Healthy Eating Guidelines Research Articles

Healthy Eating Guidelines for a School Jurisdiction: Collaborative Design and Implementation

Healthy eating is a determinant of optimal growth, and schools provide an ideal setting in which to influence students' diets. The Healthy Eating Guidelines Initiative (HEGI) was a partnership among education, health, and community stakeholders to develop and implement healthy eating guidelines across a school jurisdiction. An evaluation was conducted to examine the potential impact of the HEGI on the school food environment and students' self-reported diets. All schools in the jurisdiction were invited to participate in the evaluation. Participating schools included elementary, middle, high, and mixed grades schools. A school environment assessment and a student questionnaire were used to collect data before and after the HEGI. Twenty-two (71%) of 31 schools participated in the evaluation. The guidelines were successfully implemented in 17 of these 22 schools. Overall, a greater proportion of students reported healthier eating behaviours at the conclusion of the HEGI. In particular, a greater proportion of students in schools with cafeteria-style food service showed significantly improved self-reported dietary behaviours. These changes were not seen among students at schools with limited or no on-site food service. The findings are consistent with those of previous studies, and indicate that guidelines for a school jurisdiction can have a positive impact on the school food environment and students' food intake. The HEGI shows promise as a strategy to promote healthy eating among students.

Local Notions of Healthy Eating and National Dietary Guidelines: A Comparison in Vulnerable Salvadoran Communities

This study presents an assessment of local definitions and perceptions concerning healthy eating through a study in four resource-poor border communities in El Salvador. The study included focus groups, key-informant interviews, and observations of the food environment. Local definitions of healthy eating elicited through focus groups were compared to the national Salvadoran dietary guidelines recommendations. The comparison revealed several areas of overlap (including the importance of dietary variety, fruits, and vegetables, among others) and omissions (mention of limiting sweets/candy, salt, sugar, and alcohol). Focus group participants expressed concerns over the origin of their foods and whether food contained harmful chemicals. These conversations also revealed the contradictions between nutrition knowledge and preferences for foods classified as unhealthy. This article concludes with a discussion about barriers to healthy eating identified in the focus groups and through the food environment assessment.

Depression, diet and exercise.

Unhealthy lifestyle behaviour is driving an increase in the burden of chronic non-communicable diseases worldwide. Recent evidence suggests that poor diet and a lack of exercise contribute to the genesis and course of depression. While studies examining dietary improvement as a treatment strategy in depression are lacking, epidemiological evidence clearly points to diet quality being of importance to the risk of depression. Exercise has been shown to be an effective treatment strategy for depression, but this is not reflected in treatment guidelines, and increased physical activity is not routinely encouraged when managing depression in clinical practice. Recommendations regarding dietary improvement, increases in physical activity and smoking cessation should be routinely given to patients with depression. Specialised and detailed advice may not be necessary. Recommendations should focus on following national guidelines for healthy eating and physical activity.

Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by the American Association of Clinical Endocrinologists/The American College of Endocrinology and the Obesity Society Executive Summary

J. Michael Gonzalez-Campoy, MD, PhD, FACE1; Sachiko T. St. Jeor, PhD, RD2; Kristin Castorino, DO3; Ayesha Ebrahim, MD, FACE4; Dan Hurley, MD, FACE5; Lois Jovanovic, MD, MACE6; Jeffrey I. Mechanick, MD, FACP, FACN, FACE, ECNU7; Steven M. Petak, MD, JD, MACE, FCLM8; Yi-Hao Yu, MD, PhD, FACE9; Kristina A. Harris10; Penny Kris-Etherton, PhD, RD11; Robert Kushner, MD12; Maureen Molini-Blandford, MPH, RD13; Quang T. Nguyen, DO14; Raymond Plodkowski, MD15; David B. Sarwer, PhD16; Karmella T. Thomas, RD17

Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by the American Association of Clinical Endocrinologists/The American College of Endocrinology and the Obesity Society

The American Association of Clinical Endocrinologists (AACE) and The Obesity Society (TOS) are professional organizations dedicated to improve the lives of patients with endocrine and metabolic disorders. Chronic diseases demand treatment, but a focus on primary, secondary, and tertiary prevention strategies is important as well. Central to this approach is behavior modification to achieve consistent healthy eating and physical activity. Yet, to date there is no evidence-based clinical practice guideline (CPG) to define the standards of care for healthy eating in the management and prevention of metabolic and endocrine disorders.

Dietary energy density and its association with the nutritional quality of the diet of children and teenagers.

To examine the relationship between dietary energy density (DED) and the nutritional quality of the diet, using data from the Irish National Children's Food Survey (NCFS) and the National Teens' Food Survey (NTFS), two cross-sectional studies of food consumption were carried out between 2003 and 2006. Data from the NCFS and NTFS were used to examine the intakes of nutrients and foods among those with low- (NCFS <7·56, NTFS <7·65kJ/g), medium- (NCFS 7·56-8·75, NTFS 7·66-8·85kJ/g) and high-energy-dense diets (NCFS >8·75, NTFS >8·85kJ/g). A 7-d food diary was used to collect food intake data from children (n 594) and teenagers (n 441). DED (kJ/g) was calculated including food alone and excluding beverages. Participants with lower DED consumed more food (weight) but not more energy. They also consumed less fat and added sugars and more protein, carbohydrates, starch and dietary fibre and had higher intakes of micronutrients. Participants with lower DED had food intake patterns that adhered more closely to food-based dietary guidelines. Low DED was associated with multiple individual indicators of a better nutritional quality of the diet, including higher intakes of dietary fibre and micronutrients and a generally better balance of macronutrients, as well as being associated with food intake patterns that were closer to healthy eating guidelines. Taken together, these findings support the conclusion that a low DED may be an indicator of a better nutritional quality of the diet.

Reflections on dietary guidance and the status of carbohydrate on both sides of the Atlantic

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Dairy Consumption and Diet Quality in a Sample of Australian Children

Objective: To examine the association between intake of dairy products and indicators of diet quality among a sample of Australian children.Methods: Three 24-hour recalls were collected from 222 children aged 8–10 years living in western Sydney. Analysis of covariance was used to examine differences in mean intakes of foods and nutrients among 3 dairy consumption groups (<1 serve, 1–2 serves, ≥2 serves per day). The percentage of children meeting healthy eating guidelines for foods and estimated average requirements (EAR) for nutrients was also assessed.Results: Higher dairy consumption was associated with higher intakes of energy, protein, calcium, phosphorus, magnesium, potassium, zinc, vitamin A, riboflavin, and niacin as well as foods from the bread and cereal group but lower intakes of mono- and polyunsaturated fats, foods from the meat and alternatives group, and energy-dense, nutrient-poor foods. Children who consumed ≥2 serves of dairy products per day (38%) were more likely to meet food and nutrient recommendations. Body mass index z-score and waist circumference were not associated with dairy consumption. Milk intake was inversely associated with the intake of sugar-sweetened beverages, and children who did not meet their minimum dairy serve recommendations consumed higher quantities of sugar-sweetened beverages than milk.Conclusions: Adequate dairy consumption was associated with diets of higher nutritional quality but also higher intakes of energy, suggesting a potential benefit from shifting consumption from regular-fat to reduced-fat dairy products in line with current national recommendations.

Design of a Website on Nutrition and Physical Activity for Adolescents: Results From Formative Research

BackgroundTeens do not meet guidelines for healthy eating and physical activity. The Internet may be an effective method for delivering programs that help them adopt healthy behaviors.ObjectiveTo collect information to design content and structure for a teen-friendly website promoting healthy eating and physical activity behaviors.MethodsQualitative research, encompassing both focus group and interview techniques, were used to design the website. Participants were 12-17 year olds in Houston, Texas, and West Lafayette, Indiana.ResultsA total of 133 participants took part in 26 focus groups while 15 participated in one-on-one interviews to provide guidance for the development of teen-friendly content and structure for an online behavior change program promoting healthy eating and physical activity to 12-17 year olds. The youth made suggestions to overcome common barriers to healthy eating and physical activity. Their feedback was used to develop “Teen Choice: Food & Fitness,” a 12-week online behavior change program, populated by 4 cartoon character role models.ConclusionsIt is critical that members of the target audience be included in formative research to develop behavior change programs that are relevant, appealing, and address their needs and interests.

Meanings of food, eating and health among African Nova Scotians: ‘certain things aren't meant for Black folk'

Objective. Most research on food, ethnicity and health in Canada is focused on the dietary acculturation of first of second generation migrants. ‘Failure’ to adopt nutritional guidelines for healthy eating is generally understood as lack of education or persistence of cultural barriers. In this study we explore the meanings of food, health, and well-being embedded in the food practices of African Nova Scotians, a population with a 400-year history in Canada. Design Design. Qualitative interviews were conducted with 2 or 3 members of each of 13 families who identified as African Nova Scotian. Interviews asked about eating patterns; the influence of food preferences, health concerns, cost, and culture; perceptions of healthy eating and good eating; how food decisions were made; and changes over time. In addition, research assistants observed a ‘typical’ grocery shopping trip and one family meal. Results Results. Participants readily identified what they perceived to be distinctively ‘Black ways of eating.’ Beyond mainstream nutrition discourses about reduction of chronic disease risk, participants identified three ways of thinking about food, health, and well-being: physical well-being, emphasizing stamina, energy and strength; family and community well-being; and cultural or racial well-being, emphasizing cultural identity maintenance, but also resistance to racism. Conclusion Conclusion. While culturally traditional eating patterns are often understood as costly in terms of health, it is equally important to understand that adopting healthy eating has costs in terms of family, community, and cultural identity. Dietary change unavoidably entails cultural loss, thus resisting healthy eating guidelines may signify resistance to racism or cultural dominance. Several suggestions are offered regarding how community strengths and beliefs, as well as cultural meanings of food and health, might inform effective healthy eating interventions.

Warning—Television Viewing May Harm Your Child's Health: Parent Perceptions of Early Childhood Viewing Habits

IN 2009, THE AUSTRALIAN Government introduced the Get Up and Grow (Commonwealth Government, 2009) guidelines for healthy eating and exercise in early childhood as one element of a range of initiatives aiming to curb childhood obesity, a problem affecting an increasing proportion of Australia children. Included in the policy recommendations are banning children from watching television until they turn two; and limiting viewing to one hour a day for those aged between two and five years. These recommendations represent a considerable shift in the reported average viewing practices for these age groups, providing an opportunity for community comment. In 2009, the article ‘Childhood policy straight out of fantasyland’ (Edgar, 2009) appeared on the Sydney Morning Herald website. The article was a critique of the Get Up and Grow recommendations. Most articles on the SMH website have an anonymous blog post attached where readers can post their comments. Data was collected from this blog, and responses where the identity of the respondent as a parent was either implicitly or explicitly stated were used and the text analysed. Six themes were generated from the data: television as an educator; television as a babysitter; television as a motivator for increasing physical exercise; policy as a challenge to parental rights; age appropriateness; and viewing standards. The responses provide insights into children's viewing habits and glimpses of the way television is used in the family household. Findings also reveal that parents accept that television programs labelled as ‘educational’ are a positive influence on learning for their child, and do not scrutinise the content beyond this assumption.

The cost of a basket of food compatible with healthy eating guidelines is higher than a comparable basket of standard food

Background: Many people in the UK are not following healthy eating guidelines and consume fewer fruit, vegetables and oily fish and more saturated fat, nonmilk extrinsic sugars and salt than recommended (SACN, 2008). The relatively high cost of certain foods compatible with healthy eating and the lower price of others has been suggested as one of many barriers to achieving nutritional goals (Withall et al., 2009). Findings from published studies indicate that foods compatible with health eating are relatively more expensive but these studies were undertaken more than 10 years ago (Mooney, 1990; Cade et al., 1999). The aim of this study was to compare the current costs of a basket of food compatible with healthy eating guidelines (CHE) and a ‘standard’ basket of food in two locations differing in socioeconomic status (SES). Methods: The cost of food in four shopping baskets was determined by collecting the cheapest prices for 500 g equivalent of food from supermarkets in two locations. Two of the baskets were designed to replicate those used in a similar study by Mooney (1990), [A] containing CHE food and [B] containing standard food. The foods were updated through a defined process to reflect current intake and changes in dietary guidelines since 1990 with basket [C] containing current CHE food and basket [D] current standard food. Data were collected in an affluent location and a deprived location, 14 miles apart in the south of England. Locations were identified by SES using data from the Association of Public Health Observatories (2010). The difference between the cost of the CHE basket and standard food basket was examined using a one-tailed sign test (A versus B and C versus D) and the difference between the cost of each basket in the two different areas was examined using a paired t-test (A versus A, B versus B, C versus C, D versus D). Results: The cost of the CHE baskets was significantly more expensive than the standard baskets for both the original and current foods in both locations (Table 1). The difference between the cost of baskets from the two locations was small (range: −2 to +91 pence) and was not significantly different. Table 1. Comparison of a healthy eating guidelines compatible basket of food with a standard basket Location CHE baskets (£) Standard baskets (£) Cost difference P (£) (%) Affluent A 13.92 B 10.17 +3.75 +26.9 % 0.003 C 19.67 D 12.46 +7.21 +36.7 % 0.011 Deprived A 13.74 B 09.31 +4.43 +32.2 % 0.003 C 18.76 D 12.48 +6.28 +33.5 % 0.029 Discussion: The finding that CHE food is more expensive is comparable with the results from studies by Mooney (1990) and Cade et al. (1999) indicating little change in the relative cost of food, despite developments in eating patterns and dietary guidelines over the last 10–20 years. Although the location had no detectable impact on the cost, it is likely that the higher price of CHE food may deter people with lower incomes from purchasing them and thus may be a barrier to meeting current guidelines. This has implications for the approaches taken by healthcare professionals working to promote adherence to dietary guidelines. The limitations of the study include the hypothetical nature of pricing baskets of food, although this was used because it is a more practical method of collecting data than assessing individual or household food expenditure. Further studies using these methodologies are required to identify how higher prices impact on purchasing and consumption. Conclusions: The cost of a basket of CHE food continues to be more expensive than the cost of a comparable standard food basket but is not influenced by SES of location of purchase.

A content analysis of magazine diets in relation to the Eatwell Plate

Background: Current predictions suggest that by 2050 over half of the adult population will be classified as obese (Foresight Report, 2007). The media is a known platform for nutrition education and research indicates that health magazines specifically are highly influential in terms of their impact on health and diet (Hill, 2006). Whilst studies have examined the influence of magazine advertising on food choice, none have analysed the nutritional content of magazine diets in relation to healthy eating guidelines, or their influence over healthy dietary behaviours. The aim of this study was to identify whether the diets published in magazines adhere to national healthy eating guidelines as depicted by the Eatwell Plate (Food Standards Agency, 2007). Methods: The 15 best selling diet and health magazines were identified from national sales data and purchased from a single retailer in December 2009, with the cost of each magazine noted. Inclusion criteria were defined as the presence of a health theme, target audience within 18–54 years and incorporation of a 7-day diet plan. Diet plans were analysed using content analysis. Food lists were devised and coded through a deductive approach by cross referencing against the Eatwell Plate and previous content analysis studies. Associated word lists to determine subconscious influence were devised and coded using inductive content analysis. Each diet was analysed for food or word references which were counted against the relevant codes. References were collated as a total across all magazines and presented as the number cited by category as a percentage of the total. Descriptive statistics were used to present the data. Ethical approval was gained from Leeds Metropolitan University Research Ethics Committee. Results: Ten magazines (seven women's; three men's) met the inclusion criteria, representing a full target age range and varied cost (£2.60–£3.95). In total 1155 food references and 266 word references were cited. Fruit and vegetables were referenced most frequently (37.7%), exceeding the Eatwell Plate recommendation (33.3%); carbohydrates were referenced poorly (20.5%), below the 33.3% recommendation; protein (22.3%) was above the 13% recommendation; dairy foods (13.5%) met the Eatwell Plate recommendation (13%). No magazine represented an accurate depiction of the Eatwell Plate model. The associated words attracting most references were for fluid (15%), fat (14.3%), protein (11.3%) and energy (10.5%) with protein referenced more often in men's magazines and calories more often in women's. Discussion: The lack of evidenced based and balanced dietary information in magazine diets was of concern and contradicted government health promotion strategies. The magazines promoted popular dietary trends as opposed to evidence based healthy eating guidance. The evident repetition of words relating to calories and fat does little to promote healthy dietary behaviours and little emphasis was placed on multi-component dietary and lifestyle approaches. Conclusion: The magazine diets did not meet the Eatwell Plate guidelines, highlighting the need for furthercollaboration between the media and health professionals in order to improve public understanding and help shape the future of public health in relation to obesity prevention.

Healthy living guidelines and the disconnect with everyday life

In Western democracies, citizens are advised by governments to manage their bodily practices in highly specific ways. There are guidelines for healthy eating, alcohol consumption, exercise and screen time. However, most research works suggest that there is a substantial gap between the guidelines and the ways in which most people live their lives. How can we make sense of this disconnect between the guidelines and everyday life? In this article, I discuss Australian healthy eating and healthy drinking guidelines. I argue that the guidelines invite us to manage our bodies in an idealised, individualised world where lifestyle change is a straightforward matter of putting knowledge into practice. Instead, we inhabit complex social worlds where food and alcohol are central to social life, and the enactment of our social identities and key social practices. Citizens do actively manage their food and alcohol consumption in an effort to be healthy, but they do so from a context where ‘social well-being’ is the primary aim. On the basis of current public health practice, it seems the guidelines will remain central to public health knowledge and funding claims but increasingly disconnected and irrelevant to citizens who inhabit contextualised social worlds.

NEWS AND VIEWS: NDNS rolling programme - what do the Year 1 results show?

Summary The first results of the new National Diet and Nutrition Survey (NDNS) rolling programme were published in February 2010. The results provide insight into current trends in food consumption and nutrient intakes for children (18 months to 18 years) and adults (19–64 years) in the UK. This paper reviews the survey methodology used for the rolling programme as it differs to that of previous surveys, and also examines the preliminary findings for foods and nutrients most relevant to public health nutrition, such as fruit and vegetable and fat intake. While it appears that some progress is being made towards the recommendations and guidelines for healthy eating, further progress is required to improve the nation's diet and health.

A Matter Of Degrees: Advancing Our Understanding of Acrylamide

Until about a decade ago, acrylamide was known only as a constituent of cigarette smoke and of products such as plastics and water treatment chemicals. But in 2002 Swedish scientists were surprised to find this human neurotoxicant and probable carcinogen in many heat-processed foods, especially starchy ones such as potato chips, crackers, and french fries. A flurry of research since then has yielded general advice about reducing formation of acrylamide and other heat-generated food toxicants in home cooking and a few recommendations for healthier eating. Now, in 2010, new acrylamide studies are giving a clearer picture of the extent of exposure to the chemical in the United States. These studies also raise additional questions about whether differences in metabolism make exposure more dangerous in certain populations, including children and people who are obese.

Dietary Patterns Associated with Risk for Metabolic Syndrome in Urban Community of Karachi Defined by Cluster Analysis

4 Abstract: Dietary trends have been found to be related with metabolic syndrome in various studies. To identify dietary patterns and study associations between the dietary patterns of subjects with high and low risk of metabolic syndrome in a Karachi based community. A group of 871 men and women were selected randomly from 532 households. Data about consumption of specific foods was available for 867 adults. Participants completed a health and lifestyle questionnaire and 363 subjects provided fasting blood samples for glucose and lipids. Dietary intake was assessed by a questionnaire to identify consumption of 33 specific food items and the dietary patterns categorized into 6 food groups was assessed by cluste r analysis. Five dietary patterns were identified through cluster analysis. Cluster 1 had the lowest proportion of persons with metabolic syndrome i.e. 42.7% while cluster 2 had the highest percentage of metaboli c syndrome subjects (56.3%) (p = 0.09). Consumption of fat and caloric dense foods was significantly higher among highest risk group (cluster 2) compared to lowest risk group (cluster 1) (p = 0.0001). The consumption of food groups containing fruit, milk and meat was also more than twice in high risk compared to low risk group (p = 0.0001). Even within the same population there are marked differences in dietar y patterns and these apparently contribute to the risk of developing metabolic syndrome. Dietary pattern studies will help elucidate links between diet and disease and contribute to developing healthy eating guidelines.

Adipose tissue function and dysfunction: organ cross talk and metabolic risk

OBESITY IS A COMPLEX AND ESCALATING metabolic disorder characterized by a positive disequilibrium between energy intake and energy expenditure. The consequent expansion of the adipose organ, and in particular of visceral fat depots, increases the risk of developing obesity complications such as insulin resistance, type 2 diabetes, atherosclerosis, obstructive sleep apnea, steatohepatitis, and cardio- and cerebrovascular diseases. In this context, several clinical and biochemical elements may act as risk factors for cardiovascular disease, including low high-density lipoprotein cholesterol, high triglycerides, increased concentrations of apolipoprotein B, and small, dense low-density lipoprotein particles, arterial hypertension, hyperglycemia, hyperuricemia, and microalbuminuria. The more risk factors are present in any individual, the higher the risk of transition to diabetes and/or cardiovascular disease (10). The increase in abdominal circumference is the clinical parameter that probably best identifies the risk of clustering other features of the insulin resistance/metabolic syndrome (2) and of predicting overall mortality (8). Recent experimental evidence suggests that adipocytes located in the abdominal region display distinct cellular features compared with adipocytes from other fat depots (5). Consequently, a specific dysfunction of the visceral adipocyte has been proposed as the pathophysiological basis for the negative consequences of abdominal obesity. Although the epidemiological association between fat accumulation and excess risk of diabetes and of cardiovascular disease is striking, the biological mechanisms underlying the adverse impact of adipose tissue remain incompletely defined. Evidently, adipose tissue is not only responsible for storage of energy, but operates as a highly active and dynamic tissue. Adipocytes produce hormones and cytokines, collectively called adipokines, with pleiotropic effects on multiple tissues, leading to fine tuning of fuel utilization, energy homeostasis, and cardiovascular function. It should also be recognized that the functional attitude of visceral and subcutaneous adipocytes is programmed quite early during development and differentiation, due to inherent characteristics of the adipocyte precursors, multipotent cells that are resident in each fat depot and possess defined depot-specific genetic, biochemical, and metabolic features (3, 7, 9, 12, 15). Thus, the biological specificity of the distinct adipose tissue depots may reside in the different biological profile of the resident cells, including the adipocyte precursors.

Healthy eating guidelines in the South African context

There has been a global shift of focus onto the African continent, as Africa is the only developing area in the world with increasing numbers of underweight, stunted and hungry people, while obesity rates in the more developed areas are on the increase. South Africa, faced with the consequences of the double burden of disease due to both over- and under-nutrition, is characterized by extremes of wealth and poverty. Aiming to move public health towards balanced nutrition by applying various holistic and multisectoral approaches, the South African Health sector is actively combating these nutritional imbalances. The various applications include the food based dietary guidelines (FBDGs), fortification and supplementation programs, updating of food composition data that are specific to South African foods, and the new food labeling regulations aimed at preventing misinformation and protecting the consumer. Although improvement of the South African nutrition situation is still limited despite these implemented strategies, innovative solutions should be found by all to improve persisting global malnutrition.

Nutrition for Soccer Players

Nutrition for Soccer Players