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Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: closed (20 December 2021) | Viewed by 36056

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Special Issue Editors

Dr. Julia A. Wolfson

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Guest Editor

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Interests: food policy; food environment; food choices/behaviors; diet quality; food insecurity; diet-related disease prevention

Dr. Vanessa A. Shrewsbury

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Guest Editor

School of Health Sciences and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
Interests: dietary and lifestyle interventions; food policy; life course and social ecological approaches; noncommunicable disease prevention

Special Issue Information

Dear Colleagues,

Diet-related noncommunicable diseases (NCDs) such as type 2 diabetes, cardiovascular disease, and some cancers remain urgent public health challenges around the world. In high-income countries, the prevalence of diet-related NCDs has been rising for decades, with serious disparities in rates of diet-related NCDs based on race/ethnicity and socio-economic status. In low- and middle-income countries, diet-related NCDs are a newer public health challenge. However, rates are now rising, in part due to the “nutrition transition’, changing food environments, and the spread of a “Western diet” around the world.

A complex web of factors in various contexts influences food choices and diet behaviors at the individual level. Family, community, work, and school environments form the contexts in which people procure, prepare, and consume foods and beverages. Within these contexts, there are many opportunities for policy and public health interventions to incentivize and promote healthy food options, disincentivize unhealthy choices, and support healthy food choices among individuals. For example, restaurants, grocery stores, and other food stores/markets have high potential for interventions and policies to help promote healthy food choices. Workplace and school procurement policies, interventions to improve food options in schools and workplaces, and nutrition education opportunities have shown potential. Local policies such as zoning and tax incentives have been used to promote healthy food businesses. Various nutrition assistance programs create mechanisms to shape food choices and deliver nutrition education, particularly among low-income populations. National policies to curb unhealthy food advertising have also been passed in some countries. Economic policies such as taxes have also been proposed, and in some instances passed, to disincentivize unhealthy options such as sugar-sweetened beverages.

Effective policies and interventions will differ across populations and contexts. Tailored approaches are needed to promote healthy food choices, improve diet quality, and prevent diet-related NCDs. In order to promote the sharing of knowledge across contexts, in this Special Issue we welcome original research (quantitative and qualitative), literature reviews, systematic reviews, and meta-analyses focused on policies or interventions to promote healthy diets, improve food environments, and prevent diet-related NCDs.

Dr. Julia A. Wolfson
Dr. Vanessa A. Shrewsbury
Guest Editors

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Keywords

diet-related NCDs
policy
intervention
food environment
food choices

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Published Papers (9 papers)

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Research

10 pages, 241 KiB

Open AccessArticle

The Potential for Healthy Checkout Policies to Advance Nutrition Equity

by Jennifer Falbe, Justin S. White, Desiree M. Sigala, Anna H. Grummon, Sarah E. Solar and Lisa M. Powell

Nutrients 2021, 13(11), 4181; https://doi.org/10.3390/nu13114181 - 22 Nov 2021

Cited by 6 | Viewed by 3419

Abstract

Background: As the only place in a store where all customers must pass through and wait, the checkout lane may be particularly influential over consumer purchases. Because most foods and beverages sold at checkout are unhealthy (e.g., candy, sweets, sugar-sweetened beverages, and salty snacks), policymakers and advocates have expressed growing interest in healthy checkout policies. To understand the extent to which such policies could improve nutrition equity, we assessed the prevalence and sociodemographic correlates of purchasing items found at (i.e., from) checkout. Methods: We assessed self-reported checkout purchasing and sociodemographic characteristics in a national convenience sample of adults (n = 10,348) completing an online survey in 2021. Results: Over one third (36%) of participants reported purchasing foods or drinks from checkout during their last grocery shopping trip. Purchasing items from checkout was more common among men; adults < 55 years of age; low-income consumers; Hispanic, non-Hispanic American Indian or Alaska Native, and non-Hispanic Black consumers; those with a graduate or professional degree; parents; and consumers diagnosed with type 2 diabetes or pre-diabetes (p-values < 0.05). Conclusions: Purchasing foods or beverages from store checkouts is common and more prevalent among low-income and Hispanic, American Indian or Alaska Native, and Black consumers. These results suggest that healthy checkout policies have the potential to improve nutrition equity. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

28 pages, 5521 KiB

Open AccessArticle

Development of a System Dynamics Model to Guide Retail Food Store Policies in Baltimore City

by Siyao Zhu, Cassandra Mitsinikos, Lisa Poirier, Takeru Igusa and Joel Gittelsohn

Nutrients 2021, 13(9), 3055; https://doi.org/10.3390/nu13093055 - 31 Aug 2021

Cited by 11 | Viewed by 3285

Abstract

Policy interventions to improve food access and address the obesity epidemic among disadvantaged populations are becoming more common throughout the United States. In Baltimore MD, corner stores are a frequently used source of food for low-income populations, but these stores often do not provide a range of affordable healthy foods. This research study aimed to assist city policy makers as they considered implementing a Staple Food Ordinance (SFO) that would require small stores to provide a range and depth of stock of healthy foods. A System Dynamics (SD) model was built to simulate the complex Baltimore food environment and produce optimal values for key decision variables in SFO planning. A web-based application was created for users to access this model to optimize future SFOs, and to test out different options. Four versions of potential SFOs were simulated using this application and the advantages and drawbacks of each SFO are discussed based on the simulation results. These simulations show that a well-designed SFO has the potential to reduce staple food costs, increase corner store profits, reduce food waste, and expand the market for heathy staple foods. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

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22 pages, 332 KiB

Open AccessArticle

A Qualitative Study of Motivators, Strategies, Barriers, and Learning Needs Related to Healthy Cooking during Pregnancy

by Travertine Garcia, Kerith Duncanson, Vanessa A. Shrewsbury and Julia A. Wolfson

Nutrients 2021, 13(7), 2395; https://doi.org/10.3390/nu13072395 - 13 Jul 2021

Cited by 9 | Viewed by 3652

Abstract

Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals’ preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

14 pages, 4471 KiB

Open AccessArticle

Progress towards Achieving the Recommendations of the Commission on Ending Childhood Obesity: A Comprehensive Review and Analysis of Current Policies, Actions and Implementation Gaps in Thailand

by Sirinya Phulkerd, Parichat Nakraksa, Ladda Mo-suwan and Mark Lawrence

Nutrients 2021, 13(6), 1927; https://doi.org/10.3390/nu13061927 - 3 Jun 2021

Cited by 4 | Viewed by 3642

Abstract

Despite a significant commitment to tackling childhood overweight and obesity, questions remain about the progress the Thai Government has made in implementing childhood obesity prevention policies and actions. This study aimed to review and assess the implementation of the government’s policies and actions for childhood obesity prevention in Thailand compared with the recommendations of the Commission on Ending Childhood Obesity and to identify the implementation gaps. Policy data were collected from governmental and NGO websites and publications and via direct contact with government officials. Stakeholder meetings were held to seek further information and advice on implementation gaps and to give recommendations. The analysis of each policy was conducted against pre-determined criteria formulated from literature assessments and stakeholder consultations. The policies and actions that were implemented by the Government were consistent with 33 broad policy actions and 55 specific policy actions. Preconception and pregnancy care was the policy area that was most implemented. Six broad policy actions were assessed as ‘high’ performance, these were: sugar-sweetened beverage taxation, nutrient labeling, nutrition guidance for preconception and pregnancy care, the International Code of Marketing of Breast-milk Substitutes, regulatory measures for supporting maternal breastfeeding, and regulations on the marketing of complementary foods and beverages. Policy coherence and monitoring and evaluation (M&E) were identified as major implementation gaps. Increasing the effectiveness of childhood obesity prevention in Thailand will require national immediate attention towards building infrastructure to enhance coherence among the policies and to put in place M&E mechanisms for each policy. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

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12 pages, 613 KiB

Open AccessArticle

Beyond Ramen: Investigating Methods to Improve Food Agency among College Students

by Lizzy Pope, Mattie Alpaugh, Amy Trubek, Joan Skelly and Jean Harvey

Nutrients 2021, 13(5), 1674; https://doi.org/10.3390/nu13051674 - 14 May 2021

Cited by 13 | Viewed by 4560

Abstract

Many college students struggle to cook frequently, which has implications for their diet quality and health. Students’ ability to plan, procure, and prepare food (food agency) may be an important target for shifting the college student diet away from instant and inexpensive staples like packaged ramen. The randomized intervention study included two sequential cooking interventions: (1) six weeks of cooking classes based in food agency pedagogy held once per week, and (2) six weekly home delivered meal kits (3 meals per kit) to improve food agency, diet quality, and at home cooking frequency of college students. Based on availability and subsequent randomization, participants were assigned to one of four conditions that included active cooking classes, meal kit provision, or no intervention. Participants who took part in the cooking intervention had significant improvement in food agency immediately following the intervention period. Participants who did not participate in cooking classes and only received meal kits experienced significant, though less pronounced, improvement in food agency scores following the meal kit provision. Neither intervention improved diet quality or routinely improved cooking frequency. Active cooking classes may improve food agency of college students, though further research is needed to determine how this may translate into improved diet quality and increased cooking frequency. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

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8 pages, 217 KiB

Open AccessFeature PaperArticle

Perceptions of SNAP and Stocking Standards: A Qualitative Study of California Small Food Store Owners and Managers

by Anthony Meza, June M. Tester, Irene H. Yen, Barbara A. Laraia, Julia A. Wolfson and Cindy W. Leung

Nutrients 2021, 13(3), 752; https://doi.org/10.3390/nu13030752 - 26 Feb 2021

Cited by 2 | Viewed by 2227

Abstract

The Supplemental Nutrition Assistance Program (SNAP) is critical to alleviating food insecurity, but low diet quality among program participants is a concern. Nutrition-related interventions have focused on SNAP-authorized food retailers, but the perspectives of small food store owners and managers have not been represented in national policy discussions. This study aimed to explore the opinions of store owners/managers of SNAP-authorized small food stores about their overall perceptions of the program and the stricter stocking standards previously proposed in 2016. We conducted in-depth, semi-structured interviews with 33 small food store owners and managers in San Francisco and Oakland, California in 2016. Interviews were analyzed for thematic content using the general inductive approach. Four themes emerged from owners/managers’ discussion of their overall perceptions of SNAP: the beneficial impact of SNAP on their business, how SNAP enables them to connect with the broader community, the importance of SNAP in preventing hunger, and the nutrition-related struggles that SNAP participants face. Store owners/managers had a generally favorable response towards the proposed stricter stocking standards. Additional themes discussed pertained to the concern about whether stocking changes would lead SNAP participants to purchase more healthful food and some logistical challenges related to sourcing and storing perishable foods. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

18 pages, 1268 KiB

Open AccessArticle

Tracking Progress from Policy Development to Implementation: A Case Study on Adoption of Mandatory Regulation for Nutrition Labelling in Malaysia

by SeeHoe Ng, Bridget Kelly, Heather Yeatman, Boyd Swinburn and Tilakavati Karupaiah

Nutrients 2021, 13(2), 457; https://doi.org/10.3390/nu13020457 - 29 Jan 2021

Cited by 9 | Viewed by 4924

Abstract

Mandatory nutrition labelling, introduced in Malaysia in 2003, received a “medium implementation” rating from public health experts when previously benchmarked against international best practices by our group. The rating prompted this qualitative case study to explore barriers and facilitators during the policy process. Methods incorporated semi-structured interviews supplemented with cited documents and historical mapping of local and international directions up to 2017. Case participants held senior positions in the Federal government (n = 6), food industry (n = 3) and civil society representations (n = 3). Historical mapping revealed that international directions stimulated policy processes in Malaysia but policy inertia caused implementation gaps. Barriers hindering policy processes included lack of resources, governance complexity, lack of monitoring, technical challenges, policy characteristics linked to costing, lack of sustained efforts in policy advocacy, implementer characteristics and/or industry resistance, including corporate political activities (e.g., lobbying, policy substitution). Facilitators to the policy processes were resource maximization, leadership, stakeholder partnerships or support, policy windows and industry engagement or support. Progressing policy implementation required stronger leadership, resources, inter-ministerial coordination, advocacy partnerships and an accountability monitoring system. This study provides insights for national and global policy entrepreneurs when formulating strategies towards fostering healthy food environments. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

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13 pages, 379 KiB

Open AccessArticle

Cooking as a Health Behavior: Examining the Role of Cooking Classes in a Weight Loss Intervention

by Mattie Alpaugh, Lizzy Pope, Amy Trubek, Joan Skelly and Jean Harvey

Nutrients 2020, 12(12), 3669; https://doi.org/10.3390/nu12123669 - 28 Nov 2020

Cited by 14 | Viewed by 6578

Abstract

Americans are cooking fewer meals at home and eating more convenience foods prepared elsewhere. Cooking at home is associated with higher quality diets, while a reduction in cooking may be associated with increases in obesity and risk factors for chronic disease. The aims of this study were to examine cooking as an intervention for weight control in overweight and obese adults, and whether such an intervention increases participants’ food agency and diet quality. Overweight and obese adults were randomized into one of two intervention conditions: active or demonstration. Both conditions received the same 24-week behavioral weight loss intervention, and bi-weekly cooking classes. The active condition prepared a weekly meal during a hands-on lesson, while the demonstration condition observed a chef prepare the same meal. The active condition lost significantly more weight at six months compared with the demonstration condition (7.3% vs. 4.5%). Both conditions saw significant improvements in food agency scores and Healthy Eating Index scores, though no significant differences were noted between groups. The addition of active cooking to a weight management intervention may improve weight loss outcomes, though benefits in diet quality and cooking behaviors may also be seen with the addition of a demonstration-only cooking intervention. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

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11 pages, 375 KiB

Open AccessArticle

The Impact of Micronutrient Fortified Foods on Cognitive Functioning among Low-Income Children: A Pilot and Feasibility Study

by Juliana F. W. Cohen, Kelly Sagar, Mary Kathryn Dahlgren, Laura B. F. Kurdziel and Staci A. Gruber

Nutrients 2020, 12(11), 3351; https://doi.org/10.3390/nu12113351 - 30 Oct 2020

Cited by 1 | Viewed by 2264

Abstract

Brain development continues throughout childhood and requires micronutrients for optimal maturation, but studies have typically examined only a limited number of micronutrients and there has been inconsistent use of validated cognitive measures. This study evaluated the impact of providing low-income children with a daily fortified meal (570 kcal) in the form of a bar and shake containing >75% of the FDA Daily Values for all essential vitamins and minerals, as well as macronutrients (e.g., omega-3 and omega-6 fatty acids and protein), in an afterschool care setting (instead of the usual meal provided) on cognitive functioning. Students aged 8–12 were randomly assigned to intervention (n = 19) or control (n = 16) meals. Students completed the Stroop Color Word Task, Trail Making Test, and Conner’s Continuous Performance Task (CPT) at baseline and 3 months post-intervention. Differences in cognitive scores were examined using 2 × 2 mixed model ANOVAs (Stroop and CPT) and ANCOVAs (Trail Making Test). Significant main effects of time indicated improvements in both intervention and control groups, but there were no significant main effects of group or group*time interactions. When the amount of meal consumed was examined, most results became non-significant, suggesting that overall meal consumption significantly impacted the observed results. Overall, this pilot study suggests that there may be limited additional benefits to short-term consumption of micronutrient fortified meals among low-income children in an afterschool care setting, and potential benefits observed may be directly related to the amount of food consumed. Full article

(This article belongs to the Special Issue Policies and Interventions for the Prevention of Diet-Related Noncommunicable Diseases)

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