Affordable Nutrient Density in Brazil: Nutrient Profiling in Relation to Food Cost and NOVA Category Assignments.

Affordable nutrient density is provided by low-cost and nutrient-rich foods. We explored nutrient density, cost, and NOVA category assignments within and across food groups in Brazil. The nutrient density of the foods (n = 591) was assessed using the Nutrient Rich Food Index (NRF9.3) based on protein, fiber, vitamin A (RAE), vitamin C, vitamin E (mg), Ca, Fe, K and Mg; and NRF6.3 score for priority nutrients: Ca, Fe, Zn, vitamin A, vitamin B12, and folate. Nutrients to limit (LIM) were saturated fat, added sugar, and sodium. Affordability was defined as the ratio of energy and/or nutrient density of foods and retail price per 100 kcal. Foods were classified as minimally processed (n = 106), processed (n = 188), ultra-processed (n = 286), and culinary ingredients (n = 11). Nutrient density was positively linked to per 100 kcal food cost. Ultra-processed foods (UPF) contained more energy, fat, sugar, and salt and had lower NRF scores compared to minimally processed (MPF) foods. UPF was also less expensive than MPF foods. Nutrient-rich foods below the median per 100 kcal costs included MPF foods, but also processed foods (PF) and UPF. Affordable nutrient-rich foods can be found in the different categories of the NOVA classification.

How to Estimate Food Prices and Diet Costs in Population-Based Studies?

Health and nutrition surveys usually comprise detailed information on health characteristics and food consumption of certain population groups; however, the lack of data collection on the food prices may pose challenges for the estimation of the diet costs for the comprehensive analysis of food demand. The Household Budget Survey (HBS) represents an opportunity to obtain the data on the food prices for the nutrition surveys in the diverse countries worldwide. Although the HBS and the health and nutrition surveys may correspond to different periods, the application of the appropriate Consumer Price Index (CPI) allows to address the changes in the relative prices to perform the linkage between the data of food consumption with information on the food prices. Therefore, the aim of this study was to present the methods for the extraction and linkage of the food prices data from the Brazilian HBS (2002-2003 and 2008-2009) by using the pairing features related to the household characteristics to match the Health Survey of São Paulo [Inquérito de Saúde de São Paulo (ISA-Capital)] conducted in 2003, 2008, and 2015. Data referring to the household characteristics and food prices acquired by the household members living in São Paulo municipality were selected from the HBS datasets for integration with the ISA-Capital dataset. Specific deflators referring to the food items surveyed in São Paulo were obtained from the datasets of the Brazilian Broad Consumer Price Index (BCPI). Therefore, the pairing criteria referring to time, location, and household characteristics were adopted to allow linking foods consumed by the individuals in the ISA-Capital with the prices from the foods acquired by household members interviewed in the HBS. Matching data on the key pairing criteria (location/year/household income per capita/number of residents/family profile) resulted in the linkage of 94.4% (2003), 92.6% (2008), and 81.2% of the cases (2015). Following the data linkage, it was possible to estimate diet costs per gram and per calorie including application of cooking and conversion factors. Data were presented in the International Monetary Unit under the purchasing power parity (PPP) to allow the comparison at the international level. The mean diet costs identified in the population of São Paulo municipality were $8.45 (dp = 0.38) per capita per day in 2003, $8.72 (dp = 0.24) per capita per day in 2008, and $9.62 (dp = 0.23) per capita per day in 2015. Thus, it was possible to estimate the diet costs based on the prices of food items through pairing linkage of information from the household surveys, such as the Brazilian HBS, with the health and nutrition surveys lacking information on the expenditures or prices such as the ISA-Capital. Similar procedures may be used in the diverse countries with availability of the datasets of the household expenditures and health and nutrition surveys, allowing the researchers worldwide to associate the diet quality with food demand.

Nutritional Characteristics, Sites of Origin, and Cost of Foods Consumed during School Hours and Their Relationship to Nutritional Status of Schoolchildren in Mexico City.

Access, nutritional characteristics, preferences, and cost can affect food intake at school. A cross-sectional study was performed to determine the nutritional characteristics, sites of origin, and cost of foods consumed during school hours. Three hundred and sixty-nine children from five public elementary schools in Mexico City participated. The children gave information about the foods that they consumed five days out of the week during school hours, including the place of acquisition, cost of the food, and portion size. Anthropometric measurements of height and weight of the children were taken. Caloric consumption and percentage of recommended daily energy intake from food during school hours was determined. Children were 10.9 ± 0.9 years old; 55.6% were girls, 26% were overweight, 23% were obese, and 3.3% were of low height for age. The average calorie intake was 515 kilocalories (kcal) (boys, 535 kcal; girls, 476 kcal, p = 0.051); calorie intake was higher when school meal intakes included foods from home, school, and outside of school. No significant differences were found in calorie intake by children's nutritional status. The cost in Mexican pesos per 100 kcal consumed showed differences according to the nutritional status of the children; it was 4.0 Mexican pesos for children with normal weight and 4.2 and 3.8 pesos in children who were overweight or obese, respectively. The information obtained in this study should be used to provide nutritional guidance. The food portion size intake during school hours should be reduced, and the food should come from one or at most two sites, because each extra food represents an increase in the total kilocalorie intake.

Nutrient density and affordability of foods in Brazil by food group and degree of processing.

OBJECTIVE: Affordable nutrition refers to the relation between nutrient density of foods and their monetary cost. There are limited data on affordable nutrition in low- and middle-income countries. The present study aimed to develop a nutrient density score and nutrient affordability metrics for 377 most consumed foods in Brazil. DESIGN: The foods were aggregated into seven major food groups and four NOVA food categories. Nutrient composition data were obtained from the Brazilian Institute of Geography and Statistics. Food prices were obtained from retailer websites and were converted to prices per 100 g and 418 kJ. The Nutrient Rich Food (NRF8.2) score was based on protein, fiber, vitamins A, C and E, Ca, Fe and K. Nutrients to limit were sugar and Na. Affordability was measured as kcal/R$ and nutrients/R$. RESULTS: Grains, fats and sweets were more energy dense and had lower NRF8.2 scores than dairy, vegetables and fruits. Grains, fats and sweets were the lowest cost sources of energy. Vegetables and fruits, beans, nuts and seeds and eggs and dairy were the lowest cost sources of multiple nutrients. Ultra-processed foods (48 % of total) had higher energy density and lower NRF8.2 scores than did unprocessed foods. In Brazil, fruits, vegetables and dairy products offered the most nutrients per real. CONCLUSIONS: Analysis of the relationship between nutrient density of foods and their cost can help identify locally available foods that are nutrient rich, affordable and culturally acceptable. Achieving high nutrient density at an affordable cost should be the goal of Brazil's food systems.

The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases.

OBJECTIVE: Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition. DESIGN: Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings. SETTING: Studies conducted in LA countries. PARTICIPANTS: The search yielded 2695 articles of which eighty-four met inclusion criteria. RESULTS: Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision (n 27), marketing (n 16) and labelling (n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods. CONCLUSIONS: Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.

Diseño de una canasta saludable de alimentos y criterios para una evaluación comparativa de precios y densidad de nutrientes / Design of a healthy food basket and criteria for a comparative evaluation of prices and nutrient density

Introducción: asegurar la asequibilidad de la población a una alimentación saludable requiere abordar la conformación y el seguimiento del valor de una canasta saludable de alimentos y de los precios diferenciales de alimentos según calidad nutricional. Objetivos: diseñar una canasta saludable de alimentos (CSA) que resulte consistente con las Guías Alimentarias para la Población Argentina (GAPA). Los objetivos específicos son la definición de un índice de calidad nutricional de alimentos y bebidas, la conformación de la CSA por grupos de alimentos, su valoración económica, y comparar la calidad nutricional y los precios de alimentos disponibles en el mercado. Metodología: el marco metodológico se basó en las GAPA y el concepto de densidad nutricional. Para definir el Índice de densidad nutricional (IDN) de alimentos se consideraron 9 nutrientes esenciales (proteínas, fibra, calcio, hierro, zinc, potasio, Vitaminas A, C y B9), 3 nutrientes críticos (azúcares, sodio y ácidos grasos saturados), el contenido de almidón, y las ingestas recomendadas del Institute of Medicine (IOM). Se elaboraron especificaciones sobre cantidades, variedad y calidades de alimentos para la CSA según grupo de alimentos. Los precios fueron registrados en comercios de la Ciudad y partidos aledaños de Buenos Aires. Resultados: al aplicar el IDN a un conjunto de 320 alimentos y bebidas consumidos por la población argentina, se los clasificó en tres terciles de calidad. El ordenamiento resultante es consistente con las recomendaciones de las GAPA. El valor de la CSA fue de $ 3759.- mensuales (marzo 2018) para la unidad de referencia de 2000 kcal. Al comparar las densidades de nutrientes y precios de los alimentos, hortalizas feculentas, huevo y legumbres son las categorías con mejor relación calidad nutricional/precio. Los alimentos de mejor calidad nutricional tienen un precio de $ 14.- por 100 kcal y los de calidad mínima $ 4,5.- Discusión: la CSA y el IDN son herramientas para orientar y evaluar políticas que promuevan una mejor calidad de dieta.

Introduction: ensuring the population's accessibility to a healthy diet requires addressing the conformation and monitoring of the value of a healthy food basket and the differential prices of foods following nutritional quality. Objectives: to design a healthy food basket (HFB) consistent with the recommendations given by Argentina's dietary guidelines (GAPA). The specific objectives were to define a nutritional quality index for foods and beverages, the composition of HFB by food group, assess values, and compare the prices and nutritional quality of foods available in local markets. Methods: the methodological framework was based on GAPA and the concept of nutritional density. To define the Nutritional Density Index (NDI) of food, 9 essential nutrients (proteins, fiber, calcium, iron, zinc, potassium, Vitamins A, C and B9), 3 critical nutrients (sugars, sodium and saturated fatty acids), the starch content, and the recommended intakes of the Institute of Medicine (IOM) were considered. Specifications were prepared on quantities, variety and qualities of food for the HFB, according to the food group. The prices were registered in shops in the City Centre (CABA) and neighboring municipalities of Buenos Aires. Results: when applying the NDI to a set of 320 foods and beverages consumed by the Argentine population, they were classified into three tertiles of quality. The resulting order is consistent with the recommendations of GAPA. The value of the HFB was $ 3759.- monthly (March 2018) for the reference unit of 2000 kcal. When comparing nutrient densities and food prices, starchy vegetables, eggs and legumes are the categories with the best nutritional quality / price ratio. The foods of better nutritional quality have a price of $ 14.- per 100 kcal and those of minimum quality $ 4.5.- Discussion: the HFB and NDI are tools to guide and evaluate policies that promote a better diet quality.

¿Cuál es el impacto de un impuesto a alimentos sólidos azucarados sobre la alimentación y salud de la población?: síntesis rápida de evidencia / What is the impact of a tax on solid sugary foods on the diet and health of the population?: rapid eviodence synthesis

ANTECEDENTES Y OBJETIVO Una de las posibles causas del aumento sostenido de la obesidad/sobrepeso es la alta disponibilidad de alimentos con bajo contenido nutricional; estudios muestran que la reducción de la ingesta de este tipo de alimentos (especialmente de alto contenido de azúcar) reduce el riesgo de sobrepeso. Para abordar esta situación, gobiernos a nivel mundial se plantean diversas intervenciones para controlar la obesidad y el sobrepeso. En este contexto se solicita esta síntesis de evidencia con el objetivo de informar la toma de decisiones respecto del efecto de una política para incorporar un impuesto a alimentos azucarados. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en las bases de datos PubMed, Cochrane Library, PDQ Evidence, Health System Evidence, Health Evidence, ISIWeb of Knowledge y Support Summaries con el objetivo de identificar revisiones sistemáticas del tema. Se seleccionaron preferentemente aquellas que incluían información relevante y que fueron publicadas en los últimos 5 años. Adicionalmente, se utilizaron informes y análisis publicados sobre metodologías y experiencias de impuestos sobre alimentos azucarados. RESULTADOS Se recuperaron 6 revisiones sistemáticas, del cual se obtuvieron los siguientes resultados: -Un impuesto a alimentos azucarados reduciría la demanda e ingesta. Sin embargo, el tamaño del impacto es pequeño, especialmente en la prevalencia de obesidad. -En términos económicos, el consumo de alimentos azucarados se reduce al incrementar el precio, no obstante, esta reducción no es proporcional a la disminución del precio. -El impuesto a alimentos azucarados podría modificar el contenido nutricional de los alimentos disponibles en el mercado y/o incentivar la sustitución de alimentos gravados. -La experiencia de Hungría nos muestra que el límite para gravar un alimento va entre 25-40 g/100g. -Finlandia utiliza un impuesto global para todo tipo de alimento, proporcional al nivel de azúcar éste contenga. -Este impuesto podría ser regresivo, no obstante, la introducción conjunta de subsidios a alimentos saludables podría corregir estas imperfecciones.