Recent Trends in Dietary Habits of the Italian Population: Potential Impact on Health and the Environment.

Population growth, globalization, urbanization, and economic pressures are causing changes in food consumption all over the world. The study's aims are (1) to evaluate trends in food habits in Italy to highlight deviations from the traditional Mediterranean diet, (2) to analyze the features of the present Italian diet that should be modified to meet evidence-based global scientific targets for a healthy and sustainable diet proposed by the EAT-Lancet Commission. Trends in food availability for human consumption during the period 2000-2017 were assessed using the food balance sheets (FBSs). Greenhouse gas (GHG) emission was estimated according to life cycle assessment (LCA) analyses. During the study period, the availability of animal fat and beef meat greatly declined (-58% and -32%, respectively), followed by fruit, potatoes, vegetables, milk, and non-tropical oils (-20%, -15%, -13%, -14%, and -11%, respectively). A substantial increase has occurred for tropical oils, fish, and nuts (+156, +26%, and +21%, respectively). In order to meet the targets of consumption proposed by the EAT-Lancet Commission, the consumption of legumes and nuts should be almost doubled, whereas the consumption of meat, eggs, dairy products, animal fat, tropical oils, and sugars should be reduced by proportions ranging from 60% to 90%. If implemented, these changes would reduce the diet-related greenhouse gas emission by nearly 50%. In conclusion, these data call for nutritional education programs and interventions on the food system aimed at promoting a healthier and more environmentally sustainable diet. To this end, the availability and affordability of products with a better impact on human health and the environment should be promoted.

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study.

BACKGROUND: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. METHODS: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35-70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. FINDINGS: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75-0·94; ptrend=0·0004), total mortality (0·83, 0·72-0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72-1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58-1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67-0·90; ptrend=0·0001), and stroke (0·66, 0·53-0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71-1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82-0·99; ptrend=0·0529) and yogurt (0·86, 0·75-0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76-1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90-1·33; ptrend=0·4113). INTERPRETATION: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

Dietary Fats and Oils in India.

BACKGROUND: India is undergoing rapid nutrition transition concurrent with an increase in obesity, metabolic syndrome, and type 2 diabetes (T2DM). There is a shift from a healthy traditional home-cooked high-fiber, low-fat, low-calorie diet, towards increasing consumption of packaged, ready-to-eat foods which are calorie-dense and contain refined carbohydrates, high fat, salt and sugar; and less fiber. Although fats and oils have been an integral part of our diets, there is a change in the pattern of consumption, in terms of both quality and quantity. METHODS: A literature search was conducted using the terms "fats, oil consumption in India, effects of vegetable oils, obesity and T2DM in Indians" in the medical search database PubMed (National Library of Medicine, Bethesda, MD, USA) from 1966 to June 2016. A manual search of the relevant quoted references was also carried out from the retrieved articles. Data have also been taken from nutritional surveys in India and worldwide, websites and published documents of the World Health Organization, the Food and Agricultural Organization, National Sample Survey Organization and websites of industries related to oil production. CONCLUSION: Increasing use of saturated fat, low intake of n-3 poly unsaturated fatty acids and increase in trans-fatty acids, along with increasing intake of dietary sugars has been noted in India. Most importantly, traditional false beliefs and unawareness about health effects of oils continues to be prevalent. Aggressive public health awareness programs coupled with governmental action and guidelines tailored for Indian population are required, to promote less consumption of fats and oils, use of healthy oils and fats, decreased intake of saturated fats and trans fatty acids, and increase intake of n-3 Poly-unsaturated fatty acids and mono-unsaturated fatty acids.

Appraising nutrient availability of household food supplies using Block Dietary Screeners for individuals.

BACKGROUND/OBJECTIVE: The growing interest in environmental influences on obesity risk has spawned the development of tools for appraising home food availability. These tools reveal good reliability but tend to be limited in scope and burdensome to use. This cross-sectional study investigated the feasibility of using food categories and scoring algorithms from valid food frequency questionnaires for individuals (that is, Block Dietary Fat and Fruit-Vegetable-Fiber Screeners) to estimate nutrient availability in household food supplies. SUBJECTS/METHODS: Screeners were compared with household food inventories from 100 two-parent families with ⩾1 children ⩽12 years of age. Inventoried foods were coded to match Screener food groups, and amounts available were converted to total adult daily equivalent servings to express the greatest possible frequency at which each food group could be eaten/day/household. Scoring algorithms were converted to express all scores on a per-day basis. For the most conservative assessment, the highest point was used for day ranges for the Fruit-Vegetable-Fiber Screener and the lowest range point was used for the Fat Screener. RESULTS: Spearman's rank-order correlations (r⩾0.76) showed that the Fruit-Vegetable-Fiber Screener ranked households well for fruit/vegetable servings, vitamin C and dietary fiber. The Fat Screener and household inventory were positively correlated (r⩾0.58) for total fat, saturated fat and cholesterol. Concordance of household inventories and the Fruit-Vegetable-Fiber Screener, as determined by kappa with quadratic weighting, were strong and significant. Fat Screener concordance was moderate. CONCLUSIONS: Results indicate that it is feasible to use the efficient, valid Block Dietary Screeners for individuals to appraise household food supplies.

The effect of school district nutrition policies on dietary intake and overweight: a synthetic control approach.

School nutrition policies aim to eliminate ubiquitous unhealthy foods and beverages from schools to improve adolescent dietary behavior and reduce childhood obesity. This paper evaluates the impact of an early nutrition policy, Los Angeles Unified School District's food-and-beverage standards of 2004, using two large datasets on food intake and physical measures. I implement cohort and cross-section estimators using "synthetic" control groups, combinations of unaffected districts that are reweighted to closely resemble the treatment unit in the pre-intervention period. The results indicate that the policy was mostly ineffective at reducing the prevalence of overweight or obesity 8-15 months after the intervention but significantly decreased consumption of two key targets, soda and fried foods. The policy's impact on physical outcomes appears to be mitigated by substitution toward foods that are still (or newly) available in the schools.

Reformulating partially hydrogenated vegetable oils to maximise health gains in India: is it feasible and will it meet consumer demand?

BACKGROUND: The consumption of partially hydrogenated vegetable oils (PHVOs) high in trans fat is associated with an increased risk of cardiovascular disease and other non-communicable diseases. In response to high intakes of PHVOs, the Indian government has proposed regulation to set limits on the amount of trans fat permissible in PHVOs. Global recommendations are to replace PHVOs with polyunsaturated fatty acids (PUFAs) in order to optimise health benefits; however, little is known about the practicalities of implementation in low-income settings. The aim of this study was to examine the technical and economic feasibility of reducing trans fat in PHVOs and reformulating it using healthier fats. METHODS: Thirteen semi-structured interviews were conducted with manufacturers and technical experts of PHVOs in India. Data were open-coded and organised according to key themes. RESULTS: Interviewees indicated that reformulating PHVOs was both economically and technically feasible provided that trans fat regulation takes account of the food technology challenges associated with product reformulation. However, there will be challenges in maintaining the physical properties that consumers prefer while reducing the trans fat in PHVOs. The availability of input oils was not seen to be a problem because of the low cost and high availability of imported palm oil, which was the input oil of choice for industry. Most interviewees were not concerned about the potential increase in saturated fat associated with increased use of palm oil and were not planning to use PUFAs in product reformulation. Interviewees indicated that many smaller manufacturers would not have sufficient capacity to reformulate products to reduce trans fat. CONCLUSIONS: Reformulating PHVOs to reduce trans fat in India is feasible; however, a collision course exists where the public health goal to replace PHVOs with PUFA are opposed to the goals of industry to produce a cheap alternative product that meets consumer preferences. Ensuring that product reformulation is done in a way that maximises health benefits will require shifts in knowledge and subsequent demand of products, decreased reliance on palm oil, investment in research and development and increased capacity for smaller manufacturers.

Effect of supplementation with different fat sources on the mechanisms involved in reproductive performance in lactating dairy cattle.

Supplementary fat positively influences reproductive performance in dairy cattle, although the mechanisms involved are not clearly defined. Our objective was to determine the effects of four different fat supplements on follicle development, plasma steroid hormone concentrations and prostaglandin (PG) synthesis in lactating dairy cattle. Forty-eight early lactation Holstein-Friesian cows (21 primiparous, 27 multiparous) were used in a completely randomized block design. Cows were fed the same basal TMR diet and received one of four fat supplements: (i) palmitic acid (18:0 fatty acid; Control), (ii) flaxseed (rich in 18:3 n-3 fatty acid; Flax), (iii) conjugated linoleic acid (a mixture of cis-9, trans-11 and trans-10, cis-12 isomers; CLA), and (iv) fish oil (rich in 20:5 and 22:6 n-3 fatty acids; FO). All lipid supplements were formulated to be isolipidic; palmitic acid was added as necessary to provide a total lipid supplement intake of 500 g/day. Cows were synchronized to be in estrus on Day 15 of dietary treatment. All antral follicles were counted, and dominant follicles, subordinate follicles and corpora lutea were measured daily via transrectal ovarian ultrasonography for one complete estrous cycle. Blood samples were collected daily, and selected samples were analyzed for progesterone, estradiol, insulin-like growth factor-1, insulin, cholesterol and non-esterified fatty acids. Estrus was synchronized a second time, and liver and endometrial biopsies were collected on Day 7 of the estrous cycle. Gene expression was evaluated for a number of genes involved in prostaglandin synthesis (endometrium) and fatty acid uptake and utilization (liver). Fat supplementation had little effect on follicle development. Cows receiving supplementary n-3 fatty acids had lesser plasma progesterone (P4) and smaller corpora lutea than cows receiving the CLA or Control supplements. Effects of fat supplementation on the endometrial expression of genes involved in PG synthesis were minor. Hepatic expression of SREBF1, ASCL1 and FABP1 was reduced by FO supplementation. Reduced plasma P4 in n-3 supplemented cows may lead to a suboptimal uterine environment for embryo development and hence reduced fertility compared to cows receiving the control or CLA supplements.

Variation in oil content and fatty acid composition of the seed oil of Acacia species collected from the northwest zone of India.

BACKGROUND: The oil content and fatty acid composition of the mature seeds of Acacia species collected from natural habitat of the northwest zone of the Indian subcontinent (Rajasthan) were analyzed in order to determine their potential for human or animal consumption. RESULTS: Oil content varied between 40 and 102 g kg⁻¹. The highest oil content was obtained in Acacia bivenosa DC. (102 g kg⁻¹) among the nine Acacia species. The fatty acid composition showed higher levels of unsaturated fatty acids, especially linoleic acid (~757.7 g kg⁻¹ in A. bivenosa), oleic acid (~525.0 g kg⁻¹ in A. nubica) and dominant saturated fatty acids were found to be 192.5 g kg⁻¹ palmitic acid and 275.6 g kg⁻¹ stearic acid in A. leucophloea and A. nubica respectively. Seed oils of Acacia species can thus be classified in the linoleic-oleic acid group. Significant variations were observed in oil content and fatty acid composition of Acacia species. CONCLUSION: The present study revealed that the seed oil of Acacia species could be a new source of high linoleic-oleic acid-rich edible oil and its full potential should be exploited. The use of oil from Acacia seed is of potential economic benefit to the poor native population of the areas where it is cultivated. The fatty acid composition of Acacia seed oils is very similar to that reported for commercially available edible vegetable oils like soybean, mustard, sunflower, groundnut and olive. Hence the seed oil of Acacia species could be a new source of edible vegetable oil after toxicological studies.

The context for choice: health implications of targeted food and beverage marketing to African Americans.

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n = 20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.

Impacts of China's edible oil pricing policy on nutrition.

China's health profile has shifted to one dominated by obesity and nutrition-related noncommunicable diseases (NR-NCDs) necessitating an examination of how economic policies can improve this situation. Edible oil consumption is responsible for much of the increase in energy density of the Chinese diet and particularly linked with the shifting burden of NR-NCDs toward the poor. Longitudinal analysis among adults in the China Health and Nutrition Survey (CHNS) covering the period 1991-2000 revealed that price policy effects on edible oil can influence dietary composition (particularly of the poor) and the results identify a key preventive policy need.

Advertising and obesity: a behavioral perspective.

Concern over the levels of obesity observed in Western countries has grown as researchers forecast a rapid growth in the medical care that a progressively more obese population will require. As health workers deal with increased incidences of diabetes and other obesity-related disorders, policymakers have examined the factors contributing to this problem. In particular, advertising that promotes high fat and high sugar products to children has come under increasing scrutiny. Advertisers have rejected claims that advertising contributes to obesity by arguing that it cannot coerce people into purchasing a product, and does not affect primary demand. This reasoning overlooks the role advertising plays in reinforcing and normalising behavior, however, and it assumes that only direct causal links merit regulatory attention. Ehrenberg's "weak" theory suggests advertising will support unhealthy eating behaviors, while the wide range of sales promotions employed will prompt trial and reward continued consumption. This article presents an alternative analysis of how marketing contributes to obesity and uses behavior modification theory to analyse the "fast-food" industry's promotions. We also review the New Zealand government's response to obesity and suggest policy interventions that would foster healthier eating behaviors.

Decreased red meat fat consumption in New Zealand: 1995-2002.

AIM: To review New Zealand red meat and meat fat supply trends before and after the introduction of the Quality Mark standard. METHODS: Review of trends in: per capita meat fat supply estimates from the Food and Agriculture Organization (FAO); carcase and meat cut composition reports of knife dissection and chemical analyses; the fate of fat trim; and a Lincoln College study of home-cooked and trimmed beef. Intervention From September 1997, the red meat industry's Quality Mark required trimming of beef and lamb cuts to no more than 5 mm external fat. RESULTS: (1) Trimming of fat from red meat before sale (supported by virtually all butchers) decreased the fat and saturated fat content of a red meat carcase by 30% (beef, -27%; lamb, -30%; tallow unchanged); by -8% in the total food supply; and by -17% across all meat. In 2002, fat comprised 7.4% of trimmed beef cuts, and 11.2% of all beef sold: cuts, mince, or sausages. In 2002, fat comprised 15.3% of lamb cuts; and 15.5% with mince included. (2) From 1995 to 2002, total saturated fat availability per capita in the food supply decreased by 19% (from 65 g to 53 g per day), mostly due to 7 g less saturated fat daily from red meat. (3) When combining effects (1) and (2), saturated fat per capita decreased: -27% in total food supply; -65% in red meat excluding tallow; -48% in red meat including tallow. In 1995 (without trimming), red meat contributed 25% of saturated fat in the total food supply whereas in 2002, red meat contributed 19% before (and 13% after) trimming. (4) Home trimming may remove an additional 27% of fat from beef steaks. CONCLUSION: Centralised meat processing, and Quality Mark labelling since 1997, ensured fat was trimmed from beef and lamb cuts, and reduced saturated fat in red meats by 30%. In 2002, mince and sausages accounted for nearly half of beef fat sold as red meat.

Hungarian cancer mortality and food availability data in the last four decades of the 20th century.

OBJECTIVE: To identify the dietary risk factors present in the nutrition of the Hungarian population. METHOD: We evaluated Hungarian cancer mortality data, and carried out a comparative analysis of the Hungarian National Food Balance Sheets (food availability) and dietary surveys (energy and nutrient intake). RESULTS: The cancer mortality rate in Hungary is the highest in Europe and an analysis of the past 40 years has revealed a worsening trend. Assessment of the Hungarian dietary pattern suggests that the high fat intake could be a possible risk factor in the development of lung, colon, rectum, female breast and prostate cancer. The availability of fats in Hungary was found to be the highest in a European comparison in the second half of the 1990s, while the average fat energy percentage in the diet of the male and female population was 38.0% (SD 5.7) between 1992 and 1994. Apart from the high fat consumption, the insufficient intake of vegetables and fruits could be identified as a major, convincing risk factor present in the nutrition of Hungarians, and plays a role in the development of mouth and pharynx, esophagus, lung, stomach, colon and rectum cancers, and is a probable risk factor in the development of pancreatic tumors. The availability of vegetables and fruits in the Hungarian population is one of the lowest in Europe and, in addition, the intake of dietary fiber, carotenoids, and ascorbic acid is also inadequate. CONCLUSION: Hungary has the highest cancer mortality rate in Europe, and the death rate associated with this disease is increasing. Our analysis of food balance sheets and dietary survey data clearly demonstrate the presence of certain known dietary risk factors in the nutrition of the Hungarian population.

The New Zealand food supply and diet--trends 1961-95 and comparison with other OECD countries. Organisatioin for Economic Co-operation and Development.

AIMS: To compare the New Zealand food supply and trends from 1961 to 1995 with other Organisation for Economic Co-operation and Development (OECD) countries, with an emphasis on foods linked with coronary heart disease (CHD). METHOD: Food and Agricultural Organization per capita food supply statistics for 24 OECD countries were converted to nutritional supply values and adjusted for edible portion. RESULTS: In 1995, New Zealand had the highest supply per capita of butter and meat fats among OECD countries, ranking its food supply highest for thrombogenicity and third for atherogenicity. Seafood and alcohol supply were average and vitamin E supply was high compared with other OECD countries. Beneficial trends have occurred with increases in fruit consumption, vegetable consumption and fibre intake between 1961 and 1995. While total fat intake has not changed appreciably, the fatty acid profile has shifted and is now less likely to promote CHD. CONCLUSIONS: The New Zealand diet's tendency to promote CHD has decreased, particularly since 1985. The diet's fatty acid profile, however, remains highly atherogenic and thrombogenic, predisposing to CHD, and the fat content of the food supply remains high, predisposing to obesity. Continued efforts are needed to improve the diet of New Zealanders and to maintain food supply data collection for long term monitoring of these changes.

Worldwide patterns of dietary lipids intake and health implications.

The purpose of this paper was to identify broad patterns of dietary lipids intake in the world and to assess their health implications. Household budget surveys are a valuable source of information that have been long overlooked, even though they allow assessment of within-region variability according to sociodemographic variables. With respect to per capita dietary lipids intake at a national level, four different patterns can be identified: high total dietary lipids, high intake of mostly saturated animal lipids; high total dietary lipids, low animal lipids; moderate total dietary lipids, low to moderate animals lipids; and low total dietary lipids, low animal lipids. Over time, animal lipids intake tends to decrease in countries with the first intake pattern and consumption of saturated animal lipids and polyunsaturated plant lipids-the latter frequently partly hydrogenated-tends to increase in most of the other populations. Of the visible dietary lipids, vegetable oils have been gradually assuming greater importance, with North America showing the largest absolute increase in availability per capita over the past 30 y. Studies have shown that olive oil, which is essentially a monounsaturated oil, increases high-density-lipoprotein cholesterol and reduces low-density-lipoprotein cholesterol, promoting in a balanced way a desirable blood lipid profile. Although concerns have been raised about the long-term safety of some trans fatty acids and polyunsaturated fatty acids, epidemiologic studies suggest that olive oil may have beneficial effects not only on cardiovascular health but also on the development of several malignancies including breast cancer.

The availability of low-fat milk in an inner-city Latino community: implications for nutrition education.

Substitution of low-fat for whole milk is an important strategy for reducing saturated fat consumption, but intake of whole milk remains high among Latinos. To assess whether this is related to the unavailability of low-fat milk, we surveyed 251 grocery stores (bodegas) and 25 supermarkets in a predominantly low-income, urban Latino community. Low-fat milk was available in 73% of bodegas and 96% of supermarkets, but it constituted only 15% of total milk volume in bodegas and 37% of that volume in supermarkets. Since lack of availability was not a major obstacle to increasing low-fat milk consumption, public health nutrition campaigns should focus on increasing consumer demand.