Factors determining the nutrition transition in two Mediterranean islands: Sardinia and Malta

129

103

Objective: To describe pathways through which trade liberalisation affects the food environment, relevant to the nutrition transition, in order to enable public health nutritionists to understand trade policy as a macro-level influence on food consumption. Design: The pathways mapped in the present paper are based on the agreements of the World Trade Organization, which shape national policy. Implications for nutrition are presented based on a comprehensive literature review, and case studies are used to illustrate the various pathways. Setting: Developing countries are currently experiencing a nutrition transition, resulting in dietary patterns associated with chronic disease. Chronic diseases are amenable to prevention, and trade policy has been highlighted as a potential avenue for nutrition-related prevention. Results: Trade liberalisation influences the food environment through facilitating trade in goods and services, enabling investment and decreasing support/protection for domestic industry. These policy outcomes facilitate the nutrition transition particularly through increasing the availability and affordability of processed foods and animal products. The framework highlights the complex relationship between trade policy and the nutrition transition, with both negative and positive outcomes arising from different aspects of trade liberalisation. Conclusions: Policy change associated with trade liberalisation has created incentives for consumption patterns associated with the nutrition transition, but has also had some positive nutritional outcomes. As a result, it is important for public health nutritionists to consider the implications of trade policy decisions in their efforts to prevent and control diet-related chronic diseases.

Section: Investment and Trade In Servicesmentioning

confidence: 99%

Trade liberalisation and the nutrition transition: mapping the pathways for public health nutritionists

Thow

2009

129

103

“…Seven pan-European studies (44,46,68,81,83,92,94) used diet records or diaries, either a 7 d record or three consecutive day records. With the exception of studies which used weighed records (83) or a mixed approach (81) , most studies estimated portion size using photographs (30,46,91) , household measures and objects (e.g.…”

Section: Diet Records/diet Diariesmentioning

confidence: 99%

“…From the sourced articles, fifty-one pan-European studies in total were identified: thirty-five named projects and sixteen smaller projects (48,54,56,65,69,72,82,83,88,93,94,107,109,113,114,116) . Most studies assessed dietary intake of F&V among adults (18,41,44,46,48,50,51,(54)(55)(56)(57)59,60,(64)(65)(66)68,69,71,72,(75)(76)(77)(78)(79)(81)(82)(83)(84)86,88,(92)(93)(94)107,…”

Section: Public Health Nutritionmentioning

confidence: 99%

“…Modified dietary history method comprising a 3 d estimated record and meal-based frequency checklist X (89) X F&V intake measurement methods: a review (4,91,92) 7 (Netherlands, Finland, Yugoslavia, Japan, Italy, Greece, USA) Cross-check dietary history method X (131) X European cohorts (n 14) used 7 d records at baseline Terry et al (93) 6 (Germany, France, Canada, Sweden, Australia, USA) FFQ Tessier et al (94) 2 (Malta, Italy)…”

Section: Ffqmentioning

confidence: 99%

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A systematic review of methods to assess intake of fruits and vegetables among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study

Riordan

Ryan

Perry

et al. 2016

Evidence suggests that health benefits are associated with consuming recommended amounts of fruits and vegetables (F&V), yet standardised assessment methods to measure F&V intake are lacking. The current review aims to identify methods to assess F&V intake among children and adults in pan-European studies and inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies.\ud A literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed F&V intake were included in the review.\ud Studies involving two or more European countries were included in the review.\ud Healthy, free-living children or adults.\ud The review identified fifty-one pan-European studies which assessed F&V intake. The FFQ was the most commonly used (n 42), followed by 24 h recall (n 11) and diet records/diet history (n 7). Differences existed between the identified methods; for example, the number of F&V items on the FFQ and whether potatoes/legumes were classified as vegetables. In total, eight validated instruments were identified which assessed F&V intake among adults, adolescents or children.\ud The current review indicates that an agreed classification of F&V is needed in order to standardise intake data more effectively between European countries. Validated methods used in pan-European populations encompassing a range of European regions were identified. These methods should be considered for use by future studies focused on evaluating intake of F&V

“…It is likely that the historical influences outlined above, systematic changes to global food production and distribution systems, improving economic conditions and a dependence on foreign imports have consolidated the shift away from the traditional Mediterranean diet (46,47) and led to the adoption of a more 'Westernised' diet high in refined carbohydrates, meat, SFA and salt (34,35,48) . Thus, a century-and-a-half later, a 1986 WHO report portrayed the Maltese diet as an unhealthy one rich in fats and sugar and low in fibre, designating the Maltese as a high-risk group for non-communicable disease (49) .…”

Section: Colonial Impactmentioning

confidence: 99%

An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta

Cauchi

Rutter

Knai

2015

Objective: The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. Design: We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. Setting: Malta. Subjects: Whole population, with a focus on children. Results: Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and sociocultural dimensions of the Maltese obesogenic environment are explored. Conclusions: Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.