Choice architecture interventions promoting sustained healthier food choice and consumption by students in a secondary school setting: a systematic review of intervention studies.

OBJECTIVE: To systematically review the impact of choice architecture interventions (CAI) on the food choice of healthy adolescents in a secondary school setting. Factors potentially contributing to the effectiveness of CAI types and numbers implemented and its long-term success were examined. DESIGN: PUBMED and Web of Science were systematically searched in October 2021. Publications were included following predefined inclusion criteria and grouped according to the number and duration of implemented interventions. Intervention impact was determined by a systematic description of the reported quantitative changes in food choice and/or consumption. Intervention types were compared with regard to food selection and sustained effects either during or following the intervention. SETTING: CAI on food choice of healthy adolescents in secondary schools. PARTICIPANTS: Not applicable. RESULTS: Fourteen studies were included; four randomised controlled trials and five each of controlled or uncontrolled pre-post design, respectively. Four studies implemented a single CAI type, with ten implementing > 1. Three studies investigated CAI effects over the course of a school year either by continuous or repeated data collection, while ten studies' schools were visited on selected days during an intervention. Twelve studies reported desired changes in overall food selection, yet effects were not always significant and appeared less conclusive for longer-term studies. CONCLUSIONS: This review found promising evidence that CAI can be effective in encouraging favourable food choices in healthy adolescents in a secondary school setting. However, further studies designed to evaluate complex interventions are needed.

Beyond the Individual -A Scoping Review and Bibliometric Mapping of Ecological Determinants of Eating Behavior in Older Adults.

Objectives: The objective of this scoping review was to summarize and provide a visual overview of the present-day knowledge on ecological determinants of eating behavior in community-dwelling elderly persons in relation with nutrition communication, considering the evolution of the field. The second objective was to integrate results in recommendations for the development of nutrition communication strategies. Methods: A literature review was performed on Medline, PubMed and Google Scholar, according with the PRISMA protocol for scoping reviews. An a-priori analysis was executed by categorizing determinants from the literature according with the different levels represented in the ecological framework and an a-posteriori analysis by using VosViewer for a chronological bibliometric mapping analysis. Results: Of 4029 articles retrieved, 77 were selected for analysis. Initial publications focused more on individual determinants of eating behavior. Over time, there was a shift towards a holistic view of eating behavior considering the "food environment", including social networks, physical settings and public policy. Conclusion: Beyond the individual, all ecological levels are relevant when targeting eating behavior in the elderly. Nutrition communication strategies should be structured considering these influences.

Validation of a Visually Aided Dietary Assessment Tool to Estimate Dietary Intake in an Adult Swiss Population.

Background: Accurately assessing dietary intake is crucial for understanding how diet affects a person's health. In large cohorts, paper-based dietary assessment tools (DAT) such as food recalls or food frequency questionnaires have emerged as valid tools with a low burden for participants. Objective: To validate a visually aided DAT for use in studies with Swiss adults against the gold standard of a weighed 7-day food record (7 d-FR). Design: Fifty-one adults (n = 24 women, n = 27 males) participated in the study and were recruited within two age groups (20-40 and 50-70 y). Each participant filled out the visually aided DAT, then the 7 d-FR. The DAT was compared to the 7 d-FR for total energy intake, macronutrients, sugar, water, and portions of fruits and vegetables. Pearson correlation and Bland-Altman analyses were used for statistical analyses. Results: Total correlations ranged from 0.288 (sugar, p < 0.05) to 0.729 (water, p < 0.01). The older age group showed higher correlations for total energy intake, protein, fats, carbohydrates, and sugar, but not for water (p < 0.05). Correlations were moderate at r > 0.5, whereas only water and protein reached those values in the young group. Both groups overestimated total calories in kcal (+14.0%), grams of protein (+ 44.6%), fats (+36.3%), and portions of fruits and vegetables (+16.0%) but strongly underestimated sugar intake (-50.9%). Conclusion: This DAT showed that all macronutrients and total energy intake were estimated more accurately by the older age group and therefore might be adequate to capture dietary habits in older Swiss adults.

Estimating Dietary Intake from Grocery Shopping Data-A Comparative Validation of Relevant Indicators in Switzerland.

In light of the globally increasing prevalence of diet-related chronic diseases, new scalable and non-invasive dietary monitoring techniques are urgently needed. Automatically collected digital receipts from loyalty cards hereby promise to serve as an objective and automatically traceable digital marker for individual food choice behavior and do not require users to manually log individual meal items. With the introduction of the General Data Privacy Regulation in the European Union, millions of consumers gained the right to access their shopping data in a machine-readable form, representing a historic chance to leverage shopping data for scalable monitoring of food choices. Multiple quantitative indicators for evaluating the nutritional quality of food shopping have been suggested, but so far, no comparison has validated the potential of these alternative indicators within a comparative setting. This manuscript thus represents the first study to compare the calibration capacity and to validate the discrimination potential of previously suggested food shopping quality indicators for the nutritional quality of shopped groceries, including the Food Standards Agency Nutrient Profiling System Dietary Index (FSA-NPS DI), Grocery Purchase Quality Index-2016 (GPQI), Healthy Eating Index-2015 (HEI-2015), Healthy Trolley Index (HETI) and Healthy Purchase Index (HPI), checking if any of them performs differently from the others. The hypothesis is that some food shopping quality indicators outperform the others in calibrating and discriminating individual actual dietary intake. To assess the indicators' potentials, 89 eligible participants completed a validated food frequency questionnaire (FFQ) and donated their digital receipts from the loyalty card programs of the two leading Swiss grocery retailers, which represent 70% of the national grocery market. Compared to absolute food and nutrient intake, correlations between density-based relative food and nutrient intake and food shopping data are stronger. The FSA-NPS DI has the best calibration and discrimination performance in classifying participants' consumption of nutrients and food groups, and seems to be a superior indicator to estimate nutritional quality of a user's diet based on digital receipts from grocery shopping in Switzerland.

An App to Improve Eating Habits of Adolescents and Young Adults (Challenge to Go): Systematic Development of a Theory-Based and Target Group-Adapted Mobile App Intervention.

BACKGROUND: Due to the widespread use of mobile phones, dietary mobile apps are promising tools for preventing diet-related noncommunicable diseases early in life. However, most of the currently available nutrition apps lack scientific evaluation and user acceptance. OBJECTIVE: The objective of this study was the systematic design of a theory-driven and target group-adapted dietary mobile app concept to promote healthy eating habits with a focus on drinking habits as well as consumption of fruits and vegetables in adolescents and young adults, especially from disadvantaged backgrounds. METHODS: The design process was guided by the behavior change wheel (BCW). The development process comprised 3 stages. In stage 1, the target behavior was specified, and facilitators and barriers were identified. Furthermore, important insights into target group interests, needs, and values in the field of nutrition and apps were revealed. To this end, 2 empirical studies were conducted with the target group. In stage 2, results of stage 1 were translated into behavior change techniques (BCTs) and, finally, into app functionalities and features. Consequently, in stage 3, the concept was evaluated and optimized through expert interviews. RESULTS: Facilitators and barriers for achieving the target behavior were psychological capabilities (eg, self-efficacy), reflective motivation (eg, fitness), automatic motivation, social support, and physical opportunity (eg, time). Target group interests, needs, and values in the field of nutrition were translated into target group preferences for app usage, for example, low usage effort, visual feedback, or recipes. Education, training, incentives, persuasion, and enablement were identified as relevant intervention functions. Together with the target group preferences, these were translated via 14 BCTs, such as rewards, graded tasks, or self-monitoring into the app concept Challenge to go (C2go). The expert evaluation suggested changes of some app features for improving adherence, positive health effects, and technical feasibility. The C2go concept comprises 3 worlds: the (1) drinking, (2) vegetable, and (3) fruit worlds. In each world, the users are faced with challenges including feedback and a quiz. Tips were developed based on the health action process approach and to help users gain challenges and, thereby, achieve the target behavior. Challenges can be played alone or against someone in the community. Due to different activities, points can be collected, and levels can be achieved. Collected points open access to an Infothek (information section), where users can choose content that interests them. An avatar guides user through the app. CONCLUSIONS: C2go is aimed at adolescents and young adults and aims to improve their fruit and vegetable consumption as well as drinking habits. It is a theory-driven and target group-adapted dietary mobile intervention concept that uses gamification and was systematically developed using the BCW.

Associations between Dietary Patterns and Post-Bronchodilation Lung Function in the SAPALDIA Cohort.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is not restricted to smokers. Dietary habits may contribute to the disease occurrence. Epidemiological studies point to a protective effect of fruit and vegetable intake against COPD. OBJECTIVE: To investigate the associations between dietary patterns and parameters of lung function related to COPD in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). METHODS: Data were included from the second follow-up assessment of the SAPALDIA cohort in 2010-2011 using a food frequency questionnaire. Principal component factor analysis was used to derive dietary patterns, whose association with FEV1, FEV1/FVC, FEF2575, and COPD was investigated by applying multivariate regression analyses. RESULTS: After adjustment for potential confounders, the "prudent dietary pattern" characterised by the predominant food groups vegetables, fruits, water, tea and coffee, fish, and nuts was positively associated with FEV1 (increase of 40 mL per SD, p < 0.001). Also for factor 3 ("high-carbohydrate diet"), we found a significant positive association with FEV1 (with an increase per SD of 36 mL, p = 0.006). CONCLUSIONS: The main results are consistent with a protective effect of a diet rich in fruits, vegetables, fish, and nuts against age-related chronic respiratory disease. If confirmed in prospective cohorts, our results may guide nutritional counselling towards respiratory health promotion.

Dietary Patterns and Their Sociodemographic and Lifestyle Determinants in Switzerland: Results from the National Nutrition Survey menuCH.

From a public health perspective, determinants of diets are crucial to identify, but they remain unclear in Switzerland. Hence, we sought to define current dietary patterns and their sociodemographic and lifestyle determinants using the national nutrition survey menuCH (2014⁻2015, n = 2057). First, we applied multiple factorial analysis and hierarchical clustering on the energy-standardised daily consumption of 17 food categories. Four dietary patterns were identified ("Swiss traditional": high intakes of dairy products and chocolate, n = 744; "Western 1": soft drinks and meat, n = 383; "Western 2": alcohol, meat and starchy, n = 444; and "Prudent": n = 486). Second, we used multinomial logistic regression to examine the determinants of the four dietary patterns: ten sociodemographic or lifestyle factors (sex, age, body mass index, language region, nationality, marital status, income, physical activity, smoking status, and being on a weight-loss diet) were significantly associated with the dietary patterns. Notably, belonging to the French- and Italian-speaking regions of Switzerland increased the odds of following a "Prudent" diet (Odds ratio [95% confidence interval]: 1.92 [1.45⁻2.53] and 1.68 [0.98⁻2.90], respectively) compared to the German-speaking regions. Our findings highlight the influence of sociodemographic and lifestyle parameters on diet and the particularities of the language regions of Switzerland. These results provide the basis for public health interventions targeted for population subgroups.

Relative validation of a food frequency questionnaire to estimate food intake in an adult population.

Background: Scientifically valid descriptions of dietary intake at population level are crucial for investigating diet effects on health and disease. Food frequency questionnaires (FFQs) are the most common dietary tools used in large epidemiological studies. Objective: To examine the relative validity of a newly developed FFQ to be used as dietary assessment tool in epidemiological studies. Design: Validity was evaluated by comparing the FFQ and a 4-day weighed food record (4-d FR) at nutrient and food group levels, Spearman's correlations, Bland-Altman analysis and Wilcoxon rank sum tests were used. Fifty-six participants completed a paper format FFQ and a 4-d FR within 4 weeks. Results: Corrected correlations between the two instruments ranged from 0.27 (carbohydrates) to 0.55 (protein), and at food group level from 0.09 (soup) to 0.92 (alcohol). Nine out of 25 food groups showed correlations > 0.5, indicating moderate validity. More than half the food groups were overestimated in the FFQ, especially vegetables (82.8%) and fruits (56.3%). Water, tea and coffee were underestimated (-14.0%). Conclusions: The FFQ showed moderate relative validity for protein and the food groups fruits, egg, meat, sausage, nuts, salty snacks and beverages. This study supports the use of the FFQ as an acceptable tool for assessing nutrition as a health determinant in large epidemiological studies.

Hops (Humulus lupulus) Content in Beer Modulates Effects of Beer on the Liver After Acute Ingestion in Female Mice.

AIM: Using a binge-drinking mouse model, we aimed to determine whether hops (Humulus lupulus) in beer is involved in the less damaging effects of acute beer consumption on the liver in comparison with ethanol. METHODS: Female C57BL/6 J mice were either fed one iso-alcoholic and iso-caloric bolus dose of ethanol, beer, beer without hops (6 g ethanol/kg body weight) or an iso-caloric bolus of maltodextrin control solution. Markers of steatosis, intestinal barrier function, activation of toll-like receptor 4 signaling cascades, lipid peroxidation and lipogenesis were determined in liver, small intestine and plasma 2 h and 12 h after acute alcohol ingestion. RESULTS: Alcohol-induced hepatic fat accumulation was significantly attenuated in mice fed beer whereas in those fed beer without hops, hepatic fat accumulation was similar to that found in ethanol-fed mice. While markers of intestinal barrier function e.g. portal endotoxin levels and lipogenesis only differed slightly between groups, hepatic concentrations of myeloid differentiation primary response gene 88, inducible nitric oxide synthase (iNOS) and plasminogen-activator inhibitor 1 protein as well as of 4-hydroxynonenal and 3-nitrotyrosine protein adducts were similarly elevated in livers of mice fed ethanol or beer without hops when compared with controls. Induction of these markers was markedly attenuated in mice fed hops-containing beer. CONCLUSION: Taken together, our data suggest that hops in beer markedly attenuated acute alcohol-induced liver steatosis in female mice through mechanisms involving a suppression of iNOS induction in the liver.

Associations between domains of physical activity, sitting time, and different measures of overweight and obesity.

OBJECTIVE: To describe 1) cross-sectional associations between domain-specific physical activity, sitting time and different measures of overweight/obesity and 2) longitudinal associations between patterns of change in physical activity and overweight/obesity ten years later. METHODS: Cross-sectional and longitudinal analyses based on the first and second follow-up of the Swiss cohort study SAPALDIA (SAP) were conducted (SAP2 in 2002/03, SAP3 in 2010/11). Physical activity was assessed by self-report using the long International Physical Activity Questionnaire (IPAQ) and four short questions regarding moderate and vigorous activities. Overweight/obesity were defined based on body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and percent body fat based on bioelectric impedance analysis (BIA), all measured objectively. Multivariable logistic regression was used for analyses. RESULTS: Cross-sectionally, leisure-time and vigorous physical activity were inversely associated with all obesity parameters. Most consistent associations were found with BIA percent body fat. There were no associations between work-related and domestic activities and overweight/obesity. Sitting time was positively associated with BIA percent body fat, but not with BMI, WHR and WHtR. Longitudinally, remaining inactive from SAP2 to SAP3 was associated with obesity and BIA percent body fat at SAP3 and with weight increase, becoming inactive with BIA percent body fat and weight increase. CONCLUSIONS: The results support associations between physical activity and overweight/obesity cross-sectionally and longitudinally. Most consistent associations were found for BIA percent body fat. For prevention purposes, the results indicate that physical activity can have an important contribution to weight management.

Food consumption of adults in Germany: results of the German National Nutrition Survey II based on diet history interviews.

The second German National Nutrition Survey (NVS II) aimed to evaluate food consumption and other aspects of nutritional behaviour of a representative sample of the German population, using a modular design with three different dietary assessment methods. To assess usual food consumption, 15,371 German speaking subjects 14-80 years of age completed a diet history interview between November 2005 and November 2006. With reference to the guidelines of the German Nutrition Society (DGE), NVS II observed that the German population did not eat enough foods of plant origin, especially vegetables and consumed too much of meat and meat products. While generally similar food consumption is observed in other European countries, consumption of bread, fruit juices/nectars and beer is higher in Germany. On average, men consumed two times more meat and soft drinks as well as six times more beer than women did, whereas the consumption of vegetables, fruit as well as herbal/fruit tea was higher in women. Older participants showed a lower consumption of meat, fruit juice/nectars, soft drinks and spirits as well as a higher consumption of fish, vegetables, fruit, and herbal/fruit tea than adolescents and younger adults did. There are also differences in food consumption with regard to socio-economic status (SES). Persons with higher SES consumed more vegetables, fruit, fish, water, coffee/tea and wine, while persons with lower SES consumed more meat and meat products, soft drinks and beer. In general, the food consumption of women, the elderly and the higher SES group tends to be closer to the official dietary guidelines in Germany.