National Nutrition Policy Research Articles

Short Communication: Recommended Dietary Allowance for School-Aged Children in Cambodia

Nutrient standards have not been developed for school-aged children in Cambodia, which has led to a lack of basic nutritional education and feeding programs in schools. This article highlights the recommended dietary allowance (RDA) for school-aged children in Cambodia, which was developed by the Ministry of Health in 2016 with the participation of representatives from relevant government agencies, international organizations, and non-governmental organizations. Because of the limited amount of data and scientific knowledge specified for Cambodia, this new RDA (CAM-RDA) was based on Southeast Asian RDAs (SEA-RDA) and used extrapolation methods shown in various guidelines such as those of the World Health Organization/Food and Agriculture Organization/United Nations, Japan, or the USA/Canada. First, the Foundation for International Development/Relief (FIDR) conducted a nutritional survey using a 24-h dietary method combined with anthropometric measurements among 2,020 children aged 6–17 years throughout Cambodia between November 2014 and July 2015 (CAM-data). The body weight and height values recorded were much lower than the reference values used in SEA-RDA. Therefore, an estimated ideal weight was determined as the reference value for CAM-RDA; that is, the intermediate value between of the reference value from SEA-RDA and the median value from the CAM-data was set to the reference weight values to calculate the requirements for energy and 19 nutrients in the CAM-RDA. Because an increase in body weight of Cambodian children is expected in the future due to nutrition transition, the reference values should be reviewed. We hope that the CAM-RDA will help in guiding the national nutritional policies in Cambodia.

A Comparison of the Essential Amino Acid Content and the Retention Rate by Chicken Part according to Different Cooking Methods.

This study set out to identify the changes in the nutrient contents during the chicken cooking process as basic data for the establishment of a national health nutrition policy. Samples were produced using 3 chicken parts (wing, breast, and leg) and 7 cooking methods (boiling, pancooking, pan-frying, deep-frying, steaming, roasting, and microwaving), and the essential amino acid contents, principal components, and retention rates were analyzed. Weight loss was observed in all chicken parts with all cooking methods. The protein and essential amino acid contents of the chicken samples differed significantly according to the part and the cooking method (p<0.01). The protein and essential amino acid contents (g/100 g) of raw and cooked chicken parts showed ranges of 16.81-32.36 and 0.44-2.45, respectively. The principal component analysis (PCA) clearly demonstrated that the cooking methods and chicken parts produced similar trends for the essential amino acid contents. The retention rates of the chicken parts varied with the cooking methods, yielding a minimum value of 83% for isoleucine in a roasted wing, 91% for protein in a steamed breast, and 77% for isoleucine and lysine in a roasted leg. Therefore, the protein and amino acid contents of the roasted breast were higher than those of the other cooked chicken parts.

Changes in the policy environment for infant and young child feeding in Vietnam, Bangladesh, and Ethiopia, and the role of targeted advocacy

BackgroundThere is limited literature examining shifts in policy environments for nutrition and infant and young child feeding (IYCF) over time, and on the potential contribution of targeted advocacy to improved policy environments in low- and middle-income countries. This study tracked changes in the policy environment over a four-year period in three countries, and examined the role of targeted nutrition and IYCF advocacy strategies by a global initiative.MethodsQualitative methods, including key informant interviews, social network mapping, document and literature review, and event tracking, were used to gather data on nutrition and IYCF policies and programs, actor networks, and perceptions and salience of nutrition as an issue in 2010 and 2014 in Bangladesh, Ethiopia, and Vietnam. Theoretical frameworks from the policy sciences were used to analyze policy change over time, and drivers of change, across countries.ResultsThe written policy environment improved to differing extents in each country. By 2014, the discourse in all three countries mirrored international priorities of stunting reduction and exclusive breastfeeding. Yet competing nutrition priorities such as acute malnutrition, food insecurity, and nutrition transitions remained in each context. Key actor groups in each country were government, civil society, development partners and the private sector. Infant formula companies, in particular, emerged as key players against enforcement of IYCF legislation. The role of a targeted IYCF advocacy and policy support initiative was well-recognized in supporting multiple facets of the policy environment in each country, ranging from alliances to legislation and implementation support. Despite progress, however, government commitment to funding, implementation, and enforcement is still emerging in each country, thus challenging the potential impact of new and improved policies.ConclusionTargeted policy advocacy can catalyze change in national nutrition and IYCF policy environments, especially actor commitment, policy guidance, and legislation. Implementation constraints – financing, capacity and commitment of systems, and competing priorities and actors – are essential to address to sustain further progress. The lack of pressing political urgency for nutrition and IYCF, and the uncertain role of international networks in national policy spaces, has implications for the potential for change.

Trained Cohorts of University Students are a Useful Resource for Conducting Dietary Surveys in Mongolia.

Population-based dietary assessment is important for informing national nutrition policy. The developing country setting presents challenges for robust implementation of dietary surveys, yet effective nutrition interventions are often urgently required. To develop and evaluate a low-cost approach to epidemiologic dietary assessment in Mongolia, involving the use of large cohorts of local public health and medical students as research assistants for collecting diet records. From 2011 to 2016, over 200 Mongolian medical and public health university students were trained to collect paired summer and winter 3-day weighed diet records from urban and rural study populations across the geographic expanse of Mongolia. Students were supervised during data collection, and their performance and experience during training and data collection were qualitatively evaluated from their own perspectives as well as those of the investigators. Students collected detailed and thorough diet records and generally reported positive feedback regarding training and data collection. Frequent supervision of students during data collection proved to be extremely worthwhile. While rural participants were amenable to having students follow them, students faced several challenges in assessing the diets of urban participants. These challenges may best be addressed by separately training these participants beforehand. With adequate training and supervision, university students may be a useful and cost-effective resource for large-scale dietary surveys in regions where their use would be practical and culturally appropriate. Further research is warranted to study how well this approach may be adapted outside Mongolia and to other dietary assessment methods and technologies.

Evaluation of national food and nutrition policy in Albania.

IntroductionThe paper aims to describe the progress that has been made in the implementation of the Albanian food and nutrition policy since 2003, so as to consider its impacts to date, and to identify strategic priorities/critical areas and priorities for Albania’s future policy on improving the national food and nutrition situation.MethodsIn 2011-2012, an expert group applied an intersectoral participatory approach to evaluate the implementation of Food and Nutrition Action Plan 2003-08 in Albania. The experts employed the quantitative method, using a 9 question logical assessment matrix to measure the achievements of the individual goals of the Plan, and a qualitative tool for the interview of an interdisciplinary sample of 68-key informants-persons operating in public health nutrition, food safety and food availability related subfields, from a wide range of pertinent institutions and stakeholders.ResultsThe quantitative and qualitative assessment revealed that the implementation process has faced serious barriers linked to the design of the plan, which did not accurately anticipate a theoretical framework, or structured methods for its implementation. Other impeding factors included the lack of institutional/infrastructure support, lack of intersectoral coordination and motivation, as well as insufficient capacities and know-how. Intersectoral response to the multifaceted nature of double burden of malnutrition is of key importance to improve nutritional wellbeing and health outcomes in Albania.ConclusionsParticipatory approaches that involve all relevant sectors and actors in the development, monitoring and evaluation of the implementation of public health policies based on comprehensive action-oriented assessments are promising and should be further supported.

Development of NQ-A, Nutrition Quotient for Korean Adolescents, to assess dietary quality and food behavior

Purpose: The purpose of this study was to develop a nutrition quotient for (NQ-A) to assess overall dietary quality and food behavior of Korean adolescents. Methods: Development of the NQ-A was undertaken in three steps: item generation, item reduction, and validation. Candidate items of the NQ-A checklist were selected based on literature reviews, results of the fifth Korea National Health and Nutrition Examination Survey data, dietary guidelines for Korean adolescents, expert in-depth interviews, and national nutrition policies and recommendations. A total of 213 middle and high school students participated in a one-day dietary record survey and responded to 41 items in the food behavior checklist. Pearsons correlation coefficients between the responses to the checklist items along with nutritional status of the were calculated. Item reduction was performed, and 24 items were selected for the nation-wide survey. A total of 1,547 from 17 cities completed the checklist questionnaire. Exploratory factor and confirmatory factor analyses were performed to develop a final NQ-A model. Results: Nineteen items were finalized as the checklist items for the NQ-A. Checklist items were composed of five factors (balance, diversity, moderation, environment, and practice). The five-factor structure accounted for 47.2% of the total variance. Standardized path coefficients were used as weights of the items. The NQ-A and five-factor scores were calculated based on the obtained weights of the questionnaire items. Conclusion: Nutrition Quotient for (NQ-A) would be a useful instrument for evaluating dietary quality and food behavior of Korean adolescents. Further research on NQ-A is needed to reflect changes in adolescents food behavior and environment.

The perception of low-salt bread among preschool children and the role of educational personnel in creating a positive attitude towards reformulated food.

IntroductionThe purpose of this study was to identify the possibility of unnoticed reduction in salt content of bread as a basic food in the diet of preschool children. The response of children to less salty bread and the role of teachers and teacher assistants in the introduction of novelties into children’s nutrition ware studied.MethodsUsing hedonic sensory evaluation in the case of bread, the perception of salty taste and responses of preschool children to salt reduction were observed. The combination of quantitative and qualitative data analysis obtained from the case study group, composed of 22 preschool children and 66 teachers and teacher assistants, was studied.ResultsThe results show that a 30% salt reduction was not registered by the children, while a 50% reduction of the salt content, compared to the original recipe, though noted, was not disruptive. The perception of taste and development of good eating habits at an early age could be influenced by teachers and teacher assistants’ verbal and non-verbal communication.ConclusionSalt reduction does not significantly affect the rating of satisfaction with the tested product. Educational personnel must be aware of their decisive influence on children’s perception of new and less salty products. Such an approach could represent a basis for creating children’s eating habits, which will be of particular importance later in their lives. The findings may possibly result in an update of the national nutrition policy.

Scanning for new evidence to prioritize updates to the Dietary Reference Intakes: case studies for thiamin and phosphorus

Dietary Reference Intakes (DRIs) are fundamental to inform national nutrition policy. However, a regular systematic review of the 51 nutrients that have DRIs has limited feasibility, and many DRIs have not been reviewed in >15 y. To address this issue, individuals (nutrient review group) who were members of the Food and Nutrition Board developed a streamlined, evidence-based methodology that could be used to identify nutrients potentially in need of a systematic review. The proposed methodology, termed an evidence scan, comprises several steps. First, an analytic framework is developed to identify markers of associations between intake of a nutrient and a corresponding clinical outcome. Next, the framework is used to direct the identification of keywords for a scan of published research that is potentially relevant to intake requirements or upper intake levels for a nutrient. Last, a panel of content experts selects the abstracts that are likely to be relevant and reviews the full publications. The results may be used to determine whether a revision of the nutrient's DRI is an immediate priority but would not supplant a comprehensive systematic evidence review. To illustrate the process, 2 nutrients were selected as case studies: thiamin and phosphorus (DRIs were last set in 1998 and 1997, respectively). Using the evidence scan for thiamin, we identified 70 potentially relevant abstracts, of which 9 full publications were reviewed. For phosphorus, 127 potentially relevant abstracts were identified, and 29 full publications were reviewed. From the review of these 2 nutrients, the nutrient review group concluded that there was insufficient new evidence to assign a high priority to a comprehensive systematic review for either thiamin or phosphorus. Evidence scanning is an efficient method of identifying DRI nutrients that are most in need of either a new or an updated systematic review.

Under-Nutrition in India – A Forgotten National Nutrition Policy without a National Programme

This Paper analyses why and for how long high levels of malnutrition have afflicted India’s population. It does a historical analysis of how two centuries of colonial rule created the enabling environment for perpetuation of chronic malnutrition through interplay of increasing poverty, decreasing literacy, de-industrialization, an increased agricultural labour force, low wages, deteriorating health and nutritional status. The paper discusses the James Bhore Committee Report, 1946, first Health and Nutrition Survey in India, and the alarming nutrition data it reveals. It examines independent India’s responses- Article 47 of the Constitution, the beginnings of nutrition governance in India, development of nutrition strategies and interventions in the Five Year Plans, the announcement of the Minimum Needs Programme in 1974, launch of the ICDS in 1975, and adoption of the National Nutrition Policy (NNP) in 1993, and evaluates their impact. The paper concludes that the problem of under-nutrition in India could decrease faster if its structural causes are programmatically addressed, namely, protein-calorie-micronutrient deficit in about 50% of the people’s diet; its inter-generational character; the information and awareness deficit in the community about proper nutritional care of infants, children, adolescent girls, and pregnant women. Important prescriptions of the National Nutrition Policy, 1993, were never implemented, and India has no national programme to eradicate malnutrition. The paper concludes with recommendations that the Niti Aayog take charge of this multi-sectoral subject, and constitute a High Power Committee to revise the NNP and draft the National Nutrition Mission within a given time frame.

Mikkel Hindhede (1862-1945): A pioneering nutritionist.

The 150th anniversary of the birth of the Danish nutritionist Mikkel Hindhede (1862-1945) fell on 13 February 2012. He was brought up in a farming family and despite family traditions he chose an academic path and became a medical doctor in 1888 and he was ahead of his time and emphasized a healthy life style rather than polypharmacy. He was convinced that the Danish population ate far too much meat and investigated and debated this matter frequently. In 1910, the Danish government allocated Hindhede a laboratory to study human nutrition where he carried out several nutritional experiments on humans. Even though his research contradicted previous theories and met opposition, he had great societal influence. Hindhede's work was the reason that Denmark focused on feeding the Danish population with harvest products and therefore had to slaughter herds of cattle and pork during the food crisis of the First World War (1914-1918). According to his calculations, this may have prevented 6300 deaths in the war. Moreover, Hindhede's work later influenced both national and international nutrition policies.

Toward Food Policy for the Dual Burden of Malnutrition: An Exploratory Policy Space Analysis in India.

There is global consensus that a strong policy response is essential for addressing the dual burden of malnutrition. However, policy makers in low- and middle-income countries may perceive a conflict between food supply policies to combat persistent undernutrition and more recent recommendations for policies addressing rising rates of diet-related noncommunicable diseases (NCDs). This article explores the potential to use policy space analysis to identify food supply policy opportunities for addressing both undernutrition and diet-related NCDs and to support improved policy coherence. We conducted an exploratory policy space analysis to identify opportunities and constraints for integrated nutrition policy with respect to the food supply in India, where a dual burden of malnutrition has been well documented. We conducted a review of food supply policies and 27 key informant interviews (16 with stakeholders active in India's national nutrition policy space, and 11 with policy makers and experts in food supply policy). The analysis suggests several opportunities for an integrated food supply policy agenda, including targeting common foods of concern (such as highly processed foods) and foods that present common benefits (such as fruits and vegetables), and scaling up existing small-scale policy initiatives that support the availability of nutrient-rich foods. Challenges include policy inertia and competing priorities within the economic sector. This scoping study indicates that the policy space analysis framework used here can help to identify specific, contextually appropriate policy options and strategies for strengthening public health nutrition policy within sectors responsible for food supply policy.

Nutrition and health status of HIV-infected adults on ARVs at AMREF clinic Kibera urban slum, Kenya

The health of people living with HIV and AIDS (PLWHA) is nutritionally challenged in many nations of the world. The scourge has reduced socio-economic progress globally and more so in sub-Saharan Africa (SSA) where its impact has been compounded by poverty and food insecurity. Good nutrition with proper drug use improves the quality of life for those infected but it is not known how PLWHA exposed to chronic malnutrition and food shortages from developing nations adjust their nutrition with use of Anti-Retro-viral Drugs (ARVs). This study assessed nutritional status, dietary practices, and dietary management of common illnesses that hinder daily food intake by the patients and use of ARVs with food recommendations provided by the health care givers. A descriptive case study design was used to sample 120 HIV-infected patients using systematic sampling procedure. These patients sought health care from an urban slum, Kibera AMREF clinic. Data were collected by anthropometric measurements, bio-chemical analysis, semi-structured questionnaire and secondary data. The Statistical Package for Social Sciences (SPSS) and the Nutri-Survey software packages were used to analyze data. Dietary intakes of micro-nutrients were inadequate for >70% of the patients when compared to the Recommended Daily Requirements. When Body Mass Indices (BMI) were used, only 6.7% of the respondents were underweight (BMI 25kg/m 2 ), serum albumin test results (mean 3.34+0.06g/dl) showed 60.8% of the respondents were protein deficient and this was confirmed by low dietary protein intakes. The BMI was not related to dietary nutrient intakes, serum albumin and CD4 cell counts (p>0.05). It appeared that there was no significant difference in BMI readings at different categories of CD4 cell count (p>0.05) suggesting that the level of immunity did not affect weight gain with ARV as observed in many studies from developed countries. Malnutrition was, therefore, evident among the 60.8% of the cases as identified by serum albumin tests and food intake was not adequate (68%) for the patients as they ate once a day due to lack of food. National food and nutrition policy should incorporate food security boosting guidelines for the poor people infected with HIV and using ARVs. Keywords: Diet, Nutrition, HIV/AIDs, Serum albumin, CD4 cell counts

Quality Nutrition Education and Its Impact on Haemoglobin Levels of School Pupils of Muranga County, Kenya

Anaemia can dramatically affect school children with adverse impact on their cognitive development and school performance. Nutrition education has not been given the priority it deserves in primary schools due to the busy school curriculum although it is concerned with changing an individual’s behavior. It is in this light that this study was designed. The main objective of this study was to evaluate the effects of three main nutrition education facilitators on nutrition knowledge among primary schools children in Gatanga Sub-County. The facilitators used were researcher, 5 pupil peer educators and an agriculture staff in nutrition education classes using the FAO curriculum chart. A baseline survey was conducted in 12 randomly selected schools for class six pupils’ households. Questionnaires for pupils and an interview schedule for caregivers were used to collect data, with pre and post-tests. Demographics and socio-economic factors, food production hygienic practices, dietary intake and biochemical data were obtained. The intervention schools were Mabanda, Kigio and Kirwara (experimental) and Gakurari (control school). Baseline data were analyzed by use of Statistical Package for Social Sciences (SPSS) version 17 and Nutri-Survey software using both descriptive and inferential statistics. The data were coded to search for emerging themes and gaps identified. On average, the mean mark in nutrition knowledge at baseline was 30.05%. In the post-tests all experimental schools significantly improved in nutrition knowledge with the highest school scoring an average of 52% and lowest 40%. A total of 31.4 % pupils at baseline and 21.4% after interventions were found to be anaemic after altitude adjustments at a calculated factor 0.5 for Gatanga altitude (2237m ASL). Improvement in the adoption and use of the projects that enhance nutrition and health significantly occurred in the experimental schools as opposed to the control school. Pupils’ haemoglobin status were not significantly different (p>0.05) between the experimental and control schools at baseline. However, notable differences in haemoglobin levels occurred in the experimental schools after the interventions. The relationship between nutrition knowledge and nutrient intake was positive and there was a significant relationship between nutrition knowledge and haemoglobin levels at p<0.05 (r=0.253, p=0.025). Anaemia was found to be a significant problem and therefore the need for a comprehensive intervention strategy by all stakeholders. The study findings would contribute towards operationalization of the Kenyan National School Health Policy and Guidelines, the National Food Security and Nutrition Policy in prevention and control of IDA by enhancing nutrition education.

History of Nutrition: The Long Road Leading to the Dietary Reference Intakes for the United States and Canada.

The Dietary Reference Intakes (DRIs) are reference values to guide the planning and assessing of nutrient intakes in the United States and Canada. The DRI framework was conceptualized in 1994, and the first reports were issued from 1997–2004, based on work by expert panels and subcommittees under the guidance of the Food and Nutrition Board of the Institute of Medicine. Numerous conventions, challenges, and controversies were encountered during the process of defining and setting the DRIs, including the definition of the framework, the use of chronic disease endpoints, lack of data on requirements for children and youth, and methods for addressing nonessential bioactive substances with potential health benefits. DRIs may be used to plan and assess the nutrient intakes of both individuals and population groups, but the new paradigm particularly improved methods used for groups. It is now possible to estimate both the prevalence of inadequate intake and the prevalence of potentially excessive intake within a group. The DRIs have served as a potent influence on national nutrition policies, including those related to dietary guidance, food labeling, nutrition monitoring, food assistance programs, and military nutrition standards. Because of this important impact on nutrition policy, the DRIs must be based on the best possible and most up-to-date science. Unfortunately, no updates to specific DRIs are currently planned. Despite the long and challenging road that led to the current DRIs, it must not finish in a dead end. Monetary resources and political will are crucial to maintaining and continuously updating the DRIs.

Nutritional challenges in the Brazilian Unified National Health System for building the interface between health and food and nutritional security

This article discusses the establishment of inter-sector action between health and food and nutritional security in Brazil from 2003 to 2010, when this issue was launched as a priority on the government's agenda. A qualitative study was developed according to constructivist epistemology, using key-informant interviews in the field's nationwide social oversight body. Advances and challenges in this process are addressed as analytical categories. The National Food and Nutrition Policy (PNAN) was mentioned as the link between the two fields, decentralized through a network with activity in the states and municipalities. However, the study found political, institutional, and operational obstacles to the effective implementation of the PNAN in the Brazilian Unified National Health System and consequently to a contribution to the advancement of Health and Food and Nutritional Security in the country. The predominance of the biomedical, curative, and high-complexity model was cited as the principal impediment, while health promotion policies like the PNAN were assigned secondary priority.

Opportunities and challenges in developing a whole-of-government national food and nutrition policy: lessons from Australia's National Food Plan.

The present article tracks the development of the Australian National Food Plan as a 'whole of government' food policy that aimed to integrate elements of nutrition and sustainability alongside economic objectives. The article uses policy analysis to explore the processes of consultation and stakeholder involvement in the development of the National Food Plan, focusing on actors from the sectors of industry, civil society and government. Existing documentation and submissions to the Plan were used as data sources. Models of health policy analysis and policy streams were employed to analyse policy development processes. Australia. Australian food policy stakeholders. The development of the Plan was influenced by powerful industry groups and stakeholder engagement by the lead ministry favoured the involvement of actors representing the food and agriculture industries. Public health nutrition and civil society relied on traditional methods of policy influence, and the public health nutrition movement failed to develop a unified cross-sector alliance, while the private sector engaged in different ways and presented a united front. The National Food Plan failed to deliver an integrated food policy for Australia. Nutrition and sustainability were effectively sidelined due to the focus on global food production and positioning Australia as a food 'superpower' that could take advantage of the anticipated 'dining boom' as incomes rose in the Asia-Pacific region. New forms of industry influence are emerging in the food policy arena and public health nutrition will need to adopt new approaches to influencing public policy.

Dietary patterns: from nutritional epidemiologic analysis to national guidelines

Dietary patterns: from nutritional epidemiologic analysis to national guidelines

Dietary intake of fats and fatty acids in the Korean population: Korea National Health and Nutrition Examination Survey, 2013.

BACKGROUND/OBJECTIVESThe aim of this study was to estimate average total fat and fatty acid intakes as well as identify major food sources using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-1 (2013).SUBJECTS/METHODSTotal fat and fatty acid intakes were estimated using 24-hour dietary recall data on 7,048 participants aged ≥ 3 years from the KNHANES VI-1 (2013). Data included total fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) levels. Population means and standard errors of the mean were weighted in order to produce national estimates and separated based on sex, age, income, as well as residential region. Major food sources of fat, SFA, MUFA, PUFA, n-3 FA, and n-6 FA were identified based on mean consumption amounts of fat and fatty acids in each food.RESULTSThe mean intake of total fat was 48.0 g while mean intakes of SFA, MUFA, PUFA, n-3 FA, and n-6 FA were 14.4 g, 15.3 g, 11.6 g, 1.6 g, and 10.1 g, respectively. Intakes of MUFA and SFA were each higher than that of PUFA in all age groups. Pork was the major source of total fat, SFA, and MUFA, and soybean oil was the major source of PUFA. Milk and pork were major sources of SFA in subjects aged 3-11 years and ≥ 12 years, respectively. Perilla seed oil and soybean oil were main sources of n-3 FA in subjects aged ≥ 50 years and aged < 50 years, respectively.CONCLUSIONSEstimation of mean fatty acid intakes of this study using nationally represented samples of the Korean population could be useful for developing and evaluating national nutritional policies.

Worldwide trends in dietary sugars intake.

Estimating trends in dietary intake data is integral to informing national nutrition policy and monitoring progress towards dietary guidelines. Dietary intake of sugars is a controversial public health issue and guidance in relation to recommended intakes is particularly inconsistent. Published data relating to trends in sugars intake are relatively sparse. The purpose of the present review was to collate and review data from national nutrition surveys to examine changes and trends in dietary sugars intake. Only thirteen countries (all in the developed world) appear to report estimates of sugars intake from national nutrition surveys at more than one point in time. Definitions of dietary sugars that were used include 'total sugars', 'non-milk extrinsic sugars', 'added sugars', sucrose' and 'mono- and disaccharides'. This variability in terminology across countries meant that comparisons were limited to within countries. Hence trends in dietary sugars intake were examined by country for the whole population (where data permitted), and for specific or combined age and sex subpopulations. Findings indicate that in the majority of population comparisons, estimated dietary sugars intake is either stable or decreasing in both absolute (g/d) and relative (% energy) terms. An increase in sugars intake was observed in few countries and only in specific subpopulations. In conclusion, the findings from the present review suggest that, in the main, dietary sugars intake are decreasing or stable. A consistent approach to estimation of dietary sugars intake from national nutrition surveys is required if more valid estimates of changes in dietary sugars intakes are required in the future.

Smorgasbord or symphony? Assessing public health nutrition policies across 30 European countries using a novel framework.

BackgroundCountries across Europe have introduced a wide variety of policies to improve nutrition. However, the sheer diversity of interventions represents a potentially bewildering smorgasbord.We aimed to map existing public health nutrition policies, and examine their perceived effectiveness, in order to inform future evidence-based diet strategies.MethodsWe created a public health nutrition policy database for 30 European countries . National nutrition policies were classified and assigned using the marketing "4Ps" approach Product (reformulation, elimination, new healthier products); Price (taxes, subsidies); Promotion (advertising, food labelling, health education) and Place (schools, workplaces, etc.).We interviewed 71 senior policy-makers, public health nutrition policy experts and academics from 14 of the 30 countries, eliciting their views on diverse current and possible nutrition strategies.ResultsProduct Voluntary reformulation of foods is widespread but has variable and often modest impact. Twelve countries regulate maximum salt content in specific foods.Denmark, Austria, Iceland and Switzerland have effective trans fats bans.Price EU School Fruit Scheme subsidies are almost universal, but with variable implementation.Taxes are uncommon. However, Finland, France, Hungary and Latvia have implemented ‘sugar taxes’ on sugary foods and sugar-sweetened beverages. Finland, Hungary and Portugal also tax salty products.Promotion Dialogue, recommendations, nutrition guidelines, labelling, information and education campaigns are widespread. Restrictions on marketing to children are widespread but mostly voluntary.Place Interventions reducing the availability of unhealthy foods were most commonly found in schools and workplace canteens.Interviewees generally considered mandatory reformulation more effective than voluntary, and regulation and fiscal interventions much more effective than information strategies, but also politically more challenging.ConclusionsPublic health nutrition policies in Europe appear diverse, dynamic, complex and bewildering. The "4Ps" framework potentially offers a structured and comprehensive categorisation.Encouragingly, the majority of European countries are engaged in activities intended to increase consumption of healthy food and decrease the intake of "junk" food and sugary drinks. Leading countries include Finland, Norway, Iceland, Denmark, Hungary, Portugal and perhaps the UK. However, all countries fall short of optimal activities. More needs to be done across Europe to implement the most potentially powerful fiscal and regulatory nutrition policies.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1195) contains supplementary material, which is available to authorized users.