Eva Almiron-Roig

Socioeconomic differences in purchases of more vs. less healthy foods and beverages: analysis of over 25,000 British households in 2010.

Socioeconomic inequalities in diet-related health outcomes are well-recognised, but are not fully explained by observational studies of consumption. We provide a novel analysis to identify purchasing patterns more precisely, based on data for take-home food and beverage purchases from 25,674 British households in 2010. To examine socioeconomic differences (measured by occupation), we conducted regression analyses on the proportion of energy purchased from (a) each of 43 food or beverage categories and (b) major nutrients. Results showed numerous small category-level socioeconomic differences. Aggregation of the categories showed lower SES groups generally purchased a greater proportion of energy from less healthy foods and beverages than those in higher SES groups (65% and 60%, respectively), while higher SES groups purchased a greater proportion of energy from healthier food and beverages (28% vs. 24%). At the nutrient-level, socioeconomic differences were less marked, although higher SES was associated with purchasing greater proportions of fibre, protein and total sugars, and smaller proportions of sodium. The observed pattern of purchasing across SES groups contributes to the explanation of observed health differences between groups and highlights targets for interventions to reduce health inequalities.

Price promotions on healthier compared with less healthy foods: a hierarchical regression analysis of the impact on sales and social patterning of responses to promotions in Great Britain

Background: There is a growing concern, but limited evidence, that price promotions contribute to a poor diet and the social patterning of diet-related disease. Objective: We examined the following questions: 1) Are less-healthy foods more likely to be promoted than healthier foods? 2) Are consumers more responsive to promotions on less-healthy products? 3) Are there socioeconomic differences in food purchases in response to price promotions? Design: With the use of hierarchical regression, we analyzed data on purchases of 11,323 products within 135 food and beverage categories from 26,986 households in Great Britain during 2010. Major supermarkets operated the same price promotions in all branches. The number of stores that offered price promotions on each product for each week was used to measure the frequency of price promotions. We assessed the healthiness of each product by using a nutrient profiling (NP) model. Results: A total of 6788 products (60%) were in healthier categories and 4535 products (40%) were in less-healthy categories. There was no significant gap in the frequency of promotion by the healthiness of products neither within nor between categories. However, after we controlled for the reference price, price discount rate, and brand-specific effects, the sales uplift arising from price promotions was larger in less-healthy than in healthier categories; a 1-SD point increase in the category mean NP score, implying the category becomes less healthy, was associated with an additional 7.7–percentage point increase in sales (from 27.3% to 35.0%; P < 0.01). The magnitude of the sales uplift from promotions was larger for higher–socioeconomic status (SES) groups than for lower ones (34.6% for the high-SES group, 28.1% for the middle-SES group, and 23.1% for the low-SES group). Finally, there was no significant SES gap in the absolute volume of purchases of less-healthy foods made on promotion. Conclusion: Attempts to limit promotions on less-healthy foods could improve the population diet but would be unlikely to reduce health inequalities arising from poorer diets in low-socioeconomic groups.

Dietary assessment in minority ethnic groups: a systematic review of instruments for portion-size estimation in the United Kingdom

Context: Dietary assessment in minority ethnic groups is critical for surveillance programs and for implementing effective interventions. A major challenge is the accurate estimation of portion sizes for traditional foods and dishes. Objective: The aim of this systematic review was to assess records published up to 2014 describing a portion-size estimation element (PSEE) applicable to the dietary assessment of UK-residing ethnic minorities. Data sources, selection, and extraction: Electronic databases, internet sites, and theses repositories were searched, generating 5683 titles, from which 57 eligible full-text records were reviewed. Data analysis: Forty-two publications about minority ethnic groups (n = 20) or autochthonous populations (n = 22) were included. The most common PSEEs (47%) were combination tools (eg, food models and portion-size lists), followed by portion-size lists in questionnaires/guides (19%) and image-based and volumetric tools (17% each). Only 17% of PSEEs had been validated against weighed data. Conclusions: When developing ethnic-specific dietary assessment tools, it is important to consider customary portion sizes by sex and age, traditional household utensil usage, and population literacy levels. Combining multiple PSEEs may increase accuracy, but such methods require validation.

Acceptability and potential effectiveness of commercial portion control tools amongst people with obesity

Exposure to large portion sizes is a risk factor for obesity. Specifically designed tableware may modulate how much is eaten and help with portion control. We examined the experience of using a guided crockery set (CS) and a calibrated serving spoon set (SS) by individuals trying to manage their weight. Twenty-nine obese adults who had completed 7-12 weeks of a community weight-loss programme were invited to use both tools for 2 weeks each, in a crossover design, with minimal health professional contact. A paper-based questionnaire was used to collect data on acceptance, perceived changes in portion size, frequency, and type of meal when the tool was used. Scores describing acceptance, ease of use and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed using logistic regression. Mean acceptance, ease of use and perceived effectiveness were moderate to high (3·7-4·4 points). Tool type did not have an impact on indicators of acceptance, ease of use and perceived effectiveness (P>0·32 for all comparisons); 55 % of participants used the CS on most days v. 21 % for the SS. The CS was used for all meals, whereas the SS was mostly used for evening meals. Self-selected portion sizes increased for vegetables and decreased for chips and potatoes with both tools. Participants rated both tools as equally acceptable, easy to use and with similar perceived effectiveness. Formal trials to evaluate the impact of such tools on weight control are warranted.

Eating at Food Outlets and “On the Go” Is Associated with Less Healthy Food Choices in Adults: Cross-Sectional Data from the UK National Diet and Nutrition Survey Rolling Programme (2008–2014)

Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1–6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008–2014) were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and “on the go”. Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet) and non-core (all other foods). Out of 97,748 eating occasions reported, the most common was home (67–90% of eating occasions). Leisure places, food outlets and “on the go” combined contributed more energy from non-core (30%) than from core food (18%). Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns (p < 0.01). Our study provides evidence that eating patterns, behaviours and resulting diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption.

Influencia multisensorial sobre la conducta alimentaria: ingesta hedónica

Research in obesity has traditionally focused on prevention strategies and treatments aimed at changing lifestyle habits. However, recent research suggests that eating behavior is a habit regulated not only by homeostatic mechanisms, but also by the hedonic pathway that controls appetite and satiety processes. Cognitive, emotional, social, economic, and cultural factors, as well as organoleptic properties of food, are basic aspects to consider in order to understand eating behavior and its impact on health. This review presents a multisensory integrative view of food at both the homeostatic and non-homeostatic levels. This information will be of scientific interest to determine behavior drivers leading to overeating and, thus, to propose effective measures, at both the individual and population levels, for the prevention of obesity and associated metabolic diseases.

Eating at food outlets and leisure places and “on the go” is associated with less-healthy food choices than eating at home and in school in children: cross-sectional data from the UK National Diet and Nutrition Survey Rolling Program (2008–2014)

ABSTRACT Background Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity. Objective The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey. Design Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5–18 y from the UK National Diet and Nutrition Survey Rolling Program (2008–2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and “on the go.” Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking. Results The main eating location across all age groups was at home (69–79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and “on the go” combined increased with age, from 5% (1.5–3 y) to 7% (11–18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4–10 y who ate school-sourced foods. Conclusions Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat “on the go,” may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.