Dietary changes based on food purchase patterns following a type 2 diabetes diagnosis.

OBJECTIVE: The study explores whether type 2 diabetes (T2D) diagnosis affects food consumption patterns in line with the dietary recommendations provided to individuals in relation to a diagnosis. DESIGN: Based on detailed food purchase data, we explore which dietary changes are most common following a T2D diagnosis. Changes are investigated for several energy-adjusted nutrients and food groups and overall adherence to dietary guidelines. SETTING: We use data on diagnosis of T2D and hospitalisation in relation to T2D for a sample of adult Danes registered in the official patient register. This is combined with detailed scanner data on food purchases, which are used as a proxy for dietary intake. PARTICIPANTS: We included 274 individuals in Denmark who are diagnosed during their participation in a consumer panel where they report their food purchases and 16 395 individuals who are not diagnosed. RESULTS: Results suggest some changes in dietary composition following diagnosis, as measured by a Healthy Eating Index and for specific food groups and nutrients, although the long-term effects are limited. Socio-economic characteristics are poor predictors of dietary changes following diagnosis. Change in diet following diagnosis vary with the pre-diagnosis consumption patterns, where individuals with relatively unhealthy overall diets prior to diagnosis improve overall healthiness more compared to individuals with relatively healthy diets prior to diagnosis. CONCLUSIONS: Adherence to dietary advice is low, on average, but there is large variation in behavioural change between the diagnosed individuals. Our results stress the difficulty for diagnosed individuals to shift dietary habits, particularly in the long term.

Do prices and purchases respond similarly to soft drink tax increases and cuts?

While in January 2012, Denmark increased the long-standing tax on sugary soft drinks, the tax was cut by half in July 2013 and then completely repealed in January 2014. In this study, we examine whether increases and cuts of the soft drink tax lead to similar over- or under-shifting to prices and to similar demand responses. We use longitudinal scanner data of 1,282 Danish households to estimate within-product changes in prices and within-household changes in purchase quantity. The tax hike was overshifted by a factor of 1.6-1.8, while the tax repeal was fully passed through with a factor of 0.9-1.2. On average, consumption was 13.4 percent lower the year after the tax increase compared to the year before. The repeal of the tax was associated with an increase in purchase quantity of 31.0 percent. This is equivalent to price elasticities of -1.3 for both tax hikes and cuts. The results suggest that consumers react similarly to tax cuts compared to tax increases. Furthermore, the increase in purchases following a tax cut has no limiting effect on purchases of other beverages suggesting an increase in the intake of calories. This might have implications for health in countries that consider repealing current taxes on soft drinks.

The effects of voluntary front-of-pack nutrition labels on volume shares of products: the case of the Dutch Choices.

OBJECTIVE: The study examines the impact of a front-of-pack label (Dutch Choices) on household purchase patterns. DESIGN: Change in households' volume share of products eligible for the label (treatment group) is estimated as a function of changes in the market share of products displaying the label (treatment), while controlling for other relevant factors. SETTING: Home-scan data for five food categories, subdivided into eighteen food groups, for households participating in a Dutch consumer panel. The data are from the period 2005 to 2009, which includes the date of the introduction of the Choices label. PARTICIPANTS: Between 831 and 7216 households from all over the Netherlands. RESULTS: An increase in the market share of products displaying the label led to an increase in the volume share purchased of products eligible for the label for dairy products, yoghurts and for sauces. For some of the products, the partial effect is considerable (e.g. a 10 percentage point (pp) increase in the share of products displaying the label is associated with a 11·5 and 14·0 pp increase in the volume share of eligible products for chocolate milk and quark, respectively). CONCLUSIONS: The results suggest a positive effect from the presence of the Choices label on the volume share of eligible products purchased. Provided that eligible products are healthier than non-eligible products, the Choices label is a good guide for consumers in order to help them make healthier food choices. The positive effect is found mainly in food groups with a mix of both healthy and unhealthy food products.

Food insecurity in Denmark-socio-demographic determinants and associations with eating- and health-related variables.

Background: Food insecurity and its consequences have not received much attention in the Nordic, social-democratic welfare states. This study reports the prevalence of low and very low food security in Denmark, identifies its socio-demographic determinants and examines its associations with eating-related and health-related outcomes. Methods: A cross-sectional survey with a mixed-mode response format (telephone interviewing or Internet). A disproportional stratified random sampling design was employed (N = 1877). Main measure was the 6-item gradient food security construct adapted from the US. Results: Prevalence of low and very low food security was 6.0% (95% CI:5.4-8.5%) and 2.4% (95% CI:1.3-3.3%), respectively. Prevalence was highest in households with disposable income below OECD's poverty threshold, households receiving benefits or disability pensions, and single-parent households. After socio-demographic adjustment, adults from low/very low food secure households had a higher probability of eating an unhealthy diet (women: adj.RR 2.82 P < 0.001; men: adj.RR 2.15 P < 0.01). Adults from low/very low food secure households had lower life satisfaction (women: adj.RR 0.49, P < 0.05; men: adj.RR 0.09 P < 0.001) and higher risk of psychological distress (women: adj.RR 2.42 P < 0.05; men: adj.RR 8.95 P < 0.001). Obesity was more prevalent in low/very low food secure women (RR 2.44 P < 0.05), but not after socio-demographic adjustment. Conclusion: Food insecurity in Denmark is associated with adverse factors such as unhealthy diet, obesity, life satisfaction, and psychological distress. It is important to widen food insecurity research to non-liberal welfare states since low/very low food security is negatively associated with unhealthy eating and other health indicators, even in a social-democratic welfare state.

The consequences of unemployment on diet composition and purchase behaviour: a longitudinal study from Denmark.

OBJECTIVE: To explore and describe quantitatively the effect over time of unemployment on food purchase behaviour and diet composition. DESIGN: Longitudinal data from 2008-2012, with monthly food purchase data aligned with register data on unemployment measured as a dichotomous indicator as well as a trend accounting for the duration. SETTING: A household panel which registers daily food purchases combined with detailed nutritional information and registration of the duration of unemployment at individual level. The structure of the data set facilitates the detection of effects or associations between duration of unemployment and diet composition, purchase behaviour in terms of food expenditure, and share of food purchased on offer and in discounters while controlling for important confounding factors. SUBJECTS: Danish households of working age (n 3440) adjusted to household equivalents. We use fixed-effects econometric methods to control for unobserved heterogeneity. RESULTS: In the short run, unemployment led to substitution in favour of discount stores and increases in food expenditure and in consumption of saturated fat, total fat and protein due to increased consumption of animal-based foods. In the medium run food expenditure declined together with consumption of fresh animal-based foods and saturated fat, total fat and protein. In the even longer run these nutrients were substituted by carbohydrates and added sugar. CONCLUSIONS: Unemployment has a substantial influence on diet composition, but effects vary with duration of the unemployment period, which may have potential health implications. This ought to be taken into consideration in evaluations of existing reforms and in future reforms of welfare systems.

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets.

BACKGROUND: Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. METHODS: Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods. RESULTS: The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it. CONCLUSION: Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.

Effects of the Danish saturated fat tax on the demand for meat and dairy products.

OBJECTIVE: Taxation of unhealthy food is considered a regulation tool to improve diets. In 2011 Denmark introduced a tax on saturated fat in food products, the first country in the world to do so. The objective of the present paper is to investigate the effects of the tax on consumers' intake of saturated fat within three different types of food product group: minced beef, regular cream and sour cream. DESIGN: We use an augmented version of the Linearized Almost Ideal Demand System (LAIDS) functional form for econometric analysis, allowing for tax-induced structural breaks. SETTING: Data originate from one of the largest retail chains in Denmark (Coop Danmark) and cover January 2010 to October 2012, with monthly records of sales volume, sales revenue and information about specific campaigns from 1293 stores. RESULTS: The Danish fat tax had an insignificant or small negative effect on the price for low- and medium-fat varieties, and led to a 13-16 % price increase for high-fat varieties of minced beef and cream products. The tax induced substitution effects, budget effects and preference change effects on consumption, yielding a total decrease of 4-6 % in the intake of saturated fat from minced beef and regular cream, and a negligible effect on the intake from sour cream. CONCLUSIONS: The Danish introduction of a tax on saturated fat in food in October 2011 had statistically significant effects on the sales of fat in minced beef and cream products, but the tax seems to have reduced the beyond-recommendation saturated fat intake to only a limited extent.

Cost-effective design of economic instruments in nutrition policy.

This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn.