Julie Brimblecombe

Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review

BackgroundPoint-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting.MethodsRecords from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome.ResultsThe search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions.ConclusionsA range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.

Characteristics of the community-level diet of Aboriginal people in remote northern Australia

Objective: To describe the nutritional quality of community‐level diets in remote northern Australian communities.

Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review.

BackgroundLess healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries.MethodsRelevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes.ResultsFourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies.ConclusionsLimited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Differential association of C-reactive protein with adiposity in men and women in an Aboriginal community in northeast Arnhem Land of Australia

Objective:To examine the relationship between C-reactive protein (CRP), adiposity and other metabolic abnormalities in an Aboriginal community in Northern Australia.Design:Cross-sectional analysis of data obtained between 2001 and 2003 from 379 Aboriginal people residing in a geographically isolated community.Results:Mean (95% CI) CRP in women and men was 4.06 cholesterol (3.53, 4.66) mg/l and 3.42 (2.94, 3.97) mg/l, respectively (P=NS). The prevalence of the metabolic syndrome (US National Education program (NCEP) definition) was significantly higher for women than men (41 vs 18%, χ 2=20.94, P<0.001). C-reactive protein correlated strongly with adiposity in women (waist circumference, waist to hip ratio and body mass index; r⩾0.514, P<0.01) but much less strongly in men (r⩽0.221, P<0.05). In a multivariate stepwise linear regression model, waist circumference was the strongest independent predictor explaining 35% of CRP concentration variance in women, but only 5.4% in men (WHR). Incremental increases in CRP concentration across four BMI categories were significant in women (P linear trend<0.001) but not in men.Conclusions:High CRP levels in the surveyed population are consistent with the high prevalence of vascular disease morbidity and mortality in Aboriginal Australians. The relationship of CRP with increasing body fat was strong and consistent in women but not in men. Prospective studies are needed to elucidate the role of CRP (if any) as a predictive marker for cardiovascular events in this high-risk population.

Factors Influencing Food Choice in an Australian Aboriginal Community

We explored with Aboriginal adults living in a remote Australian community the social context of food choice and factors perceived to shape food choice. An ethnographic approach of prolonged community engagement over 3 years was augmented by interviews. Our findings revealed that knowledge, health, and resources supporting food choice were considered “out of balance,” and this imbalance was seen to manifest in a Western-imposed diet lacking variety and overrelying on familiar staples. Participants felt ill-equipped to emulate the traditional pattern of knowledge transfer through passing food-related wisdom to younger generations. The traditional food system was considered key to providing the framework for learning about the contemporary food environment. Practitioners seeking to improve diet and health outcomes for this population should attend to past and present contexts of food in nutrition education, support the educative role of caregivers, address the high cost of food, and support access to traditional foods.

Stores Healthy Options Project in Remote Indigenous Communities (SHOP@RIC): a protocol of a randomised trial promoting healthy food and beverage purchases through price discounts and in-store nutrition education

BackgroundIndigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts – much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions.This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities.Methods/DesignWe will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed.DiscussionThis study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12613000694718

Use of point-of-sale data to assess food and nutrient quality in remote stores.

OBJECTIVE To examine the feasibility of using point-of-sale data to assess dietary quality of food sales in remote stores. DESIGN A multi-site cross-sectional assessment of food and nutrient composition of food sales. Point-of-sale data were linked to Australian Food and Nutrient Data and compared across study sites and with nutrient requirements. SETTING Remote Aboriginal Australia. SUBJECT Six stores. RESULTS Point-of-sale data were readily available and provided a low-cost, efficient and objective assessment of food and nutrient sales. Similar patterns in macronutrient distribution, food expenditure and key food sources of nutrients were observed across stores. In all stores, beverages, cereal and cereal products, and meat and meat products comprised approximately half of food sales (range 49–57 %). Fruit and vegetable sales comprised 10.4 (SD 1.9) % on average. Carbohydrate contributed 54.4 (SD 3.0) % to energy; protein 13.5 (SD 1.1) %; total sugars 28.9 (SD 4.3) %; and the contribution of total saturated fat to energy ranged from 11.0 to 14.4% across stores. Mg, Ca, K and fibre were limiting nutrients, and Na was four to five times higher than the midpoint of the average intake range. Relatively few foods were major sources of nutrients. CONCLUSIONS Point-of-sale data enabled an assessment of dietary quality within stores and across stores with no burden on communities and at no cost, other than time required for analysis and reporting. Similar food spending patterns and nutrient profiles were observed across the six stores. This suggests potential in using point-of-sale data to monitor and evaluate dietary quality in remote Australian communities.

Consumer acceptance of reformulated food products: A systematic review and meta-analysis of salt-reduced foods

ABSTRACT Food product reformulation is promoted as an effective strategy to reduce population salt intake and address the associated burden of chronic disease. Salt has a number of functions in food processing, including impacting upon physical and sensory properties. Manufacturers must ensure that reformulation of foods to reduce salt does not compromise consumer acceptability. The aim of this systematic review is to determine to what extent foods can be reduced in salt without detrimental effect on consumer acceptability. Fifty studies reported on salt reduction, replacement or compensation in processed meats, breads, cheeses, soups, and miscellaneous products. For each product category, levels of salt reduction were collapsed into four groups: <40%, 40–59%, 60–79% and ≥80%. Random effects meta-analyses conducted on salt-reduced products showed that salt could be reduced by approximately 40% in breads [mean change in acceptability for reduction <40% (−0.27, 95% confidence interval (CI) −0.62, 0.08; p = 0.13)] and approximately 70% in processed meats [mean change in acceptability for reductions 60–69% (−0.18, 95% CI −0.44, 0.07; p = 0.15)] without significantly impacting consumer acceptability. Results varied for other products. These results will support manufacturers to make greater reductions in salt when reformulating food products, which in turn will contribute to a healthier food supply.

The comparative cost of food and beverages at remote Indigenous communities, Northern Territory, Australia

Objective: To determine the average price difference between foods and beverages in remote Indigenous community stores and capital city supermarkets and explore differences across products.

Does the store-turnover method still provide a useful guide to food intakes in Aboriginal communities?

Objective: To consider the application of the store‐turnover method as a guide to assess food intake in remote Aboriginal communities.