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BackgroundThere is substantial interest in the effects of nutrition labels on consumer food-purchasing behavior. However, conducting randomized controlled trials on the impact of nutrition labels in the real world presents a significant challenge. ObjectiveThe Food Label Trial (FLT) smartphone app was developed to enable conducting fully automated trials, delivering intervention remotely, and collecting individual-level data on food purchases for two nutrition-labeling randomized controlled trials (RCTs) in New Zealand and Australia. MethodsTwo versions of the smartphone app were developed: one for a 5-arm trial (Australian) and the other for a 3-arm trial (New Zealand). The RCT protocols guided requirements for app functionality, that is, obtaining informed consent, two-stage eligibility check, questionnaire administration, randomization, intervention delivery, and outcome assessment. Intervention delivery (nutrition labels) and outcome data collection (individual shopping data) used the smartphone camera technology, where a barcode scanner was used to identify a packaged food and link it with its corresponding match in a food composition database. Scanned products were either recorded in an electronic list (data collection mode) or allocated a nutrition label on screen if matched successfully with an existing product in the database (intervention delivery mode). All recorded data were transmitted to the RCT database hosted on a server. ResultsIn total approximately 4000 users have downloaded the FLT app to date; 606 (Australia) and 1470 (New Zealand) users met the eligibility criteria and were randomized. Individual shopping data collected by participants currently comprise more than 96,000 (Australia) and 229,000 (New Zealand) packaged food and beverage products. ConclusionsThe FLT app is one of the first smartphone apps to enable conducting fully automated RCTs. Preliminary app usage statistics demonstrate large potential of such technology, both for intervention delivery and data collection. Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12614000964617. New Zealand trial: Australian New Zealand Clinical Trials Registry ACTRN12614000644662.

Objective: To assess annual household purchases of sugar-sweetened beverages (SSBs), artificially sweetened beverages (AFSBs), and unsweetened beverages (USBs) by household composition and income, and over time. Design: Observational cohort study using beverage purchasing data linked to a supermarket database. ANOVA was used to compare total household purchase volumes (L) and the contribution of beverages purchased by category, household composition (size), household income (four categories from New Zealand (NZ) < $30 000 to > $90 000), and over time (trend from 2015 to 2019). Setting: Aotearoa NZ. Participants: ∼1800 households in the NielsenIQ Homescan® market research panel. Results: In 2019, the mean (sd) annual household purchase volume and relative contribution to total beverage volume of SSBs were 72·3 (93·0) L and 33 %, respectively. Corresponding values for AFSBs were 32·5 (79·3) L (15 %), and USBs were 112·5 (100·9) L (52 %). Larger households purchased more of all beverage types except AFSBs. Total purchases were similar by income, but households earning < $NZ 30 000 purchased fewer AFSBs and USBs (but not SSBs) than households earning > $NZ 90 000. Total and USB purchases were unchanged over time, but SSBs dropped by 5·9 L (P -trend = 0·04), and AFSBs increased by 5·3 L (P -trend = 0·00). Conclusions: USBs contributed the most to household beverage purchases. Total purchases were higher for larger households and similar by income, including for SSBs. The reduction over time was too small for health benefits. Findings support policies and interventions to reduce SSB consumption and highlight the importance of focusing on equitable outcomes. [ABSTRACT FROM AUTHOR]

Tailoring individualizes information to the receiver and provides a potential strategy for improving dietary intakes. The present systematic review summarizes evidence for the long-term ([greater than or equal to] 6 months) effectiveness of tailored nutrition education for adults and includes priority population groups. Key electronic databases and relevant bibliographies were searched for trials measuring the following outcomes: nutrition-related health behaviors (e.g., dietary intake and food purchases) and anthropometric measures. Data synthesis was comprised of meta-analysis (for 15 trials including all population groups) and narrative review (for five trials of priority population groups). Overall, the quality of the studies was moderate to good. Tailored nutrition education was found to be a promising strategy for improving the diets of adults (including those in priority population groups) over the long term. However, future studies should ensure adequate reporting of research design and methods and reduce the chances of false-positive findings by using more objective measures of diet, clearly identifying the primary study outcome, and concentrating on outcomes most relevant to nutrition-related disease.

Objective: To evaluate the impact of the 2017 update to the voluntary Advertising Standards Authority (ASA) code for advertising food on children and young people's exposure to unhealthy food advertisements on New Zealand television. Design: Audience ratings data were analysed for New Zealand children and young people's television viewing for eight random days prior to (June to August 2015) and following (October to December 2018) the code update, from 06.00 to midnight (864 h). Food advertisements were coded using three nutrient profiling models. The number of children and young people watching television each year was compared. Setting: Three free-to-air New Zealand television channels. Participants: New Zealand children aged 5–18 years. Results: Television viewer numbers decreased over the 3 years (P < 0·0001). The mean rate of unhealthy food advertising on weekdays was 10·4 advertisements/h (2015) and 9·5 advertisements/h (2018). Corresponding rates for weekend days were 8·1 and 7·3 advertisements/h, respectively. The percentage of food advertisements which were for unhealthy foods remained high (63·7 % on weekdays and 65·9 % on weekends) in 2018. The ASA definition of children's 'peak viewing time' (when 25 % of the audience are children) did not correspond to any broadcast times across weekdays and weekend days. Conclusions: Between 2015 and 2018, children and young people's television exposure to unhealthy food advertising decreased. However, almost two-thirds of all food advertisements were still unhealthy, and the updated ASA code excluded the times when the greatest number of children was watching television. Consequently, government regulation and regular monitoring should reflect the evolving food marketing environment. [ABSTRACT FROM AUTHOR]

Abstract Background Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries. Methods Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes. Results Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies. Conclusions Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Objective: To assess trends in relative availability, sugar content and serve size of ready-to-drink non-alcoholic beverages available for sale in supermarkets from 2013 to 2019. Design: Repeat cross-sectional surveys. Data on single-serve beverages to be consumed in one sitting were obtained from an updated brand-specific food composition database. Trends in beverages availability and proportions with serve size ≤ 250 ml were assessed by χ2 tests. Sugar content trends were examined using linear regressions. The proportion of beverages exceeding the sugar threshold of the United Kingdom Soft Drinks Industry Levy (SDIL) was assessed. Setting: New Zealand. Results: From 2013 to 2019, there was (i) an increase in the availability of sugar-free/low-sugar beverages (n 25 (8·4 %) to n 75 (19·1 %); P < 0·001) and craft sugar-sweetened soft drinks (n 11 (3·7 %) to n 36 (9·2 %); P < 0·001), and a decrease in availability of fruit/vegetable juices/drinks (n 94 (31·8 %) to n 75 (19·4 %); P < 0·001); (ii) small decreases in sugar content (mean g/100 ml) of sugar-sweetened soft drinks (3·03; 95 % CI 3·77, 2·29); fruit/vegetable juices/drinks (1·08; 95 % CI 2·14, 0·01) and energy drinks (0·98; 95 % CI 1·63, 0·32) and (iii) slight reduction in the proportion of beverages with serve size ≤ 250 ml (21·6 to 18·9 %; P < 0·001). In 2019, most beverages were sugar-sweetened or had naturally occurring sugars (79·1 %) and serve size > 250 ml (81·1 %) and most sugar-sweetened beverages exceeded the SDIL lower benchmark (72·9 %). Conclusions: Most single-serve beverages available for sale in 2019 were sugary drinks with high sugar content and large serve sizes; therefore, changes made across the years were not meaningful for population's health. [ABSTRACT FROM AUTHOR]

Improvement of national food supplies are an opportunity to improve a country's health. Our aim was to identify the major food companies manufacturing packaged foods and non-alcoholic beverages available in New Zealand supermarkets in 2018; to assess the healthiness of products using (1) the Health Star Rating (HSR) system, (2) Australian Dietary Guidelines classification (core/discretionary), and (3) by level of processing; to compare the healthiness of products displaying and not displaying the HSR and; to assess potential for food reformulation within selected food sub-categories. Information on packaged foods was obtained from the Nutritrack supermarket database. Companies that manufactured each food and brand were identified using company websites and the New Zealand companies register. In total, 13,506 packaged products were mapped to 1,767 brands and 1,214 companies. Based on market share of products available for sale (Euromonitor data), there were 22 dominating companies producing 31% of products and 17% of brands. Fifty-nine percent of products were classified as unhealthy (HSR <3.5/5 stars), 53% as discretionary, and 69% as ultra-processed. Products displaying the HSR on the package had a higher mean HSR ±SD than if the HSR was not displayed (3.2±1.3 versus 2.5±1.4, p = 0.000). Efforts to improve the healthiness of products should be directed to the 22 food companies dominating this market share, particularly in the core foods groups which are currently less likely to meet Heart Foundation reformulation targets (bread, breakfast cereals, cheese, canned baked beans, yoghurt). The New Zealand supermarket packaged food supply included in the Nutritrack database is dominated by a small number of companies and is mostly unhealthy. Government leadership is required to improve the healthiness of the packaged food supply and provide adequate information to consumers. This includes interventions setting reformulation targets for core food groups, setting population nutrient intake targets and mandating that the HSR is displayed on all products. [ABSTRACT FROM AUTHOR]

Objective: To assess trends in relative availability, sugar content and serve size of ready-to-drink non-alcoholic beverages available for sale in supermarkets from 2013 to 2019.Design: Repeat cross-sectional surveys. Data on single-serve beverages to be consumed in one sitting were obtained from an updated brand-specific food composition database. Trends in beverages availability and proportions with serve size ≤ 250 ml were assessed by χ2 tests. Sugar content trends were examined using linear regressions. The proportion of beverages exceeding the sugar threshold of the United Kingdom Soft Drinks Industry Levy (SDIL) was assessed.Setting: New Zealand.Results: From 2013 to 2019, there was (i) an increase in the availability of sugar-free/low-sugar beverages (n 25 (8·4 %) to n 75 (19·1 %); P < 0·001) and craft sugar-sweetened soft drinks (n 11 (3·7 %) to n 36 (9·2 %); P < 0·001), and a decrease in availability of fruit/vegetable juices/drinks (n 94 (31·8 %) to n 75 (19·4 %); P < 0·001); (ii) small decreases in sugar content (mean g/100 ml) of sugar-sweetened soft drinks (3·03; 95 % CI 3·77, 2·29); fruit/vegetable juices/drinks (1·08; 95 % CI 2·14, 0·01) and energy drinks (0·98; 95 % CI 1·63, 0·32) and (iii) slight reduction in the proportion of beverages with serve size ≤ 250 ml (21·6 to 18·9 %; P < 0·001). In 2019, most beverages were sugar-sweetened or had naturally occurring sugars (79·1 %) and serve size > 250 ml (81·1 %) and most sugar-sweetened beverages exceeded the SDIL lower benchmark (72·9 %).Conclusions: Most single-serve beverages available for sale in 2019 were sugary drinks with high sugar content and large serve sizes; therefore, changes made across the years were not meaningful for population's health. [ABSTRACT FROM AUTHOR]

Objective: Emerging evidence suggests that free sugars intake in many countries exceeds that recommended by the WHO. However, information regarding real-world dietary patterns associated with meeting the WHO free sugars guidelines is lacking. The current study aimed to determine dietary patterns associated with meeting the guidelines to inform effective free sugars reduction interventions in New Zealand (NZ) and similar high-income countries.Design: Dietary patterns were derived using principal component analysis on repeat 24-h NZ Adult Nutrition Survey dietary recall data. Associations between dietary patterns and the WHO guidelines (<5 and <10 % total energy intake) were determined using logistic regression analyses.Setting: New Zealand.Participants: NZ adults (n 4721) over 15 years old.Results: Eight dietary patterns were identified: 'takeaway foods and alcohol' was associated with meeting both WHO guidelines; 'contemporary' was associated with meeting the <10 % guideline (males only); 'fast foods, sugar-sweetened beverages and dessert', 'traditional' and 'breakfast foods' were negatively associated with meeting both guidelines; 'sandwich' and 'snack foods' were negatively associated with the <5 % guideline; and 'saturated fats and sugar' was negatively associated with the <10 % guideline.Conclusions: The majority of NZ dietary patterns were not consistent with WHO free sugars guidelines. It is possible to meet the WHO guidelines while consuming a healthier ('contemporary') or energy-dense, nutrient-poor ('takeaway foods and alcohol') diet. However, the majority of energy-dense patterns were not associated with meeting the guidelines. Future nutrition interventions would benefit from focusing on establishing healthier overall diets and reducing consumption and free sugars content of key foods. [ABSTRACT FROM AUTHOR]

Background Reducing sugar in packaged foods and beverages could help protect children's future health. Clear methods for the development of feasible yet impactful sugar reduction program targets are needed. Objectives To outline methods for the development of program targets that would reduce, by 20%, the total sugar content of packaged foods and beverages commonly consumed by children. New Zealand (NZ) is used as a case study. Methods Sugar content and pack size targets were developed using a 6-step process informed by the UK sugar and salt reduction programs. Food groups contributing ≥2% to children's total sugar intake were identified using national dietary survey data. Consumption volume, sugar content, and pack size were obtained from household panel data linked with a packaged food composition database. Category-specific targets were set as 20% reductions in sales-weighted means adjusted for feasibility, i.e., ∼1/3 of products already meeting the target, and alignment with existing, relevant targets. Results Twenty-two food groups were identified as major contributors to NZ children's total sugar intake. Mean reductions required in sugar content and pack size to meet the targets were 5.2 g  per 100 g/mL (26%) and 61.2 g/mL/pack (23%), respectively. The percentage of products already meeting the sugar targets ranged from 14% for electrolyte drinks and flavored dairy milk to 50% for cereal bars, and for pack size targets compliance ranged from 32% for chocolate confectionary to 62% for fruit juices and drinks. Estimated reductions in annual household sugar purchases if the sugar and pack size targets were met were 1459 g (23%) and 286 g (6%), respectively. Conclusions Methods for the development of sugar and pack size reduction targets are presented, providing a robust, step-by-step process for countries to follow. The results of the case study provide a suggested benchmark for a potential national sugar reduction program in NZ. [ABSTRACT FROM AUTHOR]

Background: Food pricing strategies have been proposed to encourage healthy eating habits, which may in turn help stem global increases in non-communicable diseases. This systematic review of simulation studies investigates the estimated association between food pricing strategies and changes in food purchases or intakes (consumption) (objective 1); Health and disease outcomes (objective 2), and whether there are any differences in these outcomes by socio-economic group (objective 3). Methods and Findings: Electronic databases, Internet search engines, and bibliographies of included studies were searched for articles published in English between 1 January 1990 and 24 October 2011 for countries in the Organisation for Economic Co-operation and Development. Where [greater than or equal to] 3 studies examined the same pricing strategy and consumption (purchases or intake) or health outcome, results were pooled, and a mean own-price elasticity (own-PE) estimated (the own-PE represents the change in demand with a 1% change in price of that good). Objective 1: pooled estimates were possible for the following: (1) taxes on carbonated soft drinks: own-PE (n = 4 studies), -0.93 (range, -0.06, -2.43), and a modelled -0.02% (-0.01%, -0.04%) reduction in energy (calorie) intake for each 1% price increase (n = 3 studies);(2) taxes on saturated fat: -0.02% (-0.01%, -0.04%) reduction in energy intake from saturated fat per 1% price increase (n = 5 studies); and (3) subsidies on fruits and vegetables: own-PE (n = 3 studies), -0.35 (-0.21, -0.77). Objectives 2 and 3: variability of food pricing strategies and outcomes prevented pooled analyses, although higher quality studies suggested unintended compensatory purchasing that could result in overall effects being counter to health. Eleven of 14 studies evaluating lower socio-economic groups estimated that food pricing strategies would be associated with pro-health outcomes. Food pricing strategies also have the potential to reduce disparities. Conclusions: Based on modelling studies, taxes on carbonated drinks and saturated fat and subsidies on fruits and vegetables would be associated with beneficial dietary change, with the potential for improved health. Additional research into possible compensatory purchasing and population health outcomes is needed. Please see later in the article for the Editors' Summary., Introduction Non-communicable diseases (NCDs) including heart disease, stroke, diabetes, cancers, and chronic respiratory disease are the leading preventable causes of global morbidity and mortality [1]. Furthermore, these diseases place substantial [...]