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BackgroundFood-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost.MethodsAverage prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods.ResultsThe one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it.ConclusionUse of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.

BackgroundThe prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project “sustainable prevention of obesity through integrated strategies” (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM).Methods/DesignSPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed.DiscussionSPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.

Background: The risk of many important diseases can be reduced by consuming a diet rich in vegetables and fruit. For this reason the World Health Organization (WHO) recommends a daily intake of more than 400 g person 21 . The pattern of both the supply and intake of vegetables and fruit and the potential health gain achieved by increasing intake in the European Union (EU) and three accession countries are presented in this paper. Methods: Patterns of supply and dietary intake were assessed using (1) FAO food balance sheets, which allow comparison between the levels of supply in countries but do not reflect actual intake; and (2) survey data reflecting dietary intake. Using WHO mortality data for coronary heart and cerebrovascular disease and major cancers up to age 65 years, the number of preventable deaths is estimated, assuming vegetable and fruit consumption were levelled up to that of the highest consuming group, and assuming relative risks of 0.5, 0.7 or 0.9. Results: Vegetable and fruit consumption varies considerably between EU Member States. The populations of about half (seven) of the EU Member States have a mean daily intake of less than 275 g. Using the best current estimates of relative risk, over 26,000 deaths before the age of 65 years would be prevented annually in the EU if intake was levelled up to the highest consumption levels (and about double this number of deaths before the age of 75 years). Conclusion: Increasing the intake of vegetables and fruit is feasible and could result in considerable improvements in public health within the EU. Priority should be given to developing methods that demonstrate the burden of disease caused by too low intakes of vegetables and fruit. This would enable the appropriate social, cultural and economic policies to be developed within the EU.

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Background: The marketing practices of the breastmilk substitutes industry have been known for decades, but little is known about the influence of the baby food industry, more generally, on public health policy, research and practice, also known as 'corporate political activity' (CPA). In this study, the baby food industry refers to for-profit companies that manufacture, market or distribute breastmilk substitutes and food products for infants and young children under two years. In addition, trade associations, public relations firms, marketing agencies and individuals or groups affiliated with the baby food industry are also considered to be part of the baby food industry. The aim of the current study was to systematically identify and monitor the CPA of the baby food industry in the USA, shown by the activities of Nestlé, the largest industry actor in this sector in the country. Methods: The case study consisted of an analysis of publicly available information for data published between January and November 2018. We included documents from the industry, the government and other sources, including professional organisations, charities and consumer associations. We analysed data using an existing framework to classify the CPA of the food industry.Results: During the period of data collection, Nestlé employed a list of action-based 'instrumental strategies'. The most prominent strategy was 'information strategy', used to fund, produce and disseminate industry-preferred information. Nestlé was further found to 'establish relationships with key opinion leaders and health organisations, and the media', 'seek involvement in community' and directly influence policies and programs through indirect access and the placement of actors in government policy settings. The company also used argument-based 'discursive strategies' to frame the debate on diet-and public health-related issues.Conclusion: This study showed that Nestlé used various CPA strategies which may have influenced public health policy, research and practice in ways favourable to the baby food industry. These results could be used to further recognise and pre-empt the influence of corporations on health, in order to ensure that commercial interests do not prevail over public health goals.

(J Epidemiol Community Health 1999;53:277-282)

Objective: The objective of this study was to describe mean macronutrient and food intakes in the Baltic republics, with a particular focus on fat, vegetable and fruit consumption. Design: Cross-sectional study. Setting: Data from surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used. Information was collected using a 24 h recall of dietary intake and an interviewer-administered questionnaire. Subjects: Representative national samples of adults were selected. All those with information from the dietary recall were included in the study (Estonia: n 2015; Latvia: n 2300; Lithuania: n 2094). Results: The mean proportion of energy from fat was high in each country, but particularly in Lithuania (44%) and Latvia (42%) compared with Estonia (36%). In contrast, percentage energy from carbohydrate, protein and alcohol was higher in Estonia. Mean protein intake was generally suf®cient if not high in some population sub-groups. Median vegetable intakes were very low (`200 gaday) in each country, particularly in Latvia. While 78% of the Lithuanian respondents consumed vegetables daily, this was the case in only 60% of the Latvian and 48% of the Estonian respondents. Conclusions: This study suggests that there is a pressing need to replace high-fat energy dense foods by foods rich in complex carbohydrates and dietary ®bre, such as vegetables and fruits, in the Baltic republics. This could provide the populations with a reduced risk and increased protection against non-communicable diseases. These issues will need to be tackled through comprehensive food and nutrition policies and health promotion campaigns.