Culturally Optimised Nutritionally Adequate Food Baskets for Dietary Guidelines for Minimum Wage Estonian Families.

Although low socioeconomic groups have the highest risk of noncommunicable diseases in Estonia, national dietary guidelines and nutrition recommendations do not consider affordability. This study aims to help develop nutritionally adequate, health-promoting, and culturally acceptable dietary guidelines at an affordable price. Three food baskets (FBs) were optimised using linear programming to meet recommended nutrient intakes (RNIs), or Estonian dietary guidelines, or both. In total, 6255 prices of 422 foods were collected. The Estonian National Dietary Survey (ENDS) provided a proxy for cultural acceptability. Food baskets for a family of four, earning minimum wage, contain between 73 and 96 foods and cost between 10.66 and 10.92 EUR per day. The nutritionally adequate FB that does not follow Estonian dietary guidelines deviates the least (26% on average) from ENDS but contains twice the sugar, sweets, and savoury snacks recommended. The health-promoting FB (40% deviation) contains a limited amount of sugar, sweets, and savoury snacks. However, values for vitamin D, iodine, iron, and folate are low compared with RNIs, as is calcium for women of reproductive age. When both the RNIs and dietary guidelines are enforced, the average deviation (73%) and cost (10.92 EUR) are highest. The composition of these FBs can help guide the development of dietary guidelines for low income families in Estonia.

Corporate political activity of the baby food industry: the example of Nestlé in the United States of America.

BACKGROUND: The marketing practices of the breastmilk substitutes industry have been known for decades, but little is known about the influence of the baby food industry, more generally, on public health policy, research and practice, also known as 'corporate political activity' (CPA). In this study, the baby food industry refers to for-profit companies that manufacture, market or distribute breastmilk substitutes and food products for infants and young children under two years. In addition, trade associations, public relations firms, marketing agencies and individuals or groups affiliated with the baby food industry are also considered to be part of the baby food industry. The aim of the current study was to systematically identify and monitor the CPA of the baby food industry in the USA, shown by the activities of Nestlé, the largest industry actor in this sector in the country. METHODS: The case study consisted of an analysis of publicly available information for data published between January and November 2018. We included documents from the industry, the government and other sources, including professional organisations, charities and consumer associations. We analysed data using an existing framework to classify the CPA of the food industry. RESULTS: During the period of data collection, Nestlé employed a list of action-based 'instrumental strategies'. The most prominent strategy was 'information strategy', used to fund, produce and disseminate industry-preferred information. Nestlé was further found to 'establish relationships with key opinion leaders and health organisations, and the media', 'seek involvement in community' and directly influence policies and programs through indirect access and the placement of actors in government policy settings. The company also used argument-based 'discursive strategies' to frame the debate on diet- and public health-related issues. CONCLUSION: This study showed that Nestlé used various CPA strategies which may have influenced public health policy, research and practice in ways favourable to the baby food industry. These results could be used to further recognise and pre-empt the influence of corporations on health, in order to ensure that commercial interests do not prevail over public health goals.

Nutritionally adequate food baskets optimised for cultural acceptability as basis for dietary guidelines for low-income Czech families.

BACKGROUND: Czech nutrition recommendations prioritize health aspects without considering affordability. Low socio-economic groups have the highest risk of nutrition-related noncommunicable diseases and cost has been identified as an obstacle to achieve a healthy diet, making the implementation of affordability into dietary guidelines necessary. The aim of this study was to develop a food basket (FB) for a low income Czech family of four that is nutritionally adequate, health-promoting and culturally acceptable at an affordable price. METHODS: Linear programming optimisation was used to ascertain that the FB covered the recommended nutrient intakes from the Czech Nutrition Society and from the World Health Organization (WHO). Cost of the FB was calculated on the basis of more than 3900 prices of 330 foods. Within a given cost constraint, all FBs were optimized for the highest possible similarity to the reported food group intake according to the most recent Czech National Food Consumption survey, which was used as a proxy for cultural acceptability. RESULTS: The optimised FB affordable at a daily food budget for a Czech family on minimum wage (CZK 177, ~ € 6.8) contained 76 foods and had an average relative deviation of 10% per food category from reported intake. The main deviations were: 72% less sweets and confectionery; 66% less salt; 52% less meat; 50% less milk products; 8% less potatoes; and 484% more milk; 69% more oils and fats; 20% more cereals; and 6% more vegetables. CONCLUSIONS: The optimised FB can help to guide the development of food-based dietary guidelines for low income households in Czech Republic.

Cost-Minimized Nutritionally Adequate Food Baskets as Basis for Culturally Adapted Dietary Guidelines for Ethiopians.

The high prevalence of undernutrition, especially stunting, in Ethiopia hampers the country's economic productivity and national development. One of the obstacles to overcome undernutrition is the relatively high cost of food for low economic groups. In this study, linear programming was used to (i) identify urban and rural nutritionally adequate food baskets (FBs) with the highest affordability for an Ethiopian family of five and (ii) create urban and rural FBs, optimized for cultural acceptability, which are affordable for a family with the lowest income. Nutritionally adequate rural and urban FBs with highest affordability cost as little as Ethiopian Birr (ETB) 31 and 38 (~USD 1.07 and 1.31), respectively, but have poor dietary diversity (16 and 19 foods). FBs that cost ETB 71.2 (~USD 2.45) contained 64 and 48 foods, respectively, and were much more similar to the food supply pattern reported by FAO (15% and 19% average relative deviation per food category). The composed FBs, which are affordable for the greater part of the Ethiopian population, may serve as a basis for the development of culturally acceptable food-based dietary guidelines. These guidelines would recommend a diet composed of approximately up to 60% cereals, up to 20% roots and tubers, 10% legumes, and 10% fruits and vegetables by weight, plus only a small share from animal foods.

Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006-2016).

OBJECTIVE: Breast-feeding is an important determinant of health of mothers and their offspring. The present study aimed to compare breast-feeding rates across Europe disaggregated by maternal education and establish what proportion achieves at least 50 % exclusive breast-feeding (EBF) at 6 months.Design/SettingSecondary analysis of national or sub-national studies' breast-feeding data for EU Member States plus Norway and Iceland, published in 2006-2016. Nineteen EU Member States plus Norway reported rates of EBF and any breast-feeding disaggregated by maternal education, of which only thirteen could be matched to the International Standard Classification of Education.ParticipantsMothers and their infants aged 0-12 months. RESULTS: Data on EBF rates at 6 and 4 months were found in only four and six countries, respectively. At 6 months, EBF rates of 49 % in Slovakia and 44 % in Hungary were closest to WHO's target of at least 50 % EBF. At 4 months, mothers with high education level in Denmark, the Netherlands and Germany had the highest EBF rates (71, 52 and 50 %, respectively). Mothers with low education level were less likely to initiate breast-feeding and cessation occurred early. The inequality gap ranged from 63 % in Irish mothers to no gap or very low levels of inequality in Poland, Sweden and Norway. CONCLUSIONS: More mothers with high, compared with low, education initiate breast-feeding and practise EBF for longer. More European policies should be targeted to protect, support and promote breast-feeding, especially among mothers with only mandatory education.

Nutritionally Optimized, Culturally Acceptable, Cost-Minimized Diets for Low Income Ghanaian Families Using Linear Programming.

The Ghanaian population suffers from a double burden of malnutrition. Cost of food is considered a barrier to achieving a health-promoting diet. Food prices were collected in major cities and in rural areas in southern Ghana. Linear programming (LP) was used to calculate nutritionally optimized diets (food baskets (FBs)) for a low-income Ghanaian family of four that fulfilled energy and nutrient recommendations in both rural and urban settings. Calculations included implementing cultural acceptability for families living in extreme and moderate poverty (food budget under USD 1.9 and 3.1 per day respectively). Energy-appropriate FBs minimized for cost, following Food Balance Sheets (FBS), lacked key micronutrients such as iodine, vitamin B12 and iron for the mothers. Nutritionally adequate FBs were achieved in all settings when optimizing for a diet cheaper than USD 3.1. However, when delimiting cost to USD 1.9 in rural areas, wild foods had to be included in order to meet nutritional adequacy. Optimization suggested to reduce roots, tubers and fruits and to increase cereals, vegetables and oil-bearing crops compared with FBS. LP is a useful tool to design culturally acceptable diets at minimum cost for low-income Ghanaian families to help advise national authorities how to overcome the double burden of malnutrition.

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.

Association between socioeconomic status of mothers, food security, food safety practices and the double burden of malnutrition in the Lalitpur district, Nepal.

BACKGROUND: The prevalence of childhood overweight and obesity is increasing in low-and middle income countries such as Nepal. At the same time, high prevalence of chronic undernutrition persists leading to a double burden of malnutrition. AIM: To identify associations between the socioeconomic status of mothers, food security, the food safety environment within the household, and prevalence of stunting and overweight of the children. METHODS: Statistical analysis of socioeconomic, food safety-related and anthropometric data from 289 mother-child dyads in an urban area of the Kathmandu Valley, Nepal. RESULTS: According to WHO standards, 26 % of the children, aged 0-59 months, were stunted, 10 % were underweight, and 6.6 % were either overweight or obese. Significantly more boys than girls were underweight (p = 0.004) and stunted (p < 0.001). The higher education level of mothers was associated with a higher height-for-age (HAZ) score in girls, but not with HAZ in boys. Irrespective of sex, children of mothers with highest education level had significantly lower BMI-for-age scores (BAZ) than those of mothers with low education levels. None of the food safety indicators were associated with either HAZ or the BAZ. CONCLUSION: The education level of mothers seems to be relevant to help reduce the double burden of malnutrition at least in some regions of Nepal. This should be taken into consideration when designing programmes to prevent both chronic undernutrition and non-communicable diseases.

Toward the prevention of childhood undernutrition: diet diversity strategies using locally produced food can overcome gaps in nutrient supply.

BACKGROUND: Chronic undernutrition is prevalent in Mozambique, where children suffer from stunting, vitamin A deficiency, anemia, and other nutrition-related disorders. Complete diet formulation products (CDFPs) are increasingly promoted to prevent chronic undernutrition. OBJECTIVE: Using linear programming, to investigate whether diet diversification using local foods should be prioritized in order to reduce the prevalence of chronic undernutrition. METHODS: Market prices of local foods were collected in Tete City, Mozambique. Linear programming was applied to calculate the cheapest possible fully nutritious food baskets (FNFB) by stepwise addition of micronutrient-dense localfoods. RESULTS: Only the top quintile of Mozambican households, using average expenditure data, could afford the FNFB that was designed using linear programming from a spectrum of local standard foods. The addition of beef heart or liver, dried fish and fresh moringa leaves, before applying linear programming decreased the price by a factor of up to 2.6. As a result, the top three quintiles could afford the FNFB optimized using both diversification strategy and linear programming. CDFPs, when added to the baskets, were unable to overcome the micronutrient gaps without greatly exceeding recommended energy intakes, due to their high ratio of energy to micronutrient density. CONCLUSIONS: Dietary diversification strategies using local, low-cost, nutrient-dense foods can meet all micronutrient recommendations and overcome all micronutrient gaps. The success of linear programming to identify a low-cost FNFB depends entirely on the investigators' ability to select appropriate micronutrient-dense foods. CDFPs added to food baskets are unable to overcome micronutrient gaps without greatly exceeding recommended energy intake.

Obesity and inequities: guidance for addressing inequities in overweight and obesity

This policy guidance aims to support European policy-makers to improve the design, implementation and evaluation of interventions and policies to reduce inequities in overweight and obesity. The prevalence of obesity in Europe is rising in many countries, and rising fastest in low socioeconomic population groups. There is a strong relationship between obesity and low socioeconomic status, especially for women. Reducing health inequities is a key strategic objective of Health 2020 – the European policy framework for health and well-being endorsed by the 53 Member States of the WHO European Region in 2012. This guide seeks to assist European policy-makers in contributing to achieving the objectives of Health 2020 in a practical way. It draws on key evidence, including from the Review of social determinants and the health divide in the WHO European Region. It sets out options to reduce the unequal distribution of obesity in Europe, through approaches which address the social determinants of obesity and the related health, social and economic consequences of the obesity inequity gradient.

Sustainable prevention of obesity through integrated strategies: The SPOTLIGHT project's conceptual framework and design.

BACKGROUND: The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM). METHODS/DESIGN: SPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed. DISCUSSION: SPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.

Питание и здоровье в Европе: новая основа для действий

В данной публикации, предназначенной для работников здравоохранения, всесторонне рассматриваются различные аспекты политики в области пищевых продуктов и питания и приводятся соответствующие фактические данные. В ней затрагиваются вопросы ухудшения состояния здоровья, вызванного пищевыми продуктами и питанием, и связанных с этим затрат, обосновывается необходимость принятия мер и предлагаются конкретные действия, которые могут предприниматься лицами, определяющими политику. Особое внимание в публикации уделяется насущной необходимости выработки комплексной политики в области пищевых продуктов и питания с участием различных секторов в целях стабильного и непрерывного производства продуктов питания, их безопасности и обеспечения всех людей пищевыми продуктами высокого качества и питательной ценности. Краткое содержание данной публикации для лиц, разрабатывающих и определяющих политику, опубликовано в 2002 г. на англ. яз. и рус. яз. Плохое питание, болезни, передаваемые через пищевые продукты, и отсутствие безопасного доступа к доброкачественным пищевым продуктам являются весьма важной составляющей бремени болезней и смертности в Европейском регионе ВОЗ. Улучшение рациона и режима питания, безопасность пищевых продуктов и обеспеченность продуктами питания не только уменьшат или предотвратят страдания отдельных людей и населения в целом, но и помогут сократить расходы и издержки систем здравоохранения и обеспечить социально-экономические выгоды и преимущества для стран.

Food and health in Europe: a new basis for action.

Poor nutrition, foodborne disease and lack of secure access to good food make an important contribution to the burden of disease and death in the WHO European Region. Better diets, food safety and food security will not only reduce or prevent suffering to individuals and societies but also help cut costs to health care systems and bring social and economic benefits to countries. People's chances for a healthy diet depend less on individual choices than on what food is available and whether it is affordable. Policies to benefit health through good food and nutrition must extend beyond the health sector to include sectors ranging from agriculture and food processing, manufacturing and trade to transport, retailing, catering and advertising. Food and nutrition policies should be coordinated so that public health is given due priority in the making of food policies by non-health sectors. This publication discusses in depth the components of food and nutrition policies and the evidence supporting them. It describes food- and nutrition-related ill health and its costs, shows the need for action and describes the steps for decision-makers to take. This book highlights the urgent need for integrated, multisectoral food and nutrition policies to encourage the sustainable production of food, its safety and the provision of food of high nutritional quality for all.

Food and health in Europe: a new basis for action

Aimed at health professionals, this publication discusses in depth the components of food and nutrition policies and the evidence supporting them. It describes food- and nutrition-related ill health and its costs, shows the need for action and describes the steps for decision-makers to take. This book highlights the urgent need for integrated, multisectoral food and nutrition policies to encourage the sustainable production of food, its safety and the provision of food of high nutritional quality for all. A summary of the book’s content, aimed at policy-makers, was published in English and Russian in 2002. Poor nutrition, foodborne disease and lack of secure access to good food make an important contribution to the burden of disease and mortality in the WHO European Region. Better diets, food safety and food security will not only reduce or prevent suffering to individuals and societies but also help cut costs to health care systems and bring social and economic benefits to countries.

Health impact assessment of agriculture and food policies: lessons learnt from the Republic of Slovenia.

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices.

Feeding and nutrition of infants and young children: guidelines for the WHO European Region, with emphasis on the former Soviet countries

Good feeding practices will prevent malnutrition and early growth retardation, which is still common in some parts of the WHO European Region, especially countries of the former Soviet Union. Despite the importance of nutrition and feeding of infants and young children, limited attention has been paid to the need for guidelines based on scientific evidence. This publication contains the scientific rationale for the development of national nutrition and feeding recommendations from birth to the age of three years. It will allow national experts to develop or update their current national nutrition recommendations and will be of particular interest to ministries of health, paediatricians, dietitians, nutrition scientists, and public health and other professionals concerned with the nutrition and health of young children.

Кормление и питание грудных детей и детей раннего возраста: методические рекомендации для Европейского региона ВОЗ с особым акцентом на республики бывшего Советского Союза

Надлежащие методы кормления позволяют предупредить неправильное питание и задержки роста в раннем детском возрасте, все еще характерные для некоторых частей Европейского региона ВОЗ, в частности для стран, сложившихся на месте Советского Союза. И все же, несмотря на важность методов питания и кормления в младенческом и раннем детском возрасте, необходимости руководящих принципов и рекомендаций, основывающихся на научно обоснованных фактических данных, не уделялось достаточного внимания. В настоящей публикации дается научное обоснование для разработки на уровне стран рекомендаций по питанию и кормлению от рождения до трехлетнего возраста. Приводимая в публикации информация должна помочь специалистам в странах разработать или обновить применяемые в настоящее время в их странах рекомендации по вопросам кормления. Публикация может представить большой интерес для министерств здравоохранения, педиатров, специалистов в области диетотерапии и питания, а также для специалистов общественного здравоохранения и других категорий профессиональных работников, сталкивающихся с проблемами питания и здоровья детей.