What limits understanding and use of food labels?

Health literacy, literacy, numeracy and nutrition label understanding and use: a scoping review of the literature

Malloy-Weir and Cooper JHND Early View

Background

Low health literacy, literacy and numeracy have been identified as barriers to consumer understanding and the interpretation of nutrition-related information. To inform policy and dietetic practice, we examined the extent, range and nature of research on empirical relationships between health literacy, literacy or numeracy and the understanding and use of nutrition labels.

Methods

A scoping review of the literature was conducted. A search of eight databases on 15 April 2014 and 26 May 2016 returned 651 and 173 records, respectively. After de-duplication and two levels of relevance screening, 16 studies were deemed eligible for inclusion in the present review.

Results

The majority of studies were conducted in the USA and focused primarily on the use of back-of-pack nutrition labels. Empirical relationships reported between health literacy and nutrition label use were inconsistent and, in some cases, contradictory. The findings from studies examining empirical relationships between literacy, numeracy and nutrition label use suggest that consumers with lower literacy and numeracy: (i) differ from those with higher levels in some of the judgements that they make about food and (ii) may benefit from interventions designed to improve their understanding and use of nutrition label information. Measurement-related issues were identified, such as a reliance on self-reports of nutrition label use, as well as a lack of independence between some measures of health literacy and nutrition label understanding and use.

Conclusions

The empirical relationships between health literacy, literacy, numeracy and nutrition label understanding and use have not been well-studied. Additional attention is needed regarding the measurement-related issues identified in the present review.

Low carbohydrate diets- impact on dietary intake

Dietary intake in people consuming a reduced-carbohydrate diet in the National Diet and Nutrition Survey

Guess JHND Early View

Background

Diets reduced or low in carbohydrates are becoming increasingly popular. The replacement foods and their accompanying nutrients determine the health effects of such diets. However, little is known about the dietary intake of people consuming reduced or low carbohydrate diets.

Methods

In this cross-sectional study, the dietary and nutrient intake of individuals aged 16–75 years consuming less than 40% of energy from carbohydrate (n = 430) was compared with individuals consuming equal to or more than 40% energy from carbohydrate (n = 1833) using the UK National Diet and Nutrition Survey.

Results

Those consuming less than 40% of total energy from carbohydrate reported a higher consumption of red and processed meat, butter, oily fish and vegetables, as well as a lower consumption of soft drinks and pulses, than those with a normal carbohydrate intake. After adjusting for socio-economic status, only red meat intake was different between the groups, and reached the maximum recommended daily intake daily intake. There were no significant differences in micronutrient intakes between the groups, although magnesium, selenium and potassium, along with fibre, were lower than recommended amounts across the cohort.

Conclusions

Individuals consuming reduced or low carbohydrate diets could benefit from replacing some red meats with white meats and vegetable sources of protein, and increasing vegetable intake.

The importance of posture when feeding older patients

Accessing hospital packaged foods and beverages: the importance of a seated posture when eating

Bell et al., JHND Early View 

Background

Hospitalised and community dwelling older people (aged 65 years and over) have difficulties opening certain food and beverage items (e.g. cheese portions and tetra packs) served in public hospitals. Previously, the role of hand strength on successful pack opening has been explored in a seated position. However, because many people in hospital eat in bed, the present laboratory study examined the differences between participants opening a selection of products in a hospital bed and a chair.

Methods

The present study used a qualitative method (satisfaction) and quantitative methods (grip and pinch strength, dexterity, time and attempts) in two conditions (bed; chair) in a sample of well older community dwelling adults (n = 34). Packs tested included foil sealed thickened pudding, foil sealed thickened water, tetra pack, dessert, custard, jam, cereal, honey sachet and cheese portions.

Results

Honey sachets, cheese portions, foil sealed thickened pudding and tetra packs were the most difficult packs to open, with 15% of cheese portions unable to be opened in either the bed or chair posture. Although grip strength was consistent for each posture, pinch grips and dexterity were adversely affected by the bed posture. Lying in a hospital bed required greater pinch strength and dexterity to open packs.

Conclusions

Eating in a seated position when in hospital has been shown to improve intake. The present study demonstrates that eating in a seated posture is also advantageous for opening the food and beverage packs used in the NSW hospital food service and supports the notion that patients should sit to eat in hospital.

 

Compliance with dietary guidelines following laparoscopic sleeve gastrectomy

Patient adherence in following a prescribed diet and micronutrient supplements after laparoscopic sleeve gastrectomy: our experience during 1 year of follow-up

Schiavo et al., JHND Early View

Background

One of the most effective surgeries for sustainable weight loss in morbidly obese patients is laparoscopic sleeve gastrectomy (LSG). The present study aimed to assess the adherence of LSG patients with respect to following post-operative dietary requirements and micronutrient supplementation, as well as to investigate their perceived barriers in achieving optimal adherence.

Methods

Retrospective data analysis was performed (3, 6, 9 and 12 months after LSG) using the medical records of 96 morbidly obese patients who had undergone LSG at our institution during 2011–2013. Data collected from patient records were: adherence to prescribed diet; adherence to prescribed consumption of fruit, vegetables, legumes and cereals; use of prescribed micronutrient supplements; and barriers to diet and micronutrient therapy adherence. Data were analysed using spss, version 14.0 (SPSS Inc., Chicago, IL, USA).

Results

At 3, 6, 9 and 12 months post-LSG, the rates of patient non-adherence to a prescribed diet were 39%, 45%, 51% and 74%, respectively. In particular, there was a low consumption of fruit, vegetables, legumes and cereals compared to the post-surgery prescription. In addition, the rates of patient non-adherence to prescribed micronutrient supplements at 3, 6, 9 and 12 months post-LSG were 43%, 51%, 59% and 67%, respectively. The main reasons for patient non-adherence to diet were poor self-discipline (72%) and poor family support (11%) whereas difficulty swallowing pills or capsules (61%) and cost (20%) were reported as the main barriers to post-LSG adherence.

Conclusions

Morbidly obese patients who have undergone LSG do not follow exactly the post-operative dietary guidelines, including micronutrient therapy.

Cognitive outcomes of food based anthocyanin interventions

Food-based anthocyanin intake and cognitive outcomes in human intervention trials: a systematic review

Kent et al., JHND Early View

Background

Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes.

Methods

A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching.

Results

Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible.

Conclusions

The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

Alternative Healthy Eating Index as a predictor of cardiovascular disease

Evaluation of the Alternative Healthy Eating Index as a predictor of 10-year cardiovascular disease risk in a group of Iranian employees

Hariri et al., JHND Early View

Background

Noncommunicable diseases, of which almost half are some form of cardiovascular disease (CVD), have overtaken communicable diseases as the world’s major disease burden. There is growing evidence that indices of diet quality could have an association with a decreased risk of CVD in several countries. We aimed to examine the association between diet quality, as measured by the Alternative Healthy Eating Index (AHEI), and 10-year predicted CVD risk based on the Framingham Risk Score (FRS) in a group of Iranian employees.

Methods

A cross-sectional descriptive study was conducted on 296 (232 male, 64 female) employees aged ≥30 years selected by nonrandom sampling. AHEI was calculated according to a food frequency questionnaire with complementary questions on intake of cooking fats and oils among households. The 10-year risk of CVD was calculated based on FRS. Total and high-density lipoprotein-cholesterol, fasting blood sugar and blood pressure were measured to help in the calculation of FRS.

Results

AHEI did not have a significant relationship with FRS (r = −0.02, P = 0.67). However, some of its components, such as the intake of nuts and soy groups (r = −0.11, P = 0.04) and fruits (r = −0.14, P= 0.01), had a significant relationship with a reduced risk of CVD. According to stepwise multiple linear regression results, for every single increase in the intake of fruit servings, there would be a 0.14 reduction in the 10-year CVD risk score (β = −0.14, P = 0.01).

Conclusions

The present study showed no significant relationship between AHEI and the 10-year predicted risk of CVD among Iranian employees.

Downward trend in consumption of added sugar in Australian adults

Trends in added sugar intake and food sources in a cohort of older Australians: 15 years of follow-up from the Blue Mountains Eye Study

Moshtaghian et al., JHND Early View

Background

The trend of added sugar (AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up.

Methods

Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992–94 to 2007–09) using a 145-item food frequency questionnaire (FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling.

Results

In men, the mean (SEM) percentage of energy provided by AS intake (EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up (Ptrend = 0.028). Women’s mean (SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively (Ptrend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years (P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up (Ptrend < 0.001).

Conclusions

An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians.