Daniel Warm

Deprivation, diet, and food-retail access: findings from the Leeds 'food deserts' study

Within a context of public policy debate in the United Kingdom on social exclusion, health inequalities, and food poverty, the metaphor of the ‘food desert’ caught the imagination of those involved in policy development. Drawing from a major cross-disciplinary investigation of food access and food poverty in British cities, the authors report in this paper findings from the first ‘before/after’ study of food consumption in a highly deprived area of a British city experiencing a sudden and significant change in its food-retail access. The study has been viewed as the first opportunity in the United Kingdom to assess the impact of a non-healthcare intervention (specifically a retail-provision intervention) on food-consumption patterns, and by extension diet-related health, in such a deprived, previously poor-retail-access community. The paper offers evidence of a positive but modest impact of the retail intervention on diet, and the authors discuss the ways in which their findings are potentially significant in the context of policy debate.

Food-frequency questionnaires: a review of their design, validation and utilisation

A review of the literature concerning the design, utilisation and validation of food-frequency questionnaires (FFQ) has been carried out using a semi-systematic approach to obtaining, reviewing and extracting data from articles. Databases were searched from 1980 to 1999. The present review identified 227 validation (from 1980 to September 1999) and 164 utilisation (for 1998 only) studies. A number of design issues have been evaluated through the present review. These include: the need to consider how portion sizes have been described, self-defined giving higher mean correlations; how an FFQ was administered, interviewer-administered giving higher mean correlations for some nutrients; how many items to include on an FFQ, those with the largest number of items having higher correlations. Validation techniques were described. Most validation studies involved comparing an FFQ against another dietary assessment method; only 19 % compared an FFQ to a biomarker. Measurement differences were most commonly assessed by correlation coefficients as opposed to other more appropriate methods. Mean correlation coefficients were highest for Ca and fat, and lowest for vitamin A and vegetables. The utilisation studies showed that FFQ were most commonly used in cross-sectional surveys, with ninety-three of the FFQ being designed to be disease-specific. The present review results were presented to a group of experts and a consensus arrived at concerning the development, validation and use of FFQ. Recommendations derived from the consensus arising from the literature review are presented as an appendix to the present paper.

The Leeds “food deserts” intervention study: what the focus groups reveal

This paper outlines the research agenda of the food deserts in British Cities project, and reports findings from a set of qualitative focus group studies conducted following a major retail provision intervention in a low‐income, deprived area of Leeds. It explores the impacts of the transformation of physical access to full‐range retailing in the area, and assesses the views of the residents who had switched their main food source as a result of the intervention compared to those who had not. Finally, it interrogates residents’ perceptions of the impact (if any) of the intervention on their food consumption habits and their potential to eat a more healthy diet.

Randomised controlled factorial trial of dietary advice for patients with a single high blood pressure reading in primary care

Abstract Objective To assess the effect of brief interventions during the “watchful waiting” period for hypertension. Design Factorial trial. Setting General practice. Methods 296 patients with blood pressure > 160/90 mm Hg were randomised to eight groups defined by three factors: an information booklet; low sodium, high potassium salt; prompt sheets for high fruit, vegetable, fibre; and low fat. Main outcome measures Blood pressure (primary outcome); secondary outcomes of diet, weight, and dietary biomarkers (urinary sodium:potassium (Na:K) ratio; carotenoid concentrations). Results Blood pressure was not affected by the booklet (mean difference (diastolic blood pressure) at one month 0.2, 95% confidence interval 1.6 to 2.0), salt (0.13; 1.7 to 2.0), or prompts (0.52; 1.3 to 2.4). The salt decreased Na:K ratio (difference 0.32; 0.08 to 0.56, P = 0.01), and the prompts helped control weight (difference 0.39 (0.85 to 0.05) kg at one month, P = 0.085; 1.2 (0.1 to 2.25) kg at six months, P = 0.03). Among those with lower fruit and vegetable consumption (< 300 g per day), prompts increased fruit and vegetable consumption and also carotenoid concentrations (difference 143 (16 to 269) mmol/l, P < 0.03) but did not decrease blood pressure. Conclusion During watchful waiting, over and above the effect of brief advice and monitoring, an information booklet, lifestyle prompts, and low sodium salt do not reduce blood pressure. Secondary analysis suggests that brief interventions—particularly lifestyle prompts—can make useful changes in diet and help control weight, which previous research indicates are likely to reduce the long term risk of stroke.

Developing an evidence-based approach to Public Health Nutrition : translating evidence into policy

The aim of this paper is to highlight the importance of an evidence-based approach to the development, implementation and evaluation of policies aimed at improving nutrition-related health in the population. Public Health Nutrition was established to realise a population-level approach to the prevention of the major nutrition-related health problems world-wide. The scope is broad and integrates activity from local, national, regional and international levels. The aim is to inform and develop coherent and effective policies that address the key rate-limiting steps critical to improving nutrition-related public health. This paper sets out the rationale for an evidence-based approach to Public Health Nutrition developed under the umbrella of the European Network for Public Health Nutrition.

Effective promotion of healthy nutrition and physical activity in Europe requires skilled and competent people; European Master's Programme in Public Health Nutrition

Scientists in basic research and epidemiology deliver messages to policy makers. Effective population based strategies then require people trained and competent in the discipline of Public Health Nutrition (PHN). Since 1997, a European Masters Programme in PHN has been undergoing planning and implementation with the aid of funding from the European Commission (DGV). PHN is used as a broad term covering Nutrition and Physical Activity as well as Health Promotion and Disease Prevention. The partners in this project are academic departments from 17 countries. The students will undertake core modules and electives for a year and a half, followed by a research project for six months. In order to set up formalised procedures for the evaluation of the quality assurance of individual modules from across Europe, a quality assurance system has been set up. The academic year 1999-2000 will allow an opportunity for Universities and Institutes to start new modules, to develop other modules, assess the movement of students between modules, tackle funding issues and allow further marketing of the programme. Future activities include strengthening of the European Network for Public Health Nutrition (ENPHN), the establishment of a consortium with universities, the co-ordination of programme activities with other European Masters Programmes in Public Health, and the incorporation of new Member States from Eastern Europe. We can look forward to a new brand of professionals, who are truly European in their training, but who also have an integrated view of nutrition and physical activity, health promotion and disease prevention and who are prepared for policy making, action planning, implementation and evaluation.

Diet and physical activity--interactions for health; public health nutrition in the European perspective.

For the majority of European adults, who neither smoke nor drink excessively, the most significant controllable risk factors affecting their long-term health are what they eat, and how physically active they are. Scientists are supposed to clarify to policy makers and health professionals the usefulness of their health messages. However, to be able to do that, a more detailed understanding is needed of the basic mechanisms behind the effects on health of diet and physical activity and, especially, the two in combination. Further, better methods for assessment of nutrition and physical activity in the population have to be developed, and more and better baseline data have to be collected. Increased and more efficient interventions are then needed. People trained and competent in the new discipline of Public Health Nutrition are required. Through the stimulating support that the European Commission, as well as other national and international partners, are presently giving to the development of Public Health Nutrition across Europe, we can hope for an increased mobility, networking and understanding between European nutrition and physical activity professionals. This will most likely result in greater and better policy making, strategy development, implementation and evaluation. We now have a great possibility to develop the integrated field of preventive nutrition and health enhancing physical activity.

A European Master's Programme in Public Health Nutrition

Effective population-based strategies require people trained and competent in the discipline of Public Health Nutrition. Since 1997, a European Masters Programme in Public Health Nutrition has been undergoing planning and implementation, by establishing initial quality assurance systems with the aid of funding from the European Commission (DG SANCO/F3). Partners from 17 European countries have been involved in the process. A European Network of Public Health Nutrition has been developed and accredited by the European Commission.

Factors affecting and limiting food choice in a 'food desert'

The UK is facing an obesity epidemic with reported figures of 17.3% for men and 21.2% for women (Department of Health, 1998). Even in childhood obesity is a prevalent condition and has been associated with an increased risk of obesity in adulthood (Kolata, 1986). It has been observed that most adult obesity treatment programmes only result in small reductions in weight which are not often maintained (Guo et al, 2000). In strategies to reduce obesity incidence it may be more advantageous to identify high-risk individuals at an early age and begin prevention in childhood rather than rely on weight management in adulthood. Previous studies have indicated that BMI in childhood has a stronger effect on adult BMI than birth weight and adult lifestyle factors (Guo et al, 2000). It is therefore essential to find out how stable relative adiposity is through the transition from childhood, through adolescence and into adulthood and from what age the onset of adult obesity may be most accurately predicted.