The UK government plans to limit price‐based and location‐based promotions for products high in saturated fat, salt and sugars. The 2004/2005 UK Nutrient Profiling Model (NPM) is the proposed legislative basis, but may be superseded by the draft 2018 NPM. This study develops an algorithm to apply both NPMs to a large food composition database (FCDB), and assesses implementation challenges. UK NPMs were applied algorithmically to the myfood24 FCDB, representing ~45 000 retail products. Pass rates – indicating free or restricted promotions – and micronutrient compositions were compared. Challenges were assessed, and recommendations addressed the legislation’s public consultation questions. For products in scope (75% of total), 6% fewer passed the 2018 NPM (36%, P < 0.001) compared with the 2004/2005 NPM (42%). Beverages showed the greatest reduction in pass rate (75%). Under both models, micronutrient contents (per 100 g of product) were generally lower for products that passed; except folate, vitamin C and vitamin D were no different for passed and failed products. Compared with products passing the 2004/2005 NPM, products passing the 2018 NPM on average had marginally higher amounts of iron (0.05 mg, 95% CI: 0.02, 0.08, P < 0.001) and magnesium (1.00 mg, 95% CI: 0.00, 1.17, P = 0.029), but marginally lower levels of calcium (−0.42 mg, 95% CI: −2.00, −0.40, P = 0.025). Missing ingredient information and heterogeneous product categories were challenges for both NPMs. Free sugars calculation further complicated 2018 NPM application. To balance feasibility and public health benefit, the proposed legislative basis may not be appropriate.
Context Most dietary assessment methods are limited by self-report biases, how long they take for participants to complete, and cost of time for dietitians to extract content. Electronically recorded, supermarket-obtained transactions are an objective measure of food purchases, with reduced bias and improved timeliness and scale. Objective The use, breadth, context, and utility of electronic purchase records for dietary research is assessed and discussed in this systematic review. Data sources Four electronic databases (MEDLINE, EMBASE, PsycINFO, Global Health) were searched. Included studies used electronically recorded supermarket transactions to investigate the diet of healthy, free-living adults. Data extraction Searches identified 3422 articles, of which 145 full texts were retrieved and 72 met inclusion criteria. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data analysis Purchase records were used in observational studies, policy evaluations, and experimental designs. Nutrition outcomes included dietary patterns, nutrients, and food category sales. Transactions were linked to nutrient data from retailers, commercial data sources, and national food composition databases. Conclusion Electronic sales data have the potential to transform dietary assessment and worldwide understanding of dietary behavior. Validation studies are warranted to understand limits to agreement and extrapolation to individual-level diets. Systematic Review Registration PROSPERO registration no. CRD42018103470
Poor diet is a leading cause of death in the United Kingdom (UK) and around the world. Methods to collect quality dietary information at scale for population research are time consuming, expensive and biased. Novel data sources offer potential to overcome these challenges and better understand population dietary patterns. In this research we will use 12 months of supermarket sales transaction data, from 2016, for primary shoppers residing in the Yorkshire and Humber region of the UK (n = 299,260), to identify dietary patterns and profile these according to their nutrient composition and the sociodemographic characteristics of the consumer purchasing with these patterns. Results identified seven dietary purchase patterns that we named: Fruity; Meat alternatives; Carnivores; Hydrators; Afternoon tea; Beer and wine lovers; and Sweet tooth. On average the daily energy intake of loyalty card holders -who may buy as an individual or for a household- is less than the adult reference intake, but this varies according to dietary purchase pattern. In general loyalty card holders meet the recommended salt intake, do not purchase enough carbohydrates, and purchase too much fat and protein, but not enough fibre. The dietary purchase pattern containing the highest amount of fibre (as an indicator of healthiness) is bought by the least deprived customers and the pattern with lowest fibre by the most deprived. In conclusion, supermarket sales data offer significant potential for understanding population dietary patterns.
Background Objective measures of built environment and physical activity provide the opportunity to directly compare their relationship across different populations and spatial contexts. This systematic review synthesises the current body of knowledge and knowledge gaps around the impact of objectively measured built environment metrics on physical activity levels in adults (≥ 18 years). Additionally, this review aims to address the need for improved quality of methodological reporting to evaluate studies and improve inter-study comparability though the creation of a reporting framework. Methods A systematic search of the literature was conducted following the PRISMA guidelines. After abstract and full-text screening, 94 studies were included in the final review. Results were synthesised using an association matrix to show overall association between built environment and physical activity variables. Finally, the new PERFORM (’Physical and Environmental Reporting Framework for Objectively Recorded Measures’) checklist was created and applied to the included studies rating them on their reporting quality across four key areas: study design and characteristics, built environment exposures, physical activity metrics, and the association between built environment and physical activity. Results Studies came from 21 countries and ranged from two days to six years in duration. Accelerometers and using geographic information system (GIS) to define the spatial extent of exposure around a pre-defined geocoded location were the most popular tools to capture physical activity and built environment respectively. Ethnicity and socio-economic status of participants were generally poorly reported. Moderate-to-vigorous physical activity (MVPA) was the most common metric of physical activity used followed by walking. Commonly investigated elements of the built environment included walkability, access to parks and green space. Areas where there was a strong body of evidence for a positive or negative association between the built environment and physical activity were identified. The new PERFORM checklist was devised and poorly reported areas identified, included poor reporting of built environment data sources and poor justification of method choice. Conclusions This systematic review highlights key gaps in studies objectively measuring the built environment and physical activity both in terms of the breadth and quality of reporting. Broadening the variety measures of the built environment and physical activity across different demographic groups and spatial areas will grow the body and quality of evidence around built environment effect on activity behaviour. Whilst following the PERFORM reporting guidance will ensure the high quality, reproducibility, and comparability of future research.
New plans to restrict in-store price and location-based promotions of less healthy foods and drinks in the UK aimed to encourage healthier choices. With responsibility for implementation likely falling to food retailers, it is important to understand the feasibility of implementation and to ensure policy success. To ensure compliance, retailers will need to assess which products are restricted under the legislation. The large number of products in retailers' portfolios poses a problem of scale. A recent research case study found the data available to retailers to be insufficient to accurately apply the rules-based approach set out by the policy proposal. Misclassification would result in some less healthy products being incorrectly promoted and vice versa. Problems with implementation feasibility have the potential to undermine the public health goals of the legislation. Interviews were carried out with nutrition representatives from the UK food retail and manufacturing sector, to understand the real-world implications of the proposed legislation. Industry nutritionists recommended a review of the use of the UK's Nutrient Profiling Model as the legislative basis, proposed data-related solutions to implementation problems and suggested a need for shared retailer-manufacturer responsibility, given the context of data availability.
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