Highly-processed Foods Research Articles

Motivators and facilitators of fruit and vegetable intake in Tonga

Food choice is complex and is heavily influenced by the environment one lives in(1). Pacific Island food environments, including those in Tonga, have changed considerably in recent years, making healthier food choice more challenging(2). A widespread nutrition transition across the region has contributed to an increase in the availability of, and accessibility to, highly-processed foods, and high rates of diet-related non-communicable diseases(3). While system change is needed to support the availability, accessibility and affordability of healthy foods, nutrition education plays an important role in supporting individuals, communities, and populations to navigate their rapidly changing food environments, and to encourage healthy food choice and behaviour change. Approaches to nutrition education in the Pacific Islands region vary and do not always consider the socio-cultural aspects of the food environment, especially when focusing on fruit and vegetable consumption. This work was driven by an intent to develop contextually appropriate nutrition education plans using a structured process, Design Online(4). However, to develop a nutrition education plan a critical analysis of the current motivators and facilitators for the behaviour are required. When reviewing the scientific literature there is limited information on determinants of food choice within Tonga, and more broadly within the Pacific Islands context. Therefore, the aim of this cohort study was to qualitatively explore and document the motivating and facilitating determinants of fruit and vegetable consumption in Tonga. Data collection took place during August and September 2023 on the main island of Tongatapu. Semi-structured interviews (n = 5 men, 3 women) and a focus group (n = 4 women) based on the most appropriate method of engaging with participants, were conducted in Tongan. Guiding questions were derived from Design Online and proposed within the following categories: motivating determinants and facilitating determinants. Interview responses were qualitatively analysed using an inductive content analysis model. Key categories for motivating determinants included health and nutrition knowledge, normal consumption patterns, availability and access, production, financial considerations and preferences, perceptions and practices. Key categories for facilitating determinants included education, community engagement, environmental factors, food preference, finance, and accessibility. While this work has explored motivating and facilitating determinants for fruit and vegetable consumption in Tonga with a small sample, it makes an important contribution to the limited literature. The findings of this study can be used to underpin activities, such as the design of nutrition education plans. The findings also provide a foundation for further exploration of determinants of food choice. This study was undertaken on the main island of Tongatapu, but it is of interest to explore determinants with communities who live in the outer islands, and at different time points during the year to reflect seasonality.

Consumption of highly processed foods in relation to overall diet quality among Japanese adults: a nationwide study.

To (i) examine the consumption of highly processed foods (HPF) in relation to diet quality among Japanese adults and (ii) compare the results when dishes prepared away home are disaggregated into food ingredients before classification by processing levels and the results when they are not. Cross-sectional analysis using 4-day dietary record data. Foods were categorised by level of processing using the framework developed by the University of North Carolina at Chapel Hill. Specifically, dishes prepared away from home were classified at both the food level (classified after disaggregation into ingredients) and dish level (classified without disaggregation). Diet quality was assessed using the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3. Twenty areas in Japan. Adults aged 20-69 years (n 388). Energy contribution of HPF was higher when dishes prepared away from home were classified at dish level than food level (48·3 % v. 32·9 %, P < 0·0001). Regardless of the classification method, cereals and starchy foods were the top food groups contributing to total energy intake from HPF. After adjusting for potential confounders, participants in higher tertiles of the energy contribution of HPF had lower total scores for Healthy Eating Index-2015 and Nutrient-Rich Food Index 9·3 (P for trend ≤ 0·007 for all), irrespective of the food- or dish-level classification. HPF accounted for at least one-third of energy intake of Japanese adults. Regardless of the classification methods for dishes prepared away from home, higher consumption of HPF was associated with lower diet quality.

The risks of misclassifying addictive food substances as non-addictive.

The risks of misclassifying addictive food substances as non-addictive.

Withdrawal: A key consideration in evaluating whether highly processed foods are addictive.

Researchers are currently debating whether theories of addiction explain compulsive overeating of highly processed (HP) foods (i.e., industrially created foods high in refined carbohydrates and/or fat), which contributes to obesity and diet-related disease. A subset of individuals consumes HP foods with behavioral phenotypes that mirror substance use disorders. Withdrawal, the emergence of aversive physical and psychological symptoms upon reduction or cessation of substance use, is a core component of addiction that was central to historical debates about other substances' addictive potential (e.g., nicotine and cocaine). However, no one has systematically considered evidence for whether HP foods cause withdrawal, which represents a key knowledge gap regarding the utility of addiction models for understanding compulsive overeating. Thus, we reviewed evidence for whether animals and humans exhibit withdrawal when reducing or eliminating HP food intake. Controlled experimental evidence indicates animals experience HP food withdrawal marked by neural reward changes and behaviors consistent with withdrawal from other addictive substances. In humans, preliminary evidence supports subjective withdrawal-like experiences. However, most current human research is limited to retrospective recall. Further experimental research is needed to evaluate this construct. We outline future research directions to investigate HP food withdrawal in humans and consider potential clinical implications.

Guidance and perspectives on highly processed foods.

Guidance from Health Canada to limit highly processed foods (HPF) seeks to ensure that Canadians remain within intake recommendations for nutrients of concern. However, HPF can contribute to dietary requirements of specific populations. The Canadian Nutrition Society and Institute for the Advancement of Food and Nutritional Sciences convened speakers for a Food for Health workshop in 2021 to provide evidence and perspectives from government, industry, and healthcare on reasons for advocating limits and potential unintended consequences of limiting HPF, and implications and necessity of HPF in clinical settings. This paper discusses advantages and disadvantages of HPF explored at this workshop.

Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF)

BackgroundRecent lifestyle changes include increased consumption of highly processed foods (HPF), which has been associated with an increased risk of non-communicable diseases (NCDs). However, nutritional information relies on the estimation of HPF consumption from food-frequency questionnaires (FFQ) that are not explicitly developed for this purpose. We aimed to develop a short screening questionnaire of HPF consumption (sQ-HPF) that integrates criteria from the existing food classification systems.MethodsData from 4400 participants (48.1% female and 51.9% male, 64.9 ± 4.9 years) of the Spanish PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial were used for this analysis. Items from the FFQ were classified according to four main food processing-based classification systems (NOVA, IARC, IFIC and UNC). Participants were classified into tertiles of HPF consumption according to each system. Using binomial logistic regression, food groups associated with agreement in the highest tertile for at least two classification systems were chosen as items for the questionnaire. ROC analysis was used to determine cut-off points for the frequency of consumption of each item, from which a score was calculated. Internal consistency of the questionnaire was assessed through exploratory factor analysis (EFA) and Cronbach’s analysis, and agreement with the four classifications was assessed with weighted kappa coefficients.ResultsRegression analysis identified 14 food groups (items) associated with high HPF consumption for at least two classification systems. EFA showed that items were representative contributors of a single underlying factor, the “HPF dietary pattern” (factor loadings around 0.2). We constructed a questionnaire asking about the frequency of consumption of those items. The threshold frequency of consumption was selected using ROC analysis. Comparison of the four classification systems and the sQ-HPF showed a fair to high agreement. Significant changes in lifestyle characteristics were detected across tertiles of the sQ-HPF score. Longitudinal changes in HPF consumption were also detected by the sQ-HPF, concordantly with existing classification systems.ConclusionsWe developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs.Trial registrationRetrospectively registered at the International Standard Randomized Controlled Trial Registry (ISRCTN89898870) on July 24, 2014.

Commentary on Minhas et al.: Food addiction--the role of substance and environmental factors.

Food addiction is associated with individual differences implicated in addictive disorders (e.g. impulsivity) and clinically significant problems (e.g. obesity). The addictive nature of highly processed foods plays a key role in driving addictive eating and the modern food environment contributes to the prevalence of food addiction in adults and children. Addiction is a complex disorder that results from an interaction between (1) the addictive nature of a substance/behavior, (2) individual differences that increase risk (e.g. impulsivity) and (3) socio-environmental factors that increase the accessibility, availability and social acceptability of the addictive substance/behavior. Minhas and colleagues investigate the role of individual differences (e.g. impulsivity) in food addiction [1]. It is also important to consider the other factors that contribute to addiction: the addictive nature of the substance and the socio-environmental setting. The modern food environment has become dominated by highly processed (HP) foods (e.g. chocolate, ice cream, chips, pizza) in the last 50 years [3]. These HP foods have unnaturally high levels of refined carbohydrates and fat [4] and are more effective at activating reward systems than minimally processed (MP) foods (e.g. fruits, vegetables) [5, 6]. These HP foods are mood-altering (e.g. increase pleasure, reduce negative affect) and trigger addictive responses, such as loss of control over consumption, intense cravings and an inability to cut down despite negative consequences [4, 7]. However, can these HP foods truly be considered addictive? As a field, we frequently debate what substances can trigger addiction. One of the last big debates surrounded tobacco products (e.g. cigarettes), which are legal, accessible and heavily marketed. They are created by an industry that optimizes tobacco's reinforcing properties to keep people hooked [8]. Tobacco does not cause an intoxication syndrome or severe physical withdrawal symptoms, which contributed to the controversy over whether it was truly addictive or just a bad habit [8, 9]. When the Surgeon General's report labeled tobacco as addictive in 1988, tobacco products were estimated to be contributing to more than 300 000 cases of preventable death each year and 75–80% of quit attempts failed [8]. Like cigarettes, HP foods are legal, accessible and heavily marketed by an industry that designs these novel products to maximize ‘cravability’ and create ‘heavy users’ [10]. Like cigarettes, HP foods are not intoxicating and do not cause severe physical withdrawal symptoms. However, frequent HP food consumption is associated with a 31% higher risk of all-cause mortality [11], and most dietary change attempts fail in the long term [12]. Although we need to eat to survive, HP foods are detrimental for health and replace intake of more nutritious MP foods [3]. In sum, HP foods are highly reinforcing, mood-altering substances that trigger the diagnostic indicators of addiction (e.g. loss of control, cravings), have stark public health consequences and high relapse rates. All these factors support the conceptualization of HP foods as addictive substances. Environmental factors that increase the harm of other addictive substances (e.g. cheap, accessible, marketed) [13] also define the HP food environment. The magnitude of individual risk (e.g. impulsivity) needed to develop addictive patterns of intake in a food environment dominated by cheap, accessible and heavily marketed HP food is probably much lower. Given that children and teens are generally more impulsive than adults [14], they may be particularly vulnerable to the negative effects of the HP food environment. Food addiction is prevalent in children and teenagers, which is related to obesity and poorer mental health [15, 16]. Personalized interventions that target addictive mechanisms may increase the success rates of current diet-change interventions for adults and children. However, environmentally focused approaches have been essential to reducing the public health consequences associated with other addictive substances (e.g. cigarette taxes, removing cigarette vending machines, marketing restrictions) [17]. If scientific consensus builds that HP foods are addictive, environmental approaches will probably play an essential role in reducing the harms associated with food addiction (e.g. obesity, lower quality of life) throughout the life-span. None.

College Students’ Perception of the Effectiveness of Vending Machine Interventions to Improve Snack Quality

Abstract Objectives The college food environment plays an integral role in student dietary intake during a critical transitional time. Snacking in the US is frequent and even more so among college students, with 98% consuming snacks daily, and about four times per day. Snacking affects overall diet quality by contributing 22% of the total energy, 36% of the total sugar, and 19% of the total fat and saturated fat consumed daily. Vending machines (VM) at colleges are of increased importance because they are used frequently and contain calorie-dense, nutrient-poor, and highly-processed foods. Many schools have attempted to improve the quality of snack foods offered in VMs with a top-down approach that often fails and might decrease VM revenue. This study aims to uncover college students' purchasing habits and preferences for improving snack options. Methods A cross-sectional survey was administered in the Spring of 2019 to a sample of 194 college students examining snacking practices and preferences at a large Hispanic serving university in South Florida. Statistical analysis using SPSS 26 included descriptive statistics and bivariate analysis in determining frequency, percentages, and relationships between VM use and factors influencing snack choice and perception of intervention effectiveness. Results Respondents' ages ranged between 18–40 years old (M = 20.9, SD = 3.10), 91% reported purchasing snack foods from vending machines. Participants who used VM (occasionally or frequently) ranked lowering the price of healthy products (score 3.45 and 3.60, respectively) as the intervention that would be most helpful in choosing a healthy snack. However, participants who rarely or never use VM chose labels indicating which items were healthy (score 3.40) as the most helpful intervention. Significant differences exist between VM users and Non-VM users related to intervention preference. Conclusions Incorporating student perspectives to tailor VM interventions to impact a broader range of VM users and non-users will improve the effectiveness. Without students' perspective, many factors that influence students' snack food choices and how they utilize VMs will be missed. By eliciting student consumers' feedback, Universities can improve food environments to include healthier options without sacrificing revenue. Funding Sources None.

Do children favor snacks and dislike vegetables? Exploring children’s food preferences using drawing as a projective technique. A cross-cultural study

ObjectiveTo avoid the rising spread of childhood obesity and preserve resources within planetary boundaries, healthy and sustainable eating habits and the consumption of adequate amounts of fruits and vegetables should be encouraged. Children's food preference was found to be an important determinant for food choice and consumption. The aim of this study was to explore children's food preferences using drawing as a projective technique in terms of healthy and sustainable eating and compare food preference patterns in Denmark and Lithuania. MethodIn total 484 children, aged between 8 and 13 years old, participated in the study (147 in Denmark and 337 in Lithuania). Participants were asked to fill the food preference questionnaire and answer questions about their daily intake of fruits, vegetables, and snacks and draw their favorite meal afterward. Sociodemographic questions about children's age, gender, parents' employment, and family composition were also included in the questionnaire. ResultsFruits, vegetables, highly-processed and animal-based foods were not included in a large part of children's most preferred meal composition. Favorite meals' composition varied among children in both countries and included different products from separate food groups. Vegetables were more likely to be present in the children's favorite meals together with meat products. Girls in both countries had more expressed vegetable preferences than boys. Boys in Lithuania had a relatively more expressed preference for highly-processed foods, while Danish girls had a more expressed preference for animal-based products. ConclusionsChildren's preferences for foods such as meat and animal-based products expressed in children's drawings, might be considered as relatively positive in terms of sustainable eating. However, children's preferences and intake of fruits and vegetables should still be encouraged among young consumers. Cultural and gender differences in children's food preferences should be considered while creating interventions and marketing strategies for promoting healthy and sustainable eating among young consumers.

The concept of “food addiction” helps inform the understanding of overeating and obesity: YES

Addictive substances such as opiates and other drugs are highly reinforcing and some (but not all) individuals consume them compulsively. Highly processed (HP) foods have unnaturally high concentrations of refined carbohydrates and fat. These foods are highly reinforcing and some (but not all) individuals consume them compulsively. HP foods, like addictive substances, are more effective in activating reward-related neural systems than minimally processed foods. More importantly, HP foods are associated with the behavioral indicators of addiction: diminished control over consumption, strong craving, continued use despite negative consequences, and repeated failed attempts to reduce or eliminate intake. Thus, HP foods are key in addictive patterns of food intake. Like addictive drugs, HP foods are complex, human-made substances designed to effectively deliver reinforcing ingredients (e.g., refined carbohydrates, fat). Withdrawal and tolerance are not necessary for an addiction classification; however, HP foods can trigger both these processes. On a public health level, the negative consequences of HP foods are high, even for those without clinically relevant levels of addictive eating. The recognition that some foods can be addictive will inform clinical obesity treatment and underscore the importance of environmentally focused policy interventions.

Dietary factors and controversies in dementia prevention

Dementia is affecting growing numbers of people. Consequently, we are inclined toper ceive it as a crucial public health issue. Although cognitive impairment relates mainly to the elderly, it also significantly burdens their caretakers. However, the development of dementia is not inevitable. The cognitive functions are influenced by a wide range of factors, starting with those at the beginning of the prenatal period. The most important determinants of cognitive impairment involve genetic defects, diseases, intellectual activity, physical activity and nutrition. The role played by anti-inflammatory, low in sugar and highly-processed foods is emphasized. Particular importance is attributed to the omega-6 to omega-3 ratio, proper amounts of EPA and DHA and the lowest possible trans fatty acids intake. The controversial aspects include, among others, high-fat diet and alcohol consumption. The aim of this paper is to conduct an analysis of controversial aspects and nutritional strategies related to cognitive impairment prevention, based on available scientific data.

Eating in the Absence of Hunger Is Related to Worse Diet Quality throughout Pregnancy

BackgroundScant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality. ObjectiveThis study investigates the association of EAH with diet quality during pregnancy. DesignPregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester. Participants/settingData were collected from March 2015 to December 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks’ gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina. InterventionParticipants were presented with highly processed (HP) and minimally processed (MP) foods in two separate assessments. Main outcome measuresScores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality. Statistical analyses performedLinear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods. ResultsLower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2- to 3-point decrease (standard error = 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5- to 7-point decrease (standard error = 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality. ConclusionsGreater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.

A narrative review of highly processed food addiction across the lifespan

Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.

Assessing the public health implications of Brexit in Wales: a health impact assessment

BackgroundIn June 2016, the UK voted to leave the European Union (EU) in a process known as Brexit, which is surrounded by political and social uncertainty. We aimed to assess the potential impact of Brexit on Wales. MethodsUsing health impact assessment methodology steered by a Strategic Advisory Group, we did a comprehensive mixed-method health impact assessment between July 2, 2018, and Jan 21, 2019. We searched MEDLINE, Embase, and Proquest databases using the well-established PICO (population, intervention, comparator, and outcome) framework used in evidence-based practice to frame and answer a health-care related question, to identify peer-reviewed literature published after January 2016, on the potential impact of Brexit on health and the economy. We supplemented the search with a review of grey literature on direct impacts, such as the environment, health care, and EU funding. Additionally, we held a stakeholder workshop including cross-sectoral representation such as housing, environmental health and planning, qualitative interviews with policy leads, and developed a community health profile using recognised data sources (eg, the National Survey for Wales) to understand the different population groups. The findings were analysed, synthesized, and collated into a published report. FindingsThe health impact assessment identified considerable potential impacts across the wider determinants of health, including effects across vulnerable population groups, mental wellbeing, and geographical areas in Wales that receive EU funding. Trade agreements, changing relationships with EU agencies, uncertainty, and loss of regulatory alignment were identified as key pathways for health impacts. For example, trade agreements can improve the supply and choice of food, but can also result in trade liberalisation and increased imports of highly-processed foods. Another example is the impact on food safety due to workforce challenges (ie, the low number of certificating officers at abattoirs who are UK-national citizens). InterpretationSince Brexit is yet to occur, the impacts identified are potential. Although this assessment was done over a short period of time, the findings have been beneficial in informing decision makers to prepare for Brexit using an evidence-informed approach. This work highlights the value of a health impact assessment approach to unprecedented events by mobilising a wide range of evidence through a transparent process, resulting in transferrable learning for others. FundingPublic Health Wales.

Salivary endocannabinoids as mediators in the relationship between omega-6 and omega-3 fatty acid ratio intake from highly-processed foods and anthropometric markers of health in women

Data suggest that a high ω6 to ω3 ratio (ω6:ω3) contributes to obesity. Highly processed foods are a common source of high ω6:ω3 and have also been associated with increased cardiovascular risk. We hypothesised that salivary endocannabinoids (eCBs) act as a mediator between ω6:ω3 from highly processed foods and anthropometric markers of cardiovascular risk. Finally, we explored sex differences on these parameters. Participants filled a self-report intake frequency inventory. Body measurements were registered, and fasted saliva was collected and analysed using LC/MRM. Overweight subjects consuming more highly processed foods, but not those consuming more whole foods, presented an increased ω6:ω3 and salivary eCB levels. Also, the ω6:ω3 ratio in participants consuming highly processed but not whole foods predicted eCB levels in overweight women. Finally, we show that salivary eCBs correlate with body composition in women only. Our study shows that the food source has a differential impact on physiological and behavioural aspects of food intake.

In Defense of Food Curriculum: A Mixed Methods Outcome Evaluation in Afterschool.

Background. Highly processed foods are inexpensive and abundant in our food supply, nutritionally poor, and disproportionately marketed to minority youth. This study is part of a curriculum development project to develop, implement, and evaluate the In Defense of Food (IDOF) curriculum designed to increase intake of whole/minimally processed foods and decrease intake of highly processed foods in youth. Aims. This pilot outcome evaluation was undertaken to assess initial effectiveness and to provide an in-depth understanding of changes in behavioral outcomes and psychosocial mediators. Methods. We used an explanatory mixed method approach, including a single-arm pretest-posttest of intervention effect, followed by a food rules assessment and in-depth interviews to describe participant responses to the intervention in more detail. The study was conducted in three afterschool classrooms in urban low-income neighborhoods with 32 multiethnic middle-school youth, receiving 10 weekly 2-hour sessions. Results. Two weeks postintervention, there was a large positive significant increase in whole/minimally processed food intake (p < .01; d = 0.59) and a small decrease in consumption of highly-processed foods (p = ns; d = 0.06), compared with baseline. Significant increases in psychosocial mediators: Self-efficacy and positive outcomes expectations were seen; others were not significant but changed in the desired direction. Qualitative assessments suggest that the intervention promoted skill building, but environmental barriers made these difficult to use. Discussion. The IDOF curriculum may be most effective for promoting consumption of fruits and vegetables, rather than decreasing intake of highly processed foods. In addition, in this young age-group, short actionable food rules may support self-regulation and behavior change. Conclusion. Among adolescent students in low-income urban neighborhoods, the IDOF afterschool curriculum may help promote self-efficacy and positive outcome expectancies and increase fruit and vegetable intake. Focusing on food processing and using "Food Rules" may be promising to elicit behavior change in youth; however, greater supports are needed to overcome social and environmental barriers.

Height, weight and body mass index of Wichí children from Formosa, Argentina.

This study provides the descriptive, anthropometric data of 194 children (aged 0-18 years) from a Wichi population located in the province of Formosa, Argentina. The objective of this study was to document growth and nutritional status in this indigenous people. Weight, height, and body mass index data were collected and the corresponding Z-scores were estimated using national and international reference standards. Most analyzed parameters were within the normal range. However, it is concerning that a significant percentage of children are overweight, which may indicate that this population is going through a process of westernization that promotes the consumption of high-calorie, highly-processed foods and a lower level of physical activity.

Trade and investment liberalization, food systems change and highly processed food consumption: a natural experiment contrasting the soft-drink markets of Peru and Bolivia.

BackgroundFree trade agreements (FTAs) can affect food environments and non-communicable disease risks through altering the availability of highly-processed foods. Few studies have quantified such effects. Using a natural experiment this paper quantifies changes in Peru’s soft-drink market before/after entry into the US-Peru FTA, compared with Bolivia, a county with no such agreement.MethodsDifference-in-difference models were used to test for between country differences in the rate of per capita foreign direct investment (FDI) inflows, soft-drink imports, the volumes of various soft-drinks sold, and the volumes of sugar from soft-drinks before/after FTA ratification (2006) and enforcement (2009).ResultsIn Peru average per capita FDI-inflows rose from US$103.11 in the pre-ratification period to US$269.79 post-ratification, with little change in Bolivia. This corresponded with a 122 % increase in Peruvian soft-drink production. There was a significant between-country difference in FDI-inflows pre-/post-ratification (DID:1.07, 95 % CI:0.19–1.96; p = 0.01). Despite little difference in total per capita soft-drink sales volumes there was a significant between-country difference in per capita sugar from soft-drinks pre-/post enforcement (DID:-0.99, 95 % CI: −1.91–0.06; p = 0.03) with stagnated growth in Peru and continued growth in Bolivia. This resulted from stagnated sugar sweetened carbonates growth and increased bottled water, juice and sports & energy drinks growth in Peru, with continued carbonates growth in Bolivia. There was a significant between-country difference in per capita carbonates (DID: −1.44, 95 % CI: −2.52–0.36, p = 0.01) and bottled water (DID:0.63; 95 % CI: −0.01–1.26; p = 0.04) sales volumes.ConclusionsThe FTA may have resulted in increased FDI-inflows and soft-drink production and also contributed to the diversification of soft drinks produced and sold in Peru with some positive (stagnated carbonates and increased bottled water) and some negative (increased juice and sports & energy drinks) implications for nutrition. These changes were not evident in Bolivia. These results should be interpreted cautiously given the study design limitations.

Hype or Reality: Should Patients with Metabolic Syndrome-related NAFLD be on the Hunter-Gatherer (Paleo) Diet to Decrease Morbidity?

The current Western diet figures centrally in the pathogenesis of several chronic diseases such as obesity, type 2 diabetes, cardiovascular disease and the emerging major health problem nonalcoholic fatty liver disease, all of them negatively impacting on life expectancy. This type of diet is represented by a high calorie uptake, high glycemic load, high fat and meat intake, as well as increased consumption of fructose. On the contrary, a simplified way of eating healthily by excluding highly-processed foods, is presumed to be the Paleolithic diet (a diet based on vegetables, fruits, nuts, roots, meat, organ meats) which improves insulin resistance, ameliorates dyslipidemia, reduces hypertension and may reduce the risk of age-related diseases. The diet is the foundation of the treatment of obesity- and type 2 diabetes-related nonalcoholic fatty liver disease and a diet similar to those of pre-agricultural societies may be an effective option. To lend sufficient credence to this type of diet, well-designed studies are needed.

Slow Food/White Noise: Food and Eating in Don DeLillo's Postmodern America

I begin with the proposition that eating is an agricultural act. Eating ends the annual drama of the food economy that begins with planting and birth. Most eaters, however, are no longer aware that...