditional foods contribute to their disappearance in people’s diets is rejected. Indeed, diets in rural areas of Benin are still dominated by “traditional foods.” However, the growing trend in the consumption of imported low nutritional value foods should be controlled by appropriate food production and trade policies.

Vegetarian diet, food substitution, and nonalcoholic fatty liver.

Objectives:Vegetarian diets have been shown to improve insulin resistance and reduce body weight, but the effects on nonalcoholic fatty liver require further confirmation. We aim to investigate the association between vegetarian diets, major food groups, and nonalcoholic fatty liver, and to compare the degree of liver fibrosis between vegetarians and nonvegetarians in those with fatty liver.Materials and Methods:We analyzed cross-sectional data from the Tzu Chi Health Study which included 2127 nonvegetarians and 1273 vegetarians who did not smoke or habitually drink alcohol and had no hepatitis B or hepatitis C. Fatty liver and liver fibrosis were determined using ultrasonography and the nonalcoholic fatty liver disease fibrosis score, respectively. Diet was assessed through a validated food frequency questionnaire.Results:Vegetarian diets were associated with lower odds of fatty liver (odds ratio = 0.79, 95% confidence interval: 0.68–0.91) after adjusting for age, gender, education, history of smoking and alcohol drinking. Adjustment for body mass index (BMI) attenuated the protective association. Vegetarians had less severe fibrosis than nonvegetarians. Replacing a serving of soy with a serving of meat or fish was associated with 12%–13% increased risk, and replacing a serving of whole grains with a serving of refined grains, fruits, and fruit juice was associated with 3%–12% increased the risk of fatty liver.Conclusion:Vegetarian diets, replacing meat and fish with soy, and replacing refined carbohydrates with whole grains, may be inversely associated with nonalcoholic fatty liver related to BMI.

Development of modified starch technology (maltodextrin) from commercial tapioca on semi production scale using oil heater dextrinator

One way to improve functional starch is by modification of starch into dextrin or maltodextrin. Maltodextrin is used in the food industry as a food substitution. Development of enzymatically modified starch technology has been performed with the use of α-amylase at optimum pH of 5.5, temperature 75-85 °C, with enzyme activity of 135 KNU/g. The maltodextrin produced from commercial tapioca has the quality requirements for food according to SNI 1992. The yield of maltodextrin obtained is about 80%. The use of the optimum amount of the α-amylase enzyme is 0.07 % v/w and the substrate amount of tapioca starch is 35%. Analysis of the feasibility of modified starch with the assumption of production scale of 300 kg per day, the economic value of 10 years business, the price of starch is IDR 8,350/kg, from tapioca starch (tapioca) IDR 4,000 – IDR 4,500/kg.

The symbolic dimension of prenatal nutrition care in diabetes Mellitus

ABSTRACT Objective Aimed at analysing the symbolic dimension of prenatal nutritional care in diabetes. Methods Participants were 17 puerperal adults diagnosed with previous or gestational diabetes. Participant observation and semi-structured interviews were conducted to collect data. The data were interpreted according to an adaptation of Bardin’s Thematic Content Analysis. Results The main meaning of diabetes was the need for changing eating habits. Nutritional care based on the Traditional Method or the Carbohydrate Counting Method was understood as an opportunity for dietary re-education. Weight loss was considered desirable by some participants, albeit against the advice of nutritionists. Pregnant women adopted the standard meal plan, rarely used the food substitution list, and reported occasional dietary transgressions, self-allowed in small portions. Foods containing sucrose were perceived as less harmful to health than added sugars. Conclusion Each pregnant woman experienced prenatal nutritional care in diabetes not as a dietary method, but as part of her lifestyle.

Pricing Strategies to Encourage Availability, Purchase, and Consumption of Healthy Foods and Beverages: A Systematic Review.

IntroductionFood pricing policies to promote healthy diets, such as taxes, price manipulations, and food subsidies, have been tested in different settings. However, little consensus exists about the effect of these policies on the availability of healthy and unhealthy foods, on what foods consumers buy, or on the impact of food purchases on consumer health outcomes. We conducted a systematic review of studies of the effect of food-pricing interventions on retail sales and on consumer purchasing and consumption of healthy foods and beverages.MethodsWe used MEDLINE, Embase, PsycINFO, Web of Science, ClinicalTrials.gov, and the Cochrane Library to conduct a systematic search for peer-reviewed articles related to studies of food pricing policies. We selected articles that were published in English from January 2000 through December 2016 on the following types of studies: 1) real-world experimental studies (randomized controlled trials, quasi-experimental studies, and natural experiments); 2) population studies of people or retail stores in middle-income and high-income countries; 3) pricing interventions alone or in combination with other strategies (price promotions, coupons, taxes, or cash-back rebates), excluding studies of vending-machine or online sales; and 4) outcomes studies at the retail (stocking, sales) and consumer (purchasing, consumption) levels. We selected 65 articles representing 30 studies for review.ResultsSixteen pricing intervention studies that sought to improve access to healthy food and beverage options reported increased stocking and sales of promoted food items. Most studies (n = 23) reported improvement in the purchasing and consumption of healthy foods or beverages or decreased purchasing and consumption of unhealthy foods or beverages. Most studies assessed promotions of fresh fruits and vegetables (n = 20); however, these foods may be hard to source, have high perishability, and raise concerns about safety and handling. Few of the pricing studies we reviewed discouraged purchasing and consumption of unhealthy foods (n = 6). Many studies we reviewed had limitations, including lack of formative research, process evaluation, or psychosocial and health assessments of the intervention’s impact; short intervention duration; or no assessment of food substitutions or the effects of pricing interventions on food purchasing and diets.ConclusionPricing interventions generally increased stocking, sales, purchasing, and consumption of promoted foods and beverages. Additional studies are needed to differentiate the potential impact of selected pricing strategies and policies over others.

Meat consumption reduction in Italian regions: Health co-benefits and decreases in GHG emissions.

IntroductionAnimal agriculture has exponentially grown in recent decades in response to the rise in global demand for meat, even in countries like Italy that traditionally eat a Mediterranean, plant-based diet. Globalization related dietary changes are contributing to the epidemic of non-communicable diseases and to the global climate crisis, and are associated with huge carbon and water footprints.The objective of the study is to assess inequalities in health impacts and in attributable greenhouse gases-GHG emissions in Italy by hypothesizing different scenarios of reduction in red and processed meat consumption towards healthier consumption patterns more compliant with the recommendations of the Mediterranean food pyramid.MethodsWe used demographic and food consumption patterns from national surveys and risk relationships between meat intake and cardiovascular and colorectal cancer mortality from IARC and other meta-analyses.From the baseline data (year 2005–2006, average 406 gr/week beef and 245 gr/week processed meat), we considered hypothetical meat reduction scenarios according to international dietary guidelines such as the Mediterranean pyramid targets. For each geographical area (Northwest, Northeast, Centre, and South) and gender, we calculated the number of avoidable deaths from colorectal cancer, and cardiovascular disease among the adult population. Moreover, years of life gained by the adult population from 2012 to 2030 and changes in life expectancy of the 2012 birth cohort were quantified using gender-specific life tables.GHG emission reductions under Mediterranean scenario were estimated only for beef by applying the Global Warming Potential (GWP) coefficient to total consumption and to a low carbon food substitution in adult diet.ResultsThe deaths avoidable (as percentage change compared to baseline) according to the three reduction scenarios for beef consumption were between 2.3% and 4.5% for colorectal cancer, and between 2.1% and 4.0% for cardiovascular disease; higher benefits would be observed in Northwestern areas and among males. In parallel, 5% and 6.4% of colorectal cancer and CVD deaths would be avoided if the Italian population ate the advised quantity of processed meat. Life table analysis suggests that the scenario that is fully compliant with the Mediterranean diet model would save 5 million years of life lost prematurely among men and women over the next 18 years and would increase average life expectancy of future generations by over 7 months.Considering the environmental impact, emissions associated with the actual total intake of beef range from 12,900 to 21,800 Gg CO2 eq; emissions saved according to the Mediterranean scenario are in the range 8000–14000 Gg CO2 eq per year. The per capita reduction is 263 KgCO2eq/year/person with higher reductions in Northwestern and Central areas.ConclusionsIn Italy, scenarios for reducing beef consumption are consistent with significant health and environmental co-benefits on current and future generations. Results support introducing policies to promote healthier behavior towards red and processed meat in the adult population within an overall balanced and healthy dietary pattern. Interventions should address gender, vulnerable population groups, and geographical differences in order to be more effective.

Food security implications of staple food substitution in Sahelian West Africa

Low-income households in Sahelian West Africa face multiple shocks that risk compressing their already-low food consumption levels. This paper develops a multi-market simulation model to evaluate the impact of common production and world-price shocks on food consumption of vulnerable groups in Sahelian West Africa. Empirical analysis confirms that poor households bear the brunt of ensuing consumption risks, particularly in closed markets, where trade barriers restrict imports, and the poor find themselves in a bidding war with richer consumers for limited food supplies. In the absence of trade, a drought that reduces domestic rainfed cereal production by 20% would compress already low calorie consumption of the rural poor by as much as 15%, four times as much as other household groups. Conversely, a 50% spike in world rice prices hits the urban poor hardest, compressing calorie consumption by up to 8%.Policy responses need to focus on two basic mechanisms that can help to moderate this pressure – consumer substitution among staple foods and trade. Immediately south of the Sahel, coastal West African countries enjoy higher rainfall, dual rainy seasons, more stable staple food production based on root crops (cassava and yams) as well as frequent double cropping of maize.Our simulation results suggest that regional trade in maize, yams and cassava-based prepared foods like gari and attieké could fill over one-third of the consumption shortfall resulting from a major drought in the Sahel. Increasing substitutability across starchy staples, for example through expansion of maize, cassava and sorghum-based convenience foods, would further moderate consumption pressure by expanding the array of food alternatives and hence supply responses available during periods of stress.

Examining the Influence of Time Constraints on Diet Quality

Much of the current research and policy aimed at understanding and mitigating disparities in diet quality between low-income and higher-income consumers has focused on food price and availability as barriers to healthy eating. Data on how consumers allocate their time could elucidate the relationship between food choice and the food environment, and also help researchers and policymakers understand relationships between time constraints and dietary quality. This research examines the influence of time constraints on the nutritional quality of purchased foods. This observational study analyzes data on food purchases from USDA's Food Acquisition and Purchase Survey of a nationally representative group of U.S. households. Our outcome measure was dietary quality, measured using the Healthy Eating Index 2010. Multivariate models assessed the influence of an objective (time spent in round-trip travel to work) and perceived (feeling too busy to prepare healthy food) time constraint on the quality of foods purchased by households. The perceived time constraint is found to be associated with a 2.5-point reduction in HEI score. Further, this relationship exists for higher-income households (those above 400% of the poverty line) and not low-income households. Perceptions of being time-constrained influence the healthfulness of purchased foods while the objective time constraint does not. This relationship holds only for higher-income households, suggesting that they are better able to substitute money for time and likely eat out more often than time-constrained, low-income households. We recommend policy solutions, such as menu labeling and nutrition education that highlights time management skills and healthier convenience food substitutions.

Antihyperlipidemic and hypolipidemic properties of Tacca leontopetaloides (L.) Kuntze (Dioscoreales: Dioscoreaceae) tuber’s aqueous extracts in the rats

Tubers of Tacca leontopetaloides (L.) Kuntze (Dioscoreales: Dioscoreaceae) play an important role in food substitution during the periods of food shortage in occidental and central Africa. It is also used in traditional medicine for the treatment of the diarrhea, dysentery, stomach evil, viral hepatitis and the infection of guinea worn. This study attempted to evaluate the antihyperlipidemic and hypolipidemic properties of aqueous extracts of the tubers of T. leontopetaloides in rats. For this experimentation, two tests were done: antihyperlipidemic and hypolipidemic tests. Hyperlipidemia was induced in rats with High Fat Diet containing 300 g of egg yolk, 2 g of cholesterol, 250 g of coconut oil and 50 g of soya oil. The group of rats on which the antihyperlipidemic test was done was fed with High Fat Diet and supplemented with T. leontopetaloides aqueous extract at 27.34 mg/kg, and 54.68 mg/kg; after 21 days of experimentation, the different groups of rats were sacrificed. The lipid profile and some biochemical parameters were evaluated. Organs like kidneys, liver and stomach were taken for histopathological evaluation. For the hypolipidemic test, after three weeks of induction of hyperlipidemia, the diet was changed to normal diet and aqueous extract of tubers was given to rats during 21 days at doses of 3.41 mg/kg and 13.67 mg/kg. The animals were sacrificed after 21 days of experimentation. The lipid profile, some biochemical parameters and histopathology of organs were evaluated. The antihyperlipidemic and hypolipidemic tests of aqueous extract of the tubers of T. leontopetaloides induced reduction in total cholesterol, triglyceride, LDL-cholesterol and an increase in HDL-cholesterol significantly (p &lt; 0.05); decreasing activities of ALAT and ASAT enzymes, levels of creatinin remained no changed. Histopathological study revealed that extracts did not repair the destructions of liver cells and glomerules of kidneys caused by High Fat Diet. Aqueous extract of tubers of T. leontopetaloides exhibits antihyperlipidemic and hypolipidemic activities; hence it could be important in the management of cardiovascular diseases.

Preference for Western diet coadapts in High Runner mice and affects voluntary exercise and spontaneous physical activity in a genotype-dependent manner

Do animals evolve (coadapt) to choose diets that positively affect their performance abilities? We addressed this question from a microevolutionary perspective by examining preference for Western diet (WD: high in fat and sugar, but lower in protein) versus standard rodent chow in adults of both sexes from 4 lines of mice selectively bred for high levels of voluntary wheel running (High Runner or HR lines) and 4 non-selected control (C) lines. We also assessed whether food preference or substitution affects physical activity (wheel running and/or spontaneous physical activity [SPA] in the attached home cages). In experiment 1 (generation 56), mice were given 6days of wheel acclimation (as is used routinely to pick breeders in the selection experiment) prior to a 2-day food choice trial. In experiment 2 (generation 56), 17days of wheel acclimation allowed mice to reach a stable level of daily running, followed by a 7-day food-choice trial. In experiment 3 (generation 58), mice had 6days of wheel acclimation with standard chow, after which half were switched to WD for two days. In experiment 1, WD was highly preferred by all mice, with somewhat greater preference in male C mice. In experiment 2, wheel running increased and SPA decreased continuously for the first 14days of adult wheel testing, followed by 3-day plateaus in both. During the subsequent 7-day food choice trial, HR mice of both sexes preferred WD significantly more than did C mice; moreover, wheel running increased in all groups except males from C lines, with the increase being significantly greater in HR than C, while SPA declined further in all groups. In experiment 3, the effect of being switched to WD depended on both linetype and sex. On standard chow, only HR females showed a significant change in wheel running during nights 7+8, increasing by 10%. In contrast, when switched to WD, C females (+28%), HR females (+33%), and HR males (+10%) all significantly increased their daily wheel-running distances. Our results show for the first time that dietary preferences can coadapt in response to selection on activity levels.

Effect of soy on metabolic syndrome and cardiovascular risk factors: a randomized controlled trial.

Cardiovascular diseases are currently the commonest cause of death worldwide. Different strategies for their primary prevention have been planned, taking into account the main known risk factors, which include an atherogenic lipid profile and visceral fat excess. The study was designed as a randomized, parallel, single-center study with a nutritional intervention duration of 12weeks. Whole soy foods corresponding to 30g/day soy protein were given in substitution of animal foods containing the same protein amount. Soy nutritional intervention resulted in a reduction in the number of MetS features in 13/26 subjects. Moreover, in the soy group we observed a significant improvement of median percentage changes for body weight (-1.5%) and BMI (-1.5%), as well as for atherogenic lipid markers, namely TC (-4.85%), LDL-C (-5.25%), non-HDL-C (-7.14%) and apoB (-14.8%). Since the majority of the studied variables were strongly correlated, three factors were identified which explained the majority (52%) of the total variance in the whole data set. Among them, factor 1, which loaded lipid and adipose variables, explained the 22% of total variance, showing a statistically significant difference between treatment arms (p=0.002). The inclusion of whole soy foods (corresponding to 30g/day protein) in a lipid-lowering diet significantly improved a relevant set of biomarkers associated with cardiovascular risk.

Modeled Dietary Impact of Pizza Reformulations in US Children and Adolescents.

Background and ObjectiveApproximately 20% of US children and adolescents consume pizza on any given day; and pizza intake is associated with higher intakes of energy, sodium, and saturated fat. The reformulation of pizza products has yet to be evaluated as a viable option to improve diets of the US youth. This study modeled the effect on nutrient intakes of two potential pizza reformulation strategies based on the standards established by the Nestlé Nutritional Profiling System (NNPS).MethodsDietary intakes were retrieved from the first 24hr-recall of the National Health and Nutrition Examination Survey (NHANES) 2011–12, for 2655 participants aged 4–19 years. The composition of pizzas in the NHANES food database (n = 69) were compared against the NNPS standards for energy, total fat, saturated fat, sodium, added sugars, and protein. In a reformulation scenario, the nutrient content of pizzas was adjusted to the NNPS standards if these were not met. In a substitution scenario, pizzas that did not meet the standards were replaced by the closest pizza, based on nutrient content, that met all of the NNPS standards.ResultsPizzas consistent with all the NNPS standards (29% of all pizzas) were significantly lower in energy, saturated fat and sodium than pizzas that were not. Among pizza consumers, modeled intakes in the reformulation and substitution scenarios were lower in energy (-14 and -45kcal, respectively), saturated fat (-1.2 and -2.7g), and sodium (-143 and -153mg) compared to baseline.ConclusionsPotential industry wide reformulation of a single food category or intra-category food substitutions may positively impact dietary intakes of US children and adolescents. Further promotion and support of these complimentary strategies may facilitate the adoption and implementation of reformulation standards.

Trimming the excess: environmental impacts of discretionary food consumption in Australia

Tackling the overconsumption of discretionary foods (foods and drinks not necessary to provide the nutrients the body needs) is central to aligning human and planetary health. Whilst the adverse health impacts of discretionary foods are well documented, the environmental and broader sustainability impacts of these products deserve more attention, especially since their consumption has been increasing in recent decades, particularly amongst low income groups. This paper presents a quantitative case study analysis of discretionary food consumption and the associated environmental impacts for households from different income groups in Australia. Environmentally extended input-output analysis is used to estimate the full life cycle environmental impacts of discretionary food consumption on the basis of household expenditures. On average, discretionary foods account for a significant 35%, 39%, 33% and 35% of the overall diet-related life cycle water use, energy use, carbon dioxide equivalent and land use respectively. These significant percentages provide further support for the need to incentivise diets that are both healthier and more sustainable, including ‘divestment’ from discretionary food products. The study highlights the challenges ahead, including the need for further research on food substitutions to minimise environmental and social impacts whilst maximising nutritional quality – especially amongst poorer socioeconomic groups.

A practical approach to a low protein diet in Brazil.

BackgroundChronic kidney disease (CKD) is an emerging health public problem in Brazil. Nutritional counseling with focus on protein restriction is a promising strategy to treatment of nondialysis CKD patients due its effects on slowing renal loss. However, Brazilian people have high protein intake, which is a challenge when low protein diet (LPD) should be prescribed. This review describes a practical approach to the dietetic management of nondialysis CKD patients in Brazil.DiscussionAlthough Brazilian cuisine varies greatly by region, Brazil has current trends of incorporating Western dietary habits, including high intake of red meat. Traditional plant-based foods, such as rice and beans, are also important contributors to the high protein content to the Brazilian diet. Thus, a successful implementation of LPD requires adaptation of these dietary habits, with reduction of portion sizes and adequate food substitution options. Intensive nutritional counseling with specialized renal dietitians is also important to improve compliance to the LPD. Moreover, the precarious health system organization and economic problems are barriers to nutritional care, which could be solved with intensive and specialized perspectives of treatment.SummaryThe adherence to protein restriction is important for better metabolic and clinical control of nondialysis CKD patients. Early dietetic attention, nutrition education strategies and intensive specialized nutritional counseling are essential to achieve diet habits that promote adherence to the LPD without excluding cultural characteristics of the Brazilian diet.

The 5-CNL Front-of-Pack Nutrition Label Appears an Effective Tool to Achieve Food Substitutions towards Healthier Diets across Dietary Profiles.

BackgroundFront-of-pack (FOP) nutrition labels are considered helpful tools to help consumers making healthier food choices, thus improving their diet. In France, the implementation of a FOP nutrition label–the 5-Colour Nutrition Label (5-CNL)–is currently under consideration. Our objective was to investigate dietary profiles in a French adult population using the 5-CNL, and to assess its potential impact in improving the diet through substitution of foods.Methods and FindingsSubjects included in the NutriNet-Santé cohort, who had completed three 24-h dietary records were included in this cross-sectional analysis. Mutually exclusive clusters of individuals were identified using the percentage of energy derived from foods of each of the 5-CNL colours as input variables. Three scenarios of substitution of foods for healthier alternative using the 5-CNL were tested. Food group and dietary intakes, socio-demographic and lifestyle data were compared across clusters using ANOVAs or Chi-square tests, as appropriate. We identified three mutually exclusive dietary profiles: ‘Healthy’ (N = 28 095, 29.3% of the sample), with high consumption of fruit, vegetables, whole cereals and fish; ‘Western’ (N = 33 386, 34.8%); with high consumption of sweetened beverages, breakfast cereal, cheese, fatty and sugary foods; ‘Traditional’ (N = 34 461, 35.1%), with high consumption of potatoes, bread, meat and dairy desserts. Overall, substitutions strategies led to an increase in the number of subjects reaching the recommended intakes in energy, macro and micronutrients. Increases were particularly high in the ‘Western’ pattern for lipids and saturates intakes: from 16.2% reaching the recommended amount for lipids (13.5% for saturates) to 60.6% and 85.7% respectively.ConclusionThe use of the 5-CNL as an indicator of food choice meaningfully characterizes clusters of dietary habits and appears as an effective tool to help improving the nutritional quality of the diet.