Behavioural Nutrition Newsletter

No 2 (3 August 2015)

News Welcome to the August edition of the APFNC Behavioural Nutrition Newsletter.

We would like to introduce Jane Willcox from Deakin University’s School of Exercise and Nutrition Sciences as a new

member of our collaboration. Jane is a Research Dietitian and PhD Candidate, and a Sidney Myer Health Scholarship

Recipient. Welcome to the AFFNC Jane.

Since the launch of the newsletter and APFNC blog site last month we have made some fabulous progress. The

proposed survey on Communication and Education has received some interesting feedback. Thank you all for your

inputs. The main areas the group thinks that consumers need to know about are:

the causes of obesity;

emotional connection to food and effects on eating habits;

the influence of the micro environment on food consumption; and

how foods are marketed and advertised

Also of much interest are:

The properties of highly processed foods: how food is regulated;

useful food shopping strategies;

what are the healthier take away meal options;

budgeting skills;

useful food rules for eating and drinking at home;

Social norms; what other people consume and what they think about highly processed foods;

Overseas food trends;

cultural influences on perceived healthiness of food items; and,

the effects of parental nutrition knowledge and attitudes to food on children's healthy food knowledge

Thank you too for your suggestions which included:

“I. Some information about food categories should be informed,

such as 1 cereals, 2 vegetables, 3 fruits, 4 meats, poultry and

fish, 5 legumes and nuts, 6 milk and dairy products, 7, fats and

oils, 8 sugars, 9 drinks etc.

II. And typical nutrients, which make significant contribution in

human nutrition and health, in each food group should be

introduced. To make connection between nutrients and foods

would give direct message and thus affect subjects’ motivation

more actively.

III Information about relationship between food groups as

above and health should be introduced,”

“ Human welfare issues”

“Trade-off between health and taste

Trade-off between health and price”

“I would suggest Food-based Dietary Guidelines, which is most

authoritative in each country.”

“Skills to choose nutritious foods

Skills to access easiest active lifestyle”

“Nutritional quality

Food safety”

“Cooking skills, Understanding properties of processed foods”

“Fruit and vegetables, any foods with low fat, sugar &salt “

“In my opinion, attitude may be equally important as

knowledge and skills.”

“Knowledge and skills necessary to choose and cook meals

which are both healthy and tasty (connect healthy with tasty)

Connect knowledge and skills outcomes with other things

people consider to be very important; for example, make

connection with financial impact of healthy dietary habits, in

terms of savings on health care costs”

“Foods influence on the development of chronic disease, not

just obesity”

Many thanks for helping to scope the development of this initiative.

Recent scientific publications

Maternal and infant nutrition Gishti, O., et al. (2015). "Influence of breastfeeding on retinal vessel calibers in school-age children. The Generation R Study." A shorter breastfeeding duration is associated with an increased risk of cardiovascular disease in adulthood. Early microvasculature structure adaptations may be part of the underlying mechanism. This study examined the associations of ever breastfeeding, breastfeeding duration and exclusivity, and the timing of introduction of solid foods with retinal vessel calibers in children. Children who were never breastfed tended to have narrower retinal venular calibers. Associations of breastfeeding duration with retinal vessel calibers were not observed. Family-based socio-demographic factors, maternal lifestylerelated factors and childhood factors only slightly influenced the observed associations.

Susiloretni, K. A., et al. (2015). “What works to improve duration of exclusive breastfeeding: Lessons from the Exclusive

Breastfeeding Promotion Program in rural Indonesia.” The aim of the study was to identify determinants of exclusive breastfeeding (EBF) at the individual, family, community,

and organizational level. This study was a secondary analysis of data from a multilevel promotion of EBF program in

two rural public health centers (PHCs) in the Demak district, Central Java, Indonesia. Mothers with a high level of

breastfeeding knowledge had the greatest EBF duration. Factors which shortened EBF duration were grandmother’s

lack of support for EBF, received formula samples at discharge, and maternal experience of breast engorgement. High

maternal breastfeeding knowledge was the only factor associated with longer duration of EBF.

In the Media

Food literacy, education and communication Project Phoenix Conventional nutrition is burned out Click on Hot stuff Project Phoenix 476 – 481

Evident inability to prevent or control obesity and diabetes at any population level is one reason why conventional

nutrition science is being questioned. Is this fair and if so, what are the implications? Journal of the World Public Health Nutrition Association - Volume 6, Number 6, June 2015

NGO urges Aregbesola to intensify efforts on pro-people policies*says school feeding programme has great impact ... The State of Osun has gained recognition on account of its highly celebrated school feeding program for schools children. Osun feeds over 250 elementary school pupils every school day with nutritious meals a programme that also has impacts on agriculture and other value chains.

Osun Defender-27 Jul 2015

Maternal and infant nutrition Breastfeeding is winning! So companies are pushing “toddler milk” to neurotic parents

If milk “does a body good,” as the classic dairy farmer ad campaign claimed, then toddler milk—the heavily fortified

and increasingly lucrative milk drinks aimed at children more than a year-old—promises to do even better. Powdered

milk-based beverages for the 1- to 5-year-old set have exploded into a $15 billion business. Thanks to massive global

advertising campaigns, they’re now the biggest and the fastest-growing product that formula makers sell.

Quartz - 09 February 2014

Battle for control of breast milk

It could trade for 400 times more than the price of crude oil and 2,000 times more than iron ore. If sold off the shelf, it

could cost more than 150 times the price of a gallon of cow's milk and 15 times more than coffee.

GOING for as much as $US4 ($A5.37) per ounce, breast milk is a hot commodity that is emerging as a surprisingly

cutthroat industry.

The Australian (blog)-9 Jul 2015

Food purchase behaviour & marketing Guthrie, J., et al. (2015). “Nudging consumers toward better food choices: Policy approaches to

changing food consumption behaviors.”

The high prevalence of obesity and its associated illnesses, such as cancer, heart disease and

diabetes, has sparked interest in finding ways to encourage consumers to make healthier food

choices. At the public level, providing information about why and how to choose a healthy diet

has been the typical approach to encouraging behavioral change. Information can also influence food producers and

marketers to develop and promote more healthful products, creating an environment in which it is easier for

consumers to make healthier dietary choices. Nevertheless, information may not always be effective in improving food

choices. One explanation is that nutrition information is complex and difficult to convey in a clear, actionable manner.

Also, knowledge, while necessary, may not be sufficient to motivate behavior change. Even when consumers

understand nutrition information, competing preferences for tastier, less expensive, or more convenient foods may

lead them to make other choices. Findings from psychology, marketing, and behavioral economics research suggest

approaches that may enhance the effectiveness of informational approaches and complement informational efforts.

Enax, L., et al. (2015). “Food packaging cues influence taste perception and increase effort provision for a

recommended snack product in children.”

Food marketing research shows that child-directed marketing cues have pronounced effects on food

preferences and consumption, but are most often placed on products with low nutritional quality. Effects of child-

directed marketing strategies for healthy food products remain to be studied in more detail. Previous research

suggests that effort provision explains additional variance in food choice. This study investigated the effects of

packaging cues on explicit preferences and effort provision for healthy food items in elementary school children. Each

of 179 children rated three, objectively identical, recommended yogurt-cereal-fruit snacks presented with different

packaging cues. Packaging cues included a plain label, a label focusing on health aspects of the product, and a label that

additionally included unknown cartoon characters. Results confirm the positive effect of child-directed marketing

strategies also for healthy snack food products. Using handgrip strength as a measure to determine the amount of

effort children are willing to provide for a product may explain additional variance in food choice and might prove to be

a promising additional research tool for field studies and the assessment of public policy interventions.

Food literacy, education and communication Whiteley, C. & L. Matwiejczyk (2015). “Preschool program improves young children’s food literacy and attitudes to

vegetables.”

Inadequate fruit and vegetable intake is a risk factor for the development of chronic disease and obesity. Only 3% of 4-

to 8-year-old Australian children meet national vegetable intake guidelines (22% when potatoes are added, including

fried potatoes), according to the 2007 Australian National Children’s Nutrition and Physical Activity Survey. Familiarity

strongly influences young children’s food preferences, so early childhood is a crucial time for interventions that will

influence lifelong tastes and food preferences. Food literacy, including knowledge about vegetables and skills regarding

their selection and preparation, can begin to be taught at a young age. In South Australia, all children aged 4 years

attend preschool for 12 months and these settings thus have a significant reach. The Vegie Fun for Everyone program

aimed to develop a positive attitude toward vegetables in preschool-attending 4-year-olds in a non-threatening and

play-based format using Piaget’s Cognitive Development Theory.

Velardo, S. (2015). “The nuances of health literacy, nutrition literacy, and food literacy.”

Health literacy, defined as the ability to access, understand, and use health information, has been identified as an

international public health goal. The term nutrition literacy has emerged as a distinct form of health literacy, yet

scholars continue to reflect on constituent skills and capabilities in light of discussions regarding what it means to be

food literate and health literate. This viewpoint argues that a comprehensive conceptualization of nutrition literacy

should reflect key elements of health literacy and food literacy constructs. Nutbeam’s tripartite model of health literacy

is employed to explore competencies that are likely to facilitate healthy food relationships.

Perceived healthiness of food and beverages

Sütterlin, B. and M. Siegrist (2015). “Simply adding the word “fruit” makes sugar healthier: The misleading effect of

symbolic information on the perceived healthiness of food.”

People may use simple heuristics to assess the healthiness of food products. For instance, the information that a

product contains “fruit sugar” (in German, “fruit sugar” is the colloquial term for fructose) could be interpreted as a

cue that the product is relatively healthy, since the term “fruit” symbolizes healthiness. This can have a misleading

effect on the perceived healthiness of a product. In Experiment 1, participants (N = 164) were asked to evaluate the

healthiness of one of two breakfast cereals based on the information provided in a nutrition table. For one group, the

label “fruit sugar” was used; for the other, the label “sugar” was used. Results suggest that the phrase “fruit sugar”

listed as an ingredient of the breakfast cereal resulted in a more positive perception of the healthiness of the cereal

compared with the ingredient labeled “sugar.” In Experiment 2 (N = 202), the results of Experiment 1 were replicated

with a within-subjects design in which participants evaluated the two products simultaneously. Experiment 3 (N = 251)

ruled out the alternative explanation that the effect could be due to differing inferences about the product’s

ingredients based on the label used, that is, that the product labeled with “fruit sugar” contains fruit. Finally, in

Experiment 4 (N = 162), the results show that the perceived healthiness associated with the labeling of the ingredient

“sugar” (“fruit sugar” vs. “sugar”) mediates the observed effect. Results of the four experiments indicate that symbolic

information is an important factor that can influence people’s health perceptions of food. These findings have

implications for marketing and public health.

Obesity and NCD risk factors

Cobb, L.K ., et al. (2015). The relationship of the local food environment with obesity: a systematic review of methods,

study quality, and results.

This study aimed to examine the relationship between local food environments and obesity and assess the quality of

studies reviewed. Despite the large number of studies, the investigators found limited evidence for associations

between local food environments and obesity. The predominantly null associations should be interpreted cautiously

due to the low quality of available studies.

Wijnhoven,T.M.A., et al. (2015). WHO European Childhood Obesity Surveillance Initiative: Health-risk behaviours on nutrition and physical activity in 6–9-year-old schoolchildren. This paper assesses to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity. Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours

was clearly associated with higher odds of obesity.

Schroeder, N., et al. (2015). "A randomized trial on the effects of 2010 dietary guidelines for Americans and Korean diet patterns on cardiovascular risk factors in overweight and obese adults." Dietary patterns that are considered healthy (eg, the Dietary Approaches to Stop Hypertension diet and Mediterranean diet) may be more successful in reducing typical cardiovascular disease risks compared to dietary patterns considered unhealthy (eg, energy-dense diets such as the typical American diet). This study assessed the effects of a Korean diet, the 2010 Dietary Guidelines for Americans (DGA), and a typical American diet on cardiometabolic risk factors, including lipid levels and blood pressure, in overweight, non-Asian individuals in the United States with elevated low-density lipoprotein cholesterol.

Salt

Trieu, K., et al. (2015) Salt reduction initiatives around the world – a

systematic review of progress towards the global target

The large and increasing number of countries with salt reduction strategies in

place is encouraging although activity remains limited in low- and middle-

income regions. The absence of a consistent approach to implementation

highlights uncertainty about the elements most important to success.

Rigorous evaluation of ongoing programs and initiation of salt reduction

programs, particularly in low- and middle- income countries, will be vital to

achieving the targeted 30% reduction in salt intake.

Downs, S.M., et al. (2015) Setting targets for salt levels in foods: A five-step approach for low- and middle-income

countries This paper proposes a step-wise process for establishing effective salt targets, drawing from the experience

of setting regional targets for the Pacific Island Countries. Establishing targets as part of a voluntary or mandatory

initiative is a key element of much-needed salt reduction strategies in LMICs. Mean population salt intake can be

reduced by decreasing salt levels in foods. It proposes effective action to reduce salt intake will save millions of lives

globally.

Further recent academic papers please visit the APFNC website and view the External publications page (log in with your

user name and password).

APFNC Reports THE FAMILIES AND FOOD SURVEY 2014

During December 2013 and January 2014, a detailed online survey (the Families and Food Survey) was conducted

among approximately 800 household food providers in each of Indonesia, Melbourne, Shanghai, Singapore and

Vietnam, by Global Market Insights, a leading online market research company.

The broad aims of the study were to:

1 To describe household food providers’ food and health behaviours and habits with respect to the nutrition

transition, with reference to main food groups and EDNP products.

2 To describe their views and opinions about the food supply, especially marketing, retailing and consumption.

3 To describe their views of the future and policies which need to be enacted to enable them to behave in ways

which sustain their health and well-being.

Reports on preliminary findings are contained under the links below:

The families and food survey 2014: 1 food marketing and communication

The families and food survey 2014: 2 perceptions of weight control and the causes of obesity

The families and food survey 2014: 3 important food knowledge and trust in information sources

The families and food survey 2014: 4 eating and drinking

The families and food survey 2014: 5. healthiness of food habits and beverages

The families and food survey 2014: 6 safety and the environment

The families and food survey 2014: descriptive data

Useful links The George Institute for Global Health…global action on salt Experts say more action is needed to reduce worldwide salt consumption after new research by The George Institute for Global Health found many countries are not meeting targets. The following article is from the George Institute provide important information into the global progress of salt reduction initiatives and steps to establish salt targets in foods. Call to action on major health initiative

George Institute for Global Health - 27 July 2015

Study scholarships; Australian Awards

Australia Awards are prestigious international scholarships and fellowships funded by the Australian Government

offering the next generation of global leaders an opportunity to undertake study, research and professional

development.

In 2013-2014, the Australian Department of Foreign Affairs and Trade invested $362.2 million in Australia Awards, enabling 4450 new recipients from 117 eligible developing countries to undertake study, research and professional development. In 2014, Indonesia, Vietnam and Papua New Guinea were the three largest recipient countries of Australia Awards, with 54 per cent of incoming recipients from the Asia region. visit: http://www.australiaawards.gov.au/Pages/about.aspx Nutrition websites

Food for life Partnership

The Food for Life partnership brings together the expertise of four

food focused charities. Helping schools across England to transform

their food culture.

Eatforhealth

Australian Dietary Guidelines: Advice about the amount and kinds

of foods that we need to eat for health and wellbeing.

Deakin University’s Centre for Physical

Activity and Nutrition Research (C-PAN)

This link describes the research activities and interests of the staff

and students in CPAN.

Contact us Stacey Ridley

APFNC Coordinator

School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia

s.ridley@deakin.edu.au

Disclaimer Links to other websites, institutions, and publications made available in this newsletter are for information purposes only. APFNC does not endorse

the reliability of information provided.