Pub Date : 2024-10-09DOI: 10.1016/j.cdnut.2024.104473
James Bullen , Xuejun Yin , Katrina Kissock , Laura Fisher , Bruce Neal , Kathy Trieu
Background
Potassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse.
Objectives
The objective of this study was to summarize the label features of potassium-enriched salt products available worldwide.
Methods
A content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as “salt substitute” or “low sodium salt.” Information on product labels was coded relating to health claims, product features, and instructions for use, and were quantitatively summarized.
Results
A total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium (n = 15), no potassium (n = 5), or that were duplicates (n = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use.
Conclusions
There was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed.
{"title":"Health Claims, Product Features and Instructions for Use on the Labels of Potassium-enriched Salt Products: A Content Analysis","authors":"James Bullen , Xuejun Yin , Katrina Kissock , Laura Fisher , Bruce Neal , Kathy Trieu","doi":"10.1016/j.cdnut.2024.104473","DOIUrl":"10.1016/j.cdnut.2024.104473","url":null,"abstract":"<div><h3>Background</h3><div>Potassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse.</div></div><div><h3>Objectives</h3><div>The objective of this study was to summarize the label features of potassium-enriched salt products available worldwide.</div></div><div><h3>Methods</h3><div>A content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as “salt substitute” or “low sodium salt.” Information on product labels was coded relating to health claims, product features, and instructions for use, and were quantitatively summarized.</div></div><div><h3>Results</h3><div>A total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium (<em>n</em> = 15), no potassium (<em>n</em> = 5), or that were duplicates (<em>n</em> = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use.</div></div><div><h3>Conclusions</h3><div>There was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 11","pages":"Article 104473"},"PeriodicalIF":3.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.cdnut.2024.104471
Julie M Hess , Madeline E Comeau , Angela J Scheett , Anne Bodensteiner , Allen S Levine
Background
The “clean eating” trend suggests that consuming fewer processed foods is important for healthy diets. Yet, a diet of mostly ultra-processed foods (UPFs) can meet recommendations from the Dietary Guidelines for Americans. Whether a diet comprised mostly of simple ingredient foods can provide a low-quality diet remains unexplored.
Objectives
The objective of this study was to compare the diet quality, shelf stability, and cost of 2 similar nutrient-poor menus, one containing primarily UPFs and the other containing less-processed foods (LPW), as defined by the Nova classification system.
Methods
A “Western” menu using LPW was developed to match the meals and recipes of a menu that contained more-processed foods (MPW). Processing level was determined using the Nova classification system. Final menus were assessed for nutrient quality and Healthy Eating Index (HEI) score. Shelf stability of foods/ingredients on both menus was determined from food storage guidance manuals. The condition of each food item when purchased (room temperature, frozen, refrigerated) was used to estimate the number of days until expiration. Food costs were determined from prices at grocery chains in Fall 2023.
Results
The LPW had similar nutrient density and diet quality scores to the MPW (HEI scores of 44 and 43, respectively). The LPW included 20% energy (kcal) from UPFs, whereas the MPW included 67% energy from UPFs. Relative percentages of shelf-stable, frozen, and refrigerated foods were similar. Using the Kaplan-Meier survival analysis method, median time to expiration of the LPW menu items was 35 d compared with 120 d for the MPW items. The “per person” cost reflecting only the amount of the food used in the menu was $15.91/d for the LPW and $9.85/d for the MPW.
Conclusions
Less-processed menus can have comparable diet quality with more-processed menus although being more costly and less shelf stable.
{"title":"Using Less Processed Food to Mimic a Standard American Diet Does Not Improve Nutrient Value and May Result in a Shorter Shelf Life at a Higher Financial Cost","authors":"Julie M Hess , Madeline E Comeau , Angela J Scheett , Anne Bodensteiner , Allen S Levine","doi":"10.1016/j.cdnut.2024.104471","DOIUrl":"10.1016/j.cdnut.2024.104471","url":null,"abstract":"<div><h3>Background</h3><div>The “clean eating” trend suggests that consuming fewer processed foods is important for healthy diets. Yet, a diet of mostly ultra-processed foods (UPFs) can meet recommendations from the Dietary Guidelines for Americans. Whether a diet comprised mostly of simple ingredient foods can provide a low-quality diet remains unexplored.</div></div><div><h3>Objectives</h3><div>The objective of this study was to compare the diet quality, shelf stability, and cost of 2 similar nutrient-poor menus, one containing primarily UPFs and the other containing less-processed foods (LPW), as defined by the Nova classification system.</div></div><div><h3>Methods</h3><div>A “Western” menu using LPW was developed to match the meals and recipes of a menu that contained more-processed foods (MPW). Processing level was determined using the Nova classification system. Final menus were assessed for nutrient quality and Healthy Eating Index (HEI) score. Shelf stability of foods/ingredients on both menus was determined from food storage guidance manuals. The condition of each food item when purchased (room temperature, frozen, refrigerated) was used to estimate the number of days until expiration. Food costs were determined from prices at grocery chains in Fall 2023.</div></div><div><h3>Results</h3><div>The LPW had similar nutrient density and diet quality scores to the MPW (HEI scores of 44 and 43, respectively). The LPW included 20% energy (kcal) from UPFs, whereas the MPW included 67% energy from UPFs. Relative percentages of shelf-stable, frozen, and refrigerated foods were similar. Using the Kaplan-Meier survival analysis method, median time to expiration of the LPW menu items was 35 d compared with 120 d for the MPW items. The “per person” cost reflecting only the amount of the food used in the menu was $15.91/d for the LPW and $9.85/d for the MPW.</div></div><div><h3>Conclusions</h3><div>Less-processed menus can have comparable diet quality with more-processed menus although being more costly and less shelf stable.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 11","pages":"Article 104471"},"PeriodicalIF":3.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104451
Abigail E Clarke , Kristie S LeBeau , Keiji Oda , Gina Segovia-Siapco , Michael Paalani , David M Reboussin , Alice H Lichtenstein , Sujatha Rajaram , Joan Sabaté
Background
Avocado intake has been associated with improvements in diet quality. Whether this response is because of avocado intake, per se, or combined with a food and/or nutrient displacement (D) has yet to be determined.
Objectives
This secondary analysis, conducted using dietary data from the Habitual Diet and Avocado Trial, sought to assess the effect of consuming a large avocado (168 g, 281 kcal) daily in the avocado-supplemented diet (AD) group compared with the habitual diet (HD) group on food and nutrient D.
Methods
Using data from 3 unannounced telephone 24-h dietary recalls conducted during the 6-mo intervention period, food intake data were evaluated for 898 participants, aged 25–87 y, and a BMI range of 20.5–60.3 kg/m2. The food group distribution, energy, and nutrient intake of the AD group (n = 436) were calculated and compared with those of the HD group (n = 462).
Results
The AD group had a higher daily intake of energy (159 ± 575 kcal) (P < 0.001), potassium (3193 ± 817 mg compared with 2419 ± 843 mg) (P < 0.005), fiber (30 ± 8 g compared with 19 ± 9 g) (P < 0.05), and a lower daily intake of animal protein (49 ± 33 g compared with 55 ± 24 g) (P = 0.02) compared with the HD group. Partial D with an avocado was observed for energy (43%), total fat (23%), and carbohydrate (87%), indicating a lower intake of these nutrients from non-avocado sources in the AD group. Food group analysis revealed a lower consumption of animal-derived protein from red meat, processed meats, poultry, and fish in the AD group, with no significant differences observed in dairy and egg intake between groups.
Conclusions
Incorporating 1 avocado daily led to favorable modifications in the dietary composition of participants, including an increase in potassium and fiber intake, which can improve diet quality.
This trial was registered at https://clinicaltrials.gov as NCT03528031.
{"title":"The Effect of Daily Avocado Intake on Food and Nutrient Displacement in a Free-Living Population with Abdominal Obesity","authors":"Abigail E Clarke , Kristie S LeBeau , Keiji Oda , Gina Segovia-Siapco , Michael Paalani , David M Reboussin , Alice H Lichtenstein , Sujatha Rajaram , Joan Sabaté","doi":"10.1016/j.cdnut.2024.104451","DOIUrl":"10.1016/j.cdnut.2024.104451","url":null,"abstract":"<div><h3>Background</h3><div>Avocado intake has been associated with improvements in diet quality. Whether this response is because of avocado intake, <em>per se</em>, or combined with a food and/or nutrient displacement (D) has yet to be determined.</div></div><div><h3>Objectives</h3><div>This secondary analysis, conducted using dietary data from the Habitual Diet and Avocado Trial, sought to assess the effect of consuming a large avocado (168 g, 281 kcal) daily in the avocado-supplemented diet (AD) group compared with the habitual diet (HD) group on food and nutrient D.</div></div><div><h3>Methods</h3><div>Using data from 3 unannounced telephone 24-h dietary recalls conducted during the 6-mo intervention period, food intake data were evaluated for 898 participants, aged 25–87 y, and a BMI range of 20.5–60.3 kg/m<sup>2</sup>. The food group distribution, energy, and nutrient intake of the AD group (<em>n</em> = 436) were calculated and compared with those of the HD group (<em>n</em> = 462).</div></div><div><h3>Results</h3><div>The AD group had a higher daily intake of energy (159 ± 575 kcal) (<em>P</em> < 0.001), potassium (3193 ± 817 mg compared with 2419 ± 843 mg) (<em>P</em> < 0.005), fiber (30 ± 8 g compared with 19 ± 9 g) (<em>P</em> < 0.05), and a lower daily intake of animal protein (49 ± 33 g compared with 55 ± 24 g) (<em>P</em> = 0.02) compared with the HD group. Partial D with an avocado was observed for energy (43%), total fat (23%), and carbohydrate (87%), indicating a lower intake of these nutrients from non-avocado sources in the AD group. Food group analysis revealed a lower consumption of animal-derived protein from red meat, processed meats, poultry, and fish in the AD group, with no significant differences observed in dairy and egg intake between groups.</div></div><div><h3>Conclusions</h3><div>Incorporating 1 avocado daily led to favorable modifications in the dietary composition of participants, including an increase in potassium and fiber intake, which can improve diet quality.</div><div>This trial was registered at <span><span>https://clinicaltrials.gov</span><svg><path></path></svg></span> as NCT03528031.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104451"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104455
Debra R Keast , Patricia M Guenther
Background
Guidance from the United States Food and Drug Administration (FDA) includes targets for the food industry to voluntarily reduce the sodium content (mg/100 g) of packaged, processed, and prepared foods sold by stores and restaurants. Assessments of sodium intake by the United States population are needed to inform sodium-reduction efforts.
Objectives
The objectives of this study were to assess the sodium content and sodium intake contributions of categories and subgroups of foods obtained from stores and restaurants and determine sodium intake reductions that would be achieved by meeting FDA targets.
Methods
Analyses used dietary data from the National Health and Nutrition Examination Survey, What We Eat in America (WWEIA), 2009–2018, to assess sodium in foods consumed by the United States population aged 2 y or older. Data describing where foods were obtained were used to identify store-bought and restaurant-prepared foods. Combination codes were used to group foods, such as separate salad ingredients, which were eaten together. Foods in their as-eaten form were then classified into WWEIA food categories and subgroups corresponding to FDA targets. Sample-weighted estimates generated by SUDAAN analyses were used to calculate projected sodium intake reductions.
Results
Store-bought, restaurant-prepared, and other foods contributed 62%, 26%, and 12%, respectively, of sodium in United States diets. Top-ranked food category contributors of sodium included sandwiches, tortilla products, pizza, poultry, soups, and breads. Subgroups of these categories contributing the most sodium included store-bought lunchmeat sandwiches and hotdogs, restaurant-prepared burgers, store-bought and restaurant-prepared tacos/burritos, restaurant-prepared pizza with meat, and store-bought white/wheat bread. Meeting the FDA targets for these subgroups achieved the highest projected sodium intake reductions.
Conclusions
Reductions of sodium in widely consumed foods, such as luncheon-meat sandwiches and restaurant-prepared pizza, have the greatest impact on reducing sodium intake by the United States population. These findings could be used by restauranteurs, food manufacturers, policymakers and regulators, and clinical practitioners to inform sodium-reduction efforts.
{"title":"Sodium Content and Sodium Intake Contributions of Store-Bought and Restaurant-Prepared Foods in Their As-Eaten Form: National Health and Nutrition Examination Survey, 2009–2018","authors":"Debra R Keast , Patricia M Guenther","doi":"10.1016/j.cdnut.2024.104455","DOIUrl":"10.1016/j.cdnut.2024.104455","url":null,"abstract":"<div><h3>Background</h3><div>Guidance from the United States Food and Drug Administration (FDA) includes targets for the food industry to voluntarily reduce the sodium content (mg/100 g) of packaged, processed, and prepared foods sold by stores and restaurants. Assessments of sodium intake by the United States population are needed to inform sodium-reduction efforts.</div></div><div><h3>Objectives</h3><div>The objectives of this study were to assess the sodium content and sodium intake contributions of categories and subgroups of foods obtained from stores and restaurants and determine sodium intake reductions that would be achieved by meeting FDA targets.</div></div><div><h3>Methods</h3><div>Analyses used dietary data from the National Health and Nutrition Examination Survey, What We Eat in America (WWEIA), 2009–2018, to assess sodium in foods consumed by the United States population aged 2 y or older. Data describing where foods were obtained were used to identify store-bought and restaurant-prepared foods. Combination codes were used to group foods, such as separate salad ingredients, which were eaten together. Foods in their as-eaten form were then classified into WWEIA food categories and subgroups corresponding to FDA targets. Sample-weighted estimates generated by SUDAAN analyses were used to calculate projected sodium intake reductions.</div></div><div><h3>Results</h3><div>Store-bought, restaurant-prepared, and other foods contributed 62%, 26%, and 12%, respectively, of sodium in United States diets. Top-ranked food category contributors of sodium included sandwiches, tortilla products, pizza, poultry, soups, and breads. Subgroups of these categories contributing the most sodium included store-bought lunchmeat sandwiches and hotdogs, restaurant-prepared burgers, store-bought and restaurant-prepared tacos/burritos, restaurant-prepared pizza with meat, and store-bought white/wheat bread. Meeting the FDA targets for these subgroups achieved the highest projected sodium intake reductions.</div></div><div><h3>Conclusions</h3><div>Reductions of sodium in widely consumed foods, such as luncheon-meat sandwiches and restaurant-prepared pizza, have the greatest impact on reducing sodium intake by the United States population. These findings could be used by restauranteurs, food manufacturers, policymakers and regulators, and clinical practitioners to inform sodium-reduction efforts.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104455"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104441
Anna W Herforth , Rachel Gilbert , Kristina Sokourenko , Tehreem Fatima , Olutayo Adeyemi , Dawit Alemayehu , Eunice Arhin , Fantu Bachewe , Yan Bai , Imran Chiosa , Tirsit Genye , Hagos Haile , Raja Jahangeer , Joyce Kinabo , Fulgence Mishili , Chioma D Nnabugwu , John Nortey , Bernice Ofosu-Baadu , Adeyinka Onabolu , Daniel Bruce Sarpong , William A Masters
Background
Governments around the world collect food price data on a frequent basis, often monthly, for the purpose of monitoring inflation. These routine economic data can be used with a nutrition-sensitive lens for understanding economic access to a healthy diet. The Food and Agriculture Organization of the United Nations has adopted the cost and affordability of a healthy diet (CoAHD) for annual tracking alongside other food security indicators. This indicator is relevant in many countries for informed decision-making and accountability toward Food Systems Summit pathways. National governments may wish to include this indicator in their own monitoring systems, using existing subnational price and income data.
Objectives
We describe emerging systems in several countries for monitoring CoAHD and analytical tools that facilitate the calculation of CoAHD. We discuss reasons why the indicator may differ when calculated using subnational data compared with the global monitoring system and how to interpret differences.
Methods
Between June 2016 and February 2024, 19 workshops were held in 7 countries (Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam), where stakeholder discussions covered sources of food price data, institutions involved, policy uses, and direct training in calculation of CoAHD. Food price data collected by national organizations were used to calculate CoAHD in partnership with government agencies.
Results
Calculating CoAHD using subnational data uses the same methods across settings, but the mechanisms for monitoring and dissemination are different in each country, illustrating heterogeneity in how the metric can most effectively be incorporated within existing structures. Results from national and global monitoring systems have expected differences based on data sources, healthy diet standards, and affordability standards.
Conclusions
CoAHD can be calculated with existing data and resources, facilitated by new software tools and user tutorials. In the future, it can be further streamlined, leveraging technical assistance from global institutions and aligning national and global monitoring systems.
{"title":"Monitoring the Cost and Affordability of a Healthy Diet within Countries: Building Systems in Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam","authors":"Anna W Herforth , Rachel Gilbert , Kristina Sokourenko , Tehreem Fatima , Olutayo Adeyemi , Dawit Alemayehu , Eunice Arhin , Fantu Bachewe , Yan Bai , Imran Chiosa , Tirsit Genye , Hagos Haile , Raja Jahangeer , Joyce Kinabo , Fulgence Mishili , Chioma D Nnabugwu , John Nortey , Bernice Ofosu-Baadu , Adeyinka Onabolu , Daniel Bruce Sarpong , William A Masters","doi":"10.1016/j.cdnut.2024.104441","DOIUrl":"10.1016/j.cdnut.2024.104441","url":null,"abstract":"<div><h3>Background</h3><div>Governments around the world collect food price data on a frequent basis, often monthly, for the purpose of monitoring inflation. These routine economic data can be used with a nutrition-sensitive lens for understanding economic access to a healthy diet. The Food and Agriculture Organization of the United Nations has adopted the cost and affordability of a healthy diet (CoAHD) for annual tracking alongside other food security indicators. This indicator is relevant in many countries for informed decision-making and accountability toward Food Systems Summit pathways. National governments may wish to include this indicator in their own monitoring systems, using existing subnational price and income data.</div></div><div><h3>Objectives</h3><div>We describe emerging systems in several countries for monitoring CoAHD and analytical tools that facilitate the calculation of CoAHD. We discuss reasons why the indicator may differ when calculated using subnational data compared with the global monitoring system and how to interpret differences.</div></div><div><h3>Methods</h3><div>Between June 2016 and February 2024, 19 workshops were held in 7 countries (Ethiopia, Ghana, Malawi, Nigeria, Pakistan, Tanzania, and Viet Nam), where stakeholder discussions covered sources of food price data, institutions involved, policy uses, and direct training in calculation of CoAHD. Food price data collected by national organizations were used to calculate CoAHD in partnership with government agencies.</div></div><div><h3>Results</h3><div>Calculating CoAHD using subnational data uses the same methods across settings, but the mechanisms for monitoring and dissemination are different in each country, illustrating heterogeneity in how the metric can most effectively be incorporated within existing structures. Results from national and global monitoring systems have expected differences based on data sources, healthy diet standards, and affordability standards.</div></div><div><h3>Conclusions</h3><div>CoAHD can be calculated with existing data and resources, facilitated by new software tools and user tutorials. In the future, it can be further streamlined, leveraging technical assistance from global institutions and aligning national and global monitoring systems.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104441"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104454
Jeffery L Heileson , Michael J Macartney , Nora L Watson , Tina E Sergi , Andrew R Jagim , Ryan Anthony , Gregory E Peoples
Background
Accumulating evidence has highlighted the acute and chronic impact of repetitive subconcussive head impacts (rSHIs) in contact sports. Neurofilament-light (Nf-L), a brain-derived biomarker of neuroaxonal injury, elevates in concert with rSHI. Recently, long-chain ω-3 polyunsaturated fatty acids (LC ω-3 PUFAs) supplementation has been suggested to mitigate brain injury from rSHI as reflected by attenuation of Nf-L concentrations within contact sport athletes.
Objective
Using a systematic review with a meta-analysis, we aimed to determine the effect of LC ω-3 PUFA supplementation on Nf-L concentrations in athletes routinely exposed to rSHI.
Methods
Electronic databases (PubMed and CINAHL) were searched from inception through January 2024. One-stage meta-analysis of individual participant-level data was used to detect changes in Nf-L concentrations between LC ω-3 PUFA and control/placebo (PL) groups from baseline to midseason (MS) and postseason (PS). Least square means (±SE) for Nf-L change from baseline were compared by treatment group for MS/PS using contrast t tests. Significance was set a priori at adjusted P ≤ 0.05.
Results
Of 460 records identified, 3 studies in collegiate American football players (n = 179; LC ω-3 PUFA = 105, PL = 71) were included in the meta-analysis. Compared with PL, the change in Nf-L concentrations was statistically similar at MS [mean difference (MD) = –1.66 ± 0.82 pg·mL–1, adjusted P = 0.09] and significantly lower at PS (MD = –2.23 ± 0.83 pg·mL–1, adjusted P = 0.02) in athletes following LC ω-3 PUFA supplementation.
Conclusions
Our findings demonstrate preliminary support for the prophylactic administration of LC ω-3 PUFA in contact sport athletes exposed to rSHI; however, further research is required to determine the effective dosage required.
This trial was registered at OSF (DOI: https://doi.org/10.17605/OSF.IO/EY5QW).
{"title":"Nutritional Optimization for Brain Health in Contact Sports: A Systematic Review and Meta-Analysis on Long-Chain ω-3 Fatty Acids and Neurofilament Light","authors":"Jeffery L Heileson , Michael J Macartney , Nora L Watson , Tina E Sergi , Andrew R Jagim , Ryan Anthony , Gregory E Peoples","doi":"10.1016/j.cdnut.2024.104454","DOIUrl":"10.1016/j.cdnut.2024.104454","url":null,"abstract":"<div><h3>Background</h3><div>Accumulating evidence has highlighted the acute and chronic impact of repetitive subconcussive head impacts (rSHIs) in contact sports. Neurofilament-light (Nf-L), a brain-derived biomarker of neuroaxonal injury, elevates in concert with rSHI. Recently, long-chain ω-3 polyunsaturated fatty acids (LC ω-3 PUFAs) supplementation has been suggested to mitigate brain injury from rSHI as reflected by attenuation of Nf-L concentrations within contact sport athletes.</div></div><div><h3>Objective</h3><div>Using a systematic review with a meta-analysis, we aimed to determine the effect of LC ω-3 PUFA supplementation on Nf-L concentrations in athletes routinely exposed to rSHI.</div></div><div><h3>Methods</h3><div>Electronic databases (PubMed and CINAHL) were searched from inception through January 2024. One-stage meta-analysis of individual participant-level data was used to detect changes in Nf-L concentrations between LC ω-3 PUFA and control/placebo (PL) groups from baseline to midseason (MS) and postseason (PS). Least square means (±SE) for Nf-L change from baseline were compared by treatment group for MS/PS using contrast t tests. Significance was set a priori at adjusted P ≤ 0.05.</div></div><div><h3>Results</h3><div>Of 460 records identified, 3 studies in collegiate American football players (n = 179; LC ω-3 PUFA = 105, PL = 71) were included in the meta-analysis. Compared with PL, the change in Nf-L concentrations was statistically similar at MS [mean difference (MD) = –1.66 ± 0.82 pg·mL–1, adjusted P = 0.09] and significantly lower at PS (MD = –2.23 ± 0.83 pg·mL–1, adjusted P = 0.02) in athletes following LC ω-3 PUFA supplementation.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate preliminary support for the prophylactic administration of LC ω-3 PUFA in contact sport athletes exposed to rSHI; however, further research is required to determine the effective dosage required.</div><div>This trial was registered at OSF (DOI: <span><span>https://doi.org/10.17605/OSF.IO/EY5QW</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104454"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104459
Nimisoere P Batubo , Carolyn I Auma , J Bernadette Moore , Michael A Zulyniak
Background
Hypertension and cardiovascular disease burden are rising rapidly in Nigeria. This trend is partly attributed to a transition from healthy to unhealthy dietary patterns. However, health care professionals lack a dietary screening tool to assess patient dietary intake and offer personalized dietary advice.
Objectives
We aimed to develop and validate a food frequency questionnaire (FFQ) that can quickly and accurately assess regional dietary intake for use by health care professionals in a hospital setting in Port Harcourt, Nigeria.
Methods
We recruited 58 patients from a single hospital in Nigeria. The FFQ was administered at baseline and again after 3 wk. To evaluate the validity of the FFQ, we used 3 repeated and nonconsecutive 24-h dietary recalls (24DR) as a reference method. Spearman rank correlations, Wilcoxon signed-rank tests, cross-classification, intraclass correlation coefficients (ICCs), and Bland–Altman analysis were performed in R software version 4.3.1 to assess the relative validity and reproducibility.
Results
The mean correlation coefficient (rs) between the FFQ and 24DR was 0.60 (P < 0.05), and ranged from 0.20 to 0.78. The Wilcoxon signed-rank tests indicated no significant differences in the 19 food groups queried (P > 0.05), except for fats and oils (P < 0.05). The exact agreement for classifying individuals into quartiles ranged from 17% for salt to 88% for processed meats and alcoholic drinks, with 90% of individuals classified into the same or neighboring quartile. Additionally, the Bland–Altman analysis demonstrated acceptable agreement, with >96% of observations within the acceptable limits of agreement for all food groups. For reproducibility, the ICC ranged from 0.31 for stew to 0.98 for fruit, with an mean ICC of 0.77 between the FFQs delivered 2 wk apart.
Conclusions
Our results support the use of the FFQ as a valid and reliable tool for ranking intakes of certain food groups among patients in a hospital setting in Nigeria.
The trial was registered at clinicaltrials.gov as NCT05973760.
{"title":"Relative Validity and Reproducibility of a Dietary Screening Tool in Nigerian Health Care","authors":"Nimisoere P Batubo , Carolyn I Auma , J Bernadette Moore , Michael A Zulyniak","doi":"10.1016/j.cdnut.2024.104459","DOIUrl":"10.1016/j.cdnut.2024.104459","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension and cardiovascular disease burden are rising rapidly in Nigeria. This trend is partly attributed to a transition from healthy to unhealthy dietary patterns. However, health care professionals lack a dietary screening tool to assess patient dietary intake and offer personalized dietary advice.</div></div><div><h3>Objectives</h3><div>We aimed to develop and validate a food frequency questionnaire (FFQ) that can quickly and accurately assess regional dietary intake for use by health care professionals in a hospital setting in Port Harcourt, Nigeria.</div></div><div><h3>Methods</h3><div>We recruited 58 patients from a single hospital in Nigeria. The FFQ was administered at baseline and again after 3 wk. To evaluate the validity of the FFQ, we used 3 repeated and nonconsecutive 24-h dietary recalls (24DR) as a reference method. Spearman rank correlations, Wilcoxon signed-rank tests, cross-classification, intraclass correlation coefficients (ICCs), and Bland–Altman analysis were performed in R software version 4.3.1 to assess the relative validity and reproducibility.</div></div><div><h3>Results</h3><div>The mean correlation coefficient (<em>r</em><sub>s</sub>) between the FFQ and 24DR was 0.60 (<em>P</em> < 0.05), and ranged from 0.20 to 0.78. The Wilcoxon signed-rank tests indicated no significant differences in the 19 food groups queried (<em>P</em> > 0.05), except for fats and oils (<em>P</em> < 0.05). The exact agreement for classifying individuals into quartiles ranged from 17% for salt to 88% for processed meats and alcoholic drinks, with 90% of individuals classified into the same or neighboring quartile. Additionally, the Bland–Altman analysis demonstrated acceptable agreement, with >96% of observations within the acceptable limits of agreement for all food groups. For reproducibility, the ICC ranged from 0.31 for stew to 0.98 for fruit, with an mean ICC of 0.77 between the FFQs delivered 2 wk apart.</div></div><div><h3>Conclusions</h3><div>Our results support the use of the FFQ as a valid and reliable tool for ranking intakes of certain food groups among patients in a hospital setting in Nigeria.</div><div>The trial was registered at <span><span>clinicaltrials.gov</span><svg><path></path></svg></span> as NCT05973760.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104459"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104443
Alvin Surya Tjahyo , Jia Yee Wu , Geoffry Smith , Cecilia Acuin , Andrea B Maier , Shaun Yong Jie Sim , Reshma Taneja , Sumanto Haldar , Christiani Jeyakumar Henry
Complementing discourse following a February 2023 event on dietary protein needs in Southeast Asia (SEA), this symposium report summarizes the region’s protein intake, while simultaneously examining the impact of dietary shift toward complementary and alternative proteins and their health implications. It highlights the importance of protein quality in dietary evaluations, optimal intake, and sustainability, advocating for environmentally conscious protein production and innovation in future foods. Discussion points, expert opinions, national nutrition data, and relevant literature, addressing protein intake and quality, their impact on human health, and various technologies for future foods production, have been included. Despite increased protein supply in SEA, protein requirements, particularly during crucial life stages, are often unmet owing to insufficient focus on protein quality. Factoring in amino acids content and bioaccessibility are crucial for assessing nutritional requirement and sustainability evaluations, rather than solely relying on protein quantity alone. Different food sources of protein also have different key conutrients for health relevance such as vitamin B-12 and ω-3 fatty acids. Innovations in food structure, processing, and technology are key to developing nutritious, sustainable, and appealing future foods, including from complementary and alternative protein sources, while considering safety aspects, especially allergenicity. Addressing protein needs in SEA requires a dual focus on protein quantity and quality, underlining the role of public health policies and guidelines that consider key nutritional differences of animal-source and plant-based proteins. To address regional demands, future food innovations should aim at creating unique yet needful food categories or supplementing current existing sources, rather than mimicking current products.
{"title":"Shifting Trend of Protein Consumption in Southeast Asia: Toward Health, Innovation, and Sustainability","authors":"Alvin Surya Tjahyo , Jia Yee Wu , Geoffry Smith , Cecilia Acuin , Andrea B Maier , Shaun Yong Jie Sim , Reshma Taneja , Sumanto Haldar , Christiani Jeyakumar Henry","doi":"10.1016/j.cdnut.2024.104443","DOIUrl":"10.1016/j.cdnut.2024.104443","url":null,"abstract":"<div><div>Complementing discourse following a February 2023 event on dietary protein needs in Southeast Asia (SEA), this symposium report summarizes the region’s protein intake, while simultaneously examining the impact of dietary shift toward complementary and alternative proteins and their health implications. It highlights the importance of protein quality in dietary evaluations, optimal intake, and sustainability, advocating for environmentally conscious protein production and innovation in future foods. Discussion points, expert opinions, national nutrition data, and relevant literature, addressing protein intake and quality, their impact on human health, and various technologies for future foods production, have been included. Despite increased protein supply in SEA, protein requirements, particularly during crucial life stages, are often unmet owing to insufficient focus on protein quality. Factoring in amino acids content and bioaccessibility are crucial for assessing nutritional requirement and sustainability evaluations, rather than solely relying on protein quantity alone. Different food sources of protein also have different key conutrients for health relevance such as vitamin B-12 and ω-3 fatty acids. Innovations in food structure, processing, and technology are key to developing nutritious, sustainable, and appealing future foods, including from complementary and alternative protein sources, while considering safety aspects, especially allergenicity. Addressing protein needs in SEA requires a dual focus on protein quantity and quality, underlining the role of public health policies and guidelines that consider key nutritional differences of animal-source and plant-based proteins. To address regional demands, future food innovations should aim at creating unique yet needful food categories or supplementing current existing sources, rather than mimicking current products.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104443"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104461
Xuan-Mai T Nguyen , Yanping Li , Stacey B Whitbourne , Luc Djousse , Dong D Wang , Kerry Ivey , Walter C Willett , John Michael Gaziano , Kelly Cho , Frank B Hu , VA Million Veteran Program
Background
Dietary quality plays an important role in disease development and prognosis, and diet is also a key contributor to disparities in many chronic diseases and health conditions.
Objectives
This study aimed to assess racial and ethnic disparities experienced by veterans; we examined food intake and dietary quality across different racial and ethnic groups of United States veterans.
Methods
The study included 420,730 males and females aged 19–107 y (91.2% males) enrolled in the Veterans Affairs Million Veteran Program with plausible dietary intake measured by food frequency questionnaire. Dietary quality was evaluated with dietary approaches to stop hypertension (DASH) score. Dietary intakes of various race and ethnicity groups were standardized to the age distribution of non-Hispanic White participants, separately for males and females. Differences across race and ethnicity groups were compared using general linear regression models after adjustment for socioeconomic and lifestyle factors as well as military service.
Results
Compared to non-Hispanic White males, non-Hispanic Black males had a relatively lower DASH score, higher red and processed meats, higher sugar-sweetened beverages (SSBs), and lower low-fat dairy intakes. Non-Hispanic Asian males had a relatively higher DASH score as compared to non-Hispanic White males with relatively higher intakes of fruits and vegetables and relatively lower intakes of sodium, red meat and SSBs. Age-standardized DASH scores of Hispanic males and “Other” race/ethnicity groups were not statistically different from non-Hispanic White males. Similar race and ethnicity dietary patterns were found in females, although not all reached a statistically significant level.
Conclusions
A modest difference in overall dietary quality (i.e., DASH score) was observed, but unique differences in food preferences across the different racial/ethnic groups were identified. Findings from our study may provide insight for the potential development of specific interventions to help address nutritional disparities experienced among veterans.
{"title":"Racial and Ethnic Disparities in Dietary Intake and Quality Among United States Veterans","authors":"Xuan-Mai T Nguyen , Yanping Li , Stacey B Whitbourne , Luc Djousse , Dong D Wang , Kerry Ivey , Walter C Willett , John Michael Gaziano , Kelly Cho , Frank B Hu , VA Million Veteran Program","doi":"10.1016/j.cdnut.2024.104461","DOIUrl":"10.1016/j.cdnut.2024.104461","url":null,"abstract":"<div><h3>Background</h3><div>Dietary quality plays an important role in disease development and prognosis, and diet is also a key contributor to disparities in many chronic diseases and health conditions.</div></div><div><h3>Objectives</h3><div>This study aimed to assess racial and ethnic disparities experienced by veterans; we examined food intake and dietary quality across different racial and ethnic groups of United States veterans.</div></div><div><h3>Methods</h3><div>The study included 420,730 males and females aged 19–107 y (91.2% males) enrolled in the Veterans Affairs Million Veteran Program with plausible dietary intake measured by food frequency questionnaire. Dietary quality was evaluated with dietary approaches to stop hypertension (DASH) score. Dietary intakes of various race and ethnicity groups were standardized to the age distribution of non-Hispanic White participants, separately for males and females. Differences across race and ethnicity groups were compared using general linear regression models after adjustment for socioeconomic and lifestyle factors as well as military service.</div></div><div><h3>Results</h3><div>Compared to non-Hispanic White males, non-Hispanic Black males had a relatively lower DASH score, higher red and processed meats, higher sugar-sweetened beverages (SSBs), and lower low-fat dairy intakes. Non-Hispanic Asian males had a relatively higher DASH score as compared to non-Hispanic White males with relatively higher intakes of fruits and vegetables and relatively lower intakes of sodium, red meat and SSBs. Age-standardized DASH scores of Hispanic males and “Other” race/ethnicity groups were not statistically different from non-Hispanic White males. Similar race and ethnicity dietary patterns were found in females, although not all reached a statistically significant level.</div></div><div><h3>Conclusions</h3><div>A modest difference in overall dietary quality (i.e., DASH score) was observed, but unique differences in food preferences across the different racial/ethnic groups were identified. Findings from our study may provide insight for the potential development of specific interventions to help address nutritional disparities experienced among veterans.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104461"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.cdnut.2024.104456
Emily A Busey , Grace Chamberlin , Kayla Mardin , Michelle Perry , Lindsey Smith Taillie , Francesca R Dillman Carpentier , Barry M Popkin
The school food environment is a key intervention point for influencing children’s and adolescents’ diets. As more countries establish school meal programs to provide critical nourishment to students, establishing standards for the foods served can increase the consumption of key nutrients and limit the consumption of foods that do not build health. This global scoping review explores the prevalence and basic characteristics of national policies that regulate food served through school meals across 193 countries, particularly by restricting the provision of categories, nutrients, or ingredients of nutritional concern. We gathered evidence from policy databases, grey literature, peer-reviewed literature, and primary policy documents. We included nationally mandated policies that included restrictions on categories, nutrients, or ingredients of concern served in school meals. Policies that were sub-national, voluntary, and/or did not include restrictive language were excluded from this review. Data was collected in research electronic data capture then extracted into Microsoft Excel and analyzed for policy frequency, prevalence by world region or country income group, and prevalence of certain policy characteristics. Globally, only 15% of countries were found to have a national-level policy restricting foods served through school meals in some capacity, including either nutritional or categorical restrictions. The majority of these policies were found in high-income countries, and no low-income countries had a policy meeting inclusion criteria. Policies in Latin-American and Caribbean countries limited the content of more nutrients of concern than in other regions. Although many policies included explicit guidelines to monitor implementation, few outlined mechanisms for policy enforcement. Future research should evaluate the impact of various school meal regulatory approaches, including implementation of similar policies at sub-national levels, and other elements that affect the impact of school meal programs, such as procurement, infrastructure, costs to school and to students and their families, and acceptability and consumption of foods provided.
学校食品环境是影响儿童和青少年饮食的关键干预点。随着越来越多的国家制定学校供餐计划,为学生提供重要的营养,制定供餐食品标准可以增加关键营养素的摄入量,限制不利于健康的食品的摄入量。这篇全球范围的综述探讨了 193 个国家规范学校供餐食品的国家政策的普遍性和基本特征,特别是限制提供营养问题类别、营养素或配料的政策。我们从政策数据库、灰色文献、同行评审文献和主要政策文件中收集证据。我们纳入了国家强制政策,其中包括对学校膳食中提供的有关类别、营养素或成分的限制。次国家级、自愿性和/或不包含限制性语言的政策不在本次审查范围内。通过研究电子数据采集收集数据,然后提取到 Microsoft Excel 中,并对政策频率、按世界地区或国家收入组别划分的普遍性以及某些政策特征的普遍性进行分析。研究发现,在全球范围内,只有 15%的国家制定了国家级政策,对学校供餐中的食品进行某种限制,包括营养限制或分类限制。这些政策大多出现在高收入国家,没有一个低收入国家的政策符合纳入标准。与其他地区相比,拉丁美洲和加勒比地区国家的政策限制了更多营养素的含量。尽管许多政策都包含明确的监督实施准则,但很少有政策概述了政策执行机制。未来的研究应评估各种学校膳食监管方法的影响,包括在国家以下各级实施类似政策的情况,以及影响学校膳食计划影响的其他因素,如采购、基础设施、学校和学生及其家庭的成本,以及所提供食品的可接受性和消费量。
{"title":"National Policies to Limit Nutrients, Ingredients, or Categories of Concern in School Meals: A Global Scoping Review","authors":"Emily A Busey , Grace Chamberlin , Kayla Mardin , Michelle Perry , Lindsey Smith Taillie , Francesca R Dillman Carpentier , Barry M Popkin","doi":"10.1016/j.cdnut.2024.104456","DOIUrl":"10.1016/j.cdnut.2024.104456","url":null,"abstract":"<div><div>The school food environment is a key intervention point for influencing children’s and adolescents’ diets. As more countries establish school meal programs to provide critical nourishment to students, establishing standards for the foods served can increase the consumption of key nutrients and limit the consumption of foods that do not build health. This global scoping review explores the prevalence and basic characteristics of national policies that regulate food served through school meals across 193 countries, particularly by restricting the provision of categories, nutrients, or ingredients of nutritional concern. We gathered evidence from policy databases, grey literature, peer-reviewed literature, and primary policy documents. We included nationally mandated policies that included restrictions on categories, nutrients, or ingredients of concern served in school meals. Policies that were sub-national, voluntary, and/or did not include restrictive language were excluded from this review. Data was collected in research electronic data capture then extracted into Microsoft Excel and analyzed for policy frequency, prevalence by world region or country income group, and prevalence of certain policy characteristics. Globally, only 15% of countries were found to have a national-level policy restricting foods served through school meals in some capacity, including either nutritional or categorical restrictions. The majority of these policies were found in high-income countries, and no low-income countries had a policy meeting inclusion criteria. Policies in Latin-American and Caribbean countries limited the content of more nutrients of concern than in other regions. Although many policies included explicit guidelines to monitor implementation, few outlined mechanisms for policy enforcement. Future research should evaluate the impact of various school meal regulatory approaches, including implementation of similar policies at sub-national levels, and other elements that affect the impact of school meal programs, such as procurement, infrastructure, costs to school and to students and their families, and acceptability and consumption of foods provided.</div></div>","PeriodicalId":10756,"journal":{"name":"Current Developments in Nutrition","volume":"8 10","pages":"Article 104456"},"PeriodicalIF":3.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}