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Background: Nutrition claims on food labels are used to attract attention to products. Inaccurate claims on ready-to-eat (RTE) snack food products may mislead consumers into consuming a higher volume of a seemingly ‘healthy’ product.Objectives: A study was undertaken to determine the following surrounding the packaging of RTE snack food products: (i) compliance of health and or nutrient claims; (ii) average nutrient content per snack category; (iii) accuracy of the total energy content; (iv) eligibility to make claims once the R429 legislation is implemented.Outcome measures: Nutrient content per 100 g and serving size was analysed. Claims related to nutrient content were audited.Design: An analysis was undertaken of the labels of 93 South African-produced RTE snack food products from 10 categories, displaying health and or nutrition claims.Results: Ninety-one products displayed nutrient content claims. Twenty-three (25.3%) nutrient content claims were noncompliant with the R146 legislation. Twenty-one (22.6%) displayed negative claims, three (14.3%) were ineligible. Eighteen products (19.4%) displayed endorsement claims, four (4.4%) were eligible. Sixty-four products (68.8%) displayed a higher total energy content when applying the conversion factors to the displayed macronutrient values. Only 22 (23.7%) products would be eligible to make health and/or nutrition claims once the R429 legislation is promulgated.Conclusion: A higher proportion of eligible claims were found. More than 70% of food manufacturers will need to make changes to the nutrient content or labels once the R429 legislation is implemented. A two-pronged approach of manufacturer compliance and consumer education may improve food choices and reduce the incidence of obesity and NCDs.

A frozen banana pulp with functional properties was developed and characterized in this work. For this, 0 g, 3 g, 5 g and 7 g of psyllium in 100 g of banana pulp were added. The use of this fiber in industrialized products can contribute to the nutritional enrichment of the products and provide functional benefits already acknowledged, such as lowering LDL cholesterol, lowering blood glucose, increasing satiety and relieving constipation. According to the World Health Organization, vegetable consumption should be increased, as it reduces the risk of chronic diseases. The main purpose of this work was to incorporate psyllium in frozen banana pulp to develop a healthy product. The samples were evaluated through chemical analyses, rheological properties and sensory testing with Check-All-That-Apply questions (CATA). The addition of psyllium had a significant effect not only on the viscosity but also on the sensory and nutritional properties of the frozen banana pulp. This study indicated that the production of frozen banana pulp with psyllium is viable, as it has desirable nutritional and sensory characteristics which can contribute to the maintenance of health.

Hypercholesterolemia is a risk factor for cardiovascular disease. Conventional treatment methods include lifestyle changes and pharmaceutical interventions, but recently Health Canada approved a health claim for whole ground flaxseed as an alternative treatment for hypercholesterolemia. The literature suggests flaxseed lignans are responsible for the cholesterol-reducing effects of flaxseed. In this study, 96.1% secoisolariciresinol diglucoside (SDG) and a 50% SDG enriched polymer (SDG polymer) were investigated as treatments for hypercholesterolemia in rats. Wistar female rats were fed a 1% high-cholesterol diet for a one-week acclimatization prior to a 23-day intervention with enriched SDG or SDG polymer. A reduction in body weight normalized liver weight was observed in rats treated with enriched SDG when compared to the controls. Both enriched SDG (96.1%) and SDG polymer reduced serum triacylglycerol (19% and 15%, respectively) and increased high-density lipoprotein cholesterol (15% and 24%, respectively). Histopathologic analyses revealed lipid-lowering effects of either enriched SDG or SDG polymer along with lower steatosis scores and nonalcoholic fatty liver disease activity. Furthermore, the lack of statistical significance between SDG and SDG polymer treatment groups suggests that SDG polymer may be a potential alternative to enriched SDG for hypercholesterolemia with similar efficacy but lower cost.

Background The marketing literature suggests that consumers prefer simple messages; however, text clarity—i.e., the extent to which a message is communicated in plain and unambiguous language—has rarely been investigated in the context of health claims. Scope and approach Focusing on extra-virgin olive oil (EVOO), this commentary investigates how text clarity affects this product's perceived healthiness, and whether such a perception enhances consumers' intentions to purchase the product and share positive word-of-mouth about it. Furthermore, it investigates whether the degree of arousal—an emotional state of activation—elicited by health claims moderates the effect of perceived healthiness on consumers' intentions. An experiment with 80 participants examined their responses to the four EVOO health claims authorized by the European Union (EU). Participants' arousal was assessed through FaceReader™, while two moderated-mediation analyses assessed the aforementioned effects. Key findings and conclusions Text clarity increased EVOO's perceived healthiness, which in turn enhanced participants' intentions. However, there was an interaction between EVOO's perceived healthiness and arousal, such that perceived healthiness increased participants' intentions when health claims elicited greater arousal. The study is the first to investigate the moderating role of arousal—using an innovative approach based on physiological measures—in the relationships between health claim clarity, perceived product healthiness, and consumers' intentions toward EVOO.

Leila Arfaoui,1 Areej Alkhaldy,1 Ahad Alareeshi,1 Ghadeer AlSaadi,1 Shaima Alhendi,1 Afnan Alghanmi,1 Wejdan Alghafari,1 Mourad Assidi2,3 1Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 2Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 3Medical Laboratory Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi ArabiaCorrespondence: Leila Arfaoui Tel +966 126401000 (ext. 41612)Email leila.arfaoui@gmail.comBackground: Few studies have investigated the knowledge and attitudes towards the nutrition facts label, the nutrient content and health claims (NHCs) among consumers from different countries/cultures.Methods: This cross-sectional study assessed the knowledge and self-reported use of the nutrition facts label and NHCs among Saudi adults. A total of 722 participants were recruited using an online questionnaire.Results: Total knowledge score was 5.8 ± 2.5/13 points (45%). Approximately, 18%, 77%, and 5% of the participants had low, medium, and high levels of knowledge, respectively. Participants were more knowledgeable on the nutrition facts label (2.6 ± 1.6/5 points) and health claims (2.7 ± 1.2/4 points) versus nutrient content claims (0.5 ± 0.7/4 points). The total use score was 20.1 ± 5.7/30 points (67%); approximately, 2%, 61%, and 37% of the participants were classified as low, medium, and high use level, respectively. Participants’ use of the nutrition facts label, nutrient content claims, and health claims was 10.0 ± 3.1/15, 6.5 ± 2.2/9, and 3.6 ± 1.8/6 points, respectively.Conclusion: This study highlights the need for more education and public awareness programs to enhance consumer knowledge and use of the nutrition facts label and NHCs, and consequently lead to healthy dietary choices.Keywords: health claims, knowledge, nutrition facts label, nutrient claims, nutritional information

Beyond genetics, there are several environmental factors which are responsible for the surging rates of obesity. Food advertisements being a part of multiple levels of food environment influence eating habits and contributes to obesity and other noncommunicable diseases. This research was a triphasic study conducted to evaluate the content of food advertisements appearing on most popular TV channels watched by children and their mothers, living in Delhi. In the first phase, TV viewing pattern of 30 children (8-12 years) and their mothers was determined, followed by the second phase which involved observation of food advertisements on most watched TV channels. In last phase, content analysis of food advertisements and corresponding food labels was carried out vis-a-vis advertising appeals (emotional and rational) and health/nutrition claims in accordance with Food Safety and Standards (Advertising and Claims) Regulations, 2018 and Advertising Council of India (ASCI) guidelines. Television viewing was identified as a regular habit among children and their mothers with the preferred time slot of 8 p.m. to 11 p.m. The most watched advertised food category among children was chocolate / candies / lollipops (80%) and among mothers were grocery products (96.6%). Compared to mainstream, proportion of food commercials was almost double on kids' channels however; most advertised food category (chocolate / candies / lollipops) was found to be common on both channels. Use of advertising appeals along with health / nutrition claims (56%) was prevalent in food advertisements. No gross violation of claims was found; however, few conditional and health claims were depicted in a manner to mislead the consumers.

Given the challenges with nutrition research, the Canadian Nutrition Society and Intertek Health Sciences Inc held an expert consultation in late 2019 to discuss the development and implementation of best practices for clinical trials on whole foods. Key challenges in the design, interpretation, and reporting of clinical efficacy studies on whole foods and opportunities for the future development of best practices are reported. Novelty: Outlines existing tools, resources, and checklists for clinical nutrition trials and provides clear and tangible steps to develop best practices for studies on whole foods.

Indoor tanning continues to remain common, despite evidence of an increased risk of skin cancer from artificial ultraviolet (UV) radiation. In the hopes of gaining customers, the tanning bed industry has marketed health benefits of indoor tanning such as increased vitamin D production, development of a base tan, enhanced mood, and treatment of certain dermatologic conditions. To better educate their patients, providers need a comprehensive reference reviewing the evidence that support or oppose these claims. In this work, we conducted an evidence-based review of the literature to identify and grade studies that investigate health claims related to UV exposure. Results indicate that there is little evidence to support each of these proposed health benefits. Tanning beds emit primarily UVA radiation, which is relatively ineffective at activating vitamin D or mood enhancing pathways, and the effects are minimal in regard to tanning beds generating a protective base tan or treating dermatologic conditions compared with the increased risk of skin cancer. Health care providers must continue to warn and educate patients about the misleading information propagated by the tanning bed industry as well as about the dangers of artificial UV radiation.

Nowadays, the interest towards functional food has increased; however, several factors jeopardize their diffusion on the market. In fact, functional foods do not have either a specific regulatory framework or a statutory definition in Europe. A functional food with any nutrition and health claim related to vitamins, minerals, or other substances in their labeling have to meet only the specific requirements established by the Regulation (EC) 1924/2006. Consequently, these products are not uniquely recognizable and the perception of consumers towards them remains a confusing concept. In this scenario, this paper investigates knowledge and factors affecting consumers' consumption intention towards functional food in Italy. For this purpose, a survey was designed, and a logit model was used to explain motivators for the consumption of functional products. The result indicates that consumers are still confused about the concept of functional foods. An important motive for the consumption of functional food is the maintenance of good nutrition, health conditions as well as well-being. An additional factor in the success of functional products is the familiarity and the knowledge of the effects of a particular product on health conditions. The probability of the consumption of a functional product increases when the consumer associates the knows of the functional characteristic and the healthful properties with the consequences of their consumption. Results are useful to verify the opportunities for further expansion of these products on the Italian market.

Nutritional supplements for eye health are very popular, but the size of the market makes it difficult to grasp for the clinician. To guide patients and clinicians in the subject it would therefore be valuable to have a list of available products and their content. The purpose of this study was to investigate the ocular nutritional supplements available on the Scandinavian market and how their doses relate to current evidence. A list of nutritional supplements for ocular health available on the Scandinavian market was compiled by structured internet searches, and the products and their contents were compared with current evidence and legislated upper tolerable levels. Out of 104 products on the Scandinavian market, only two products reached the Age-Related Eye Disease Study 2 (AREDS2)-formula at the recommended dose. One additional product reached the same formula if the recommended dose was exceeded. As only two nutritional supplements for ocular health on the Scandinavian market reached the AREDS2-dose at recommended dose, clinicians offering such substances need to have knowledge not only about the substances but also of the doses. In the future it would be welcome if the health claims for nutritional supplements were based on placebo-controlled intervention studies, to avoid ineffective products.

Introduction Although the FDA prohibits using inaccurate, reduced-risk descriptors on tobacco product advertising, descriptors that imply reduced risk or an enhanced user experience may be present on cigar product advertising in retail outlets near schools. Therefore, to inform the development of federal labeling and advertising requirements that reduce youth appeal of cigars, we conducted a content analysis of cigar ads in retailers near schools to document the presence of implied health claims and other selling propositions that may convey enhanced smoking experience. Aims and Methods Up to four interior and exterior little cigar and cigarillo advertisements were photographed in a random sample of licensed tobacco retailers (n = 530) near California middle and high schools. Unique ads (n = 234) were coded for brand, flavor, and presence of implicit health claims, premium branding descriptors, and sensory descriptors. Logistic regressions assessed the association among flavored ads and presence of implicit health claims, premium branding, or sensory descriptors. Results Seventeen cigar brands were advertised near schools; Black & Mild (20.1%) and Swisher Sweets (20.1%) were most common. Flavor was featured in 64.5% of ads, with explicit flavor names (eg, grape) being more prevalent than ambiguous names (eg, Jazz) (49.6% vs. 34.2%). Compared to ads without flavors, ads with ambiguous flavors were more likely to feature implicit health claims (OR = 1.83, 95% CI = 1.06% to 3.19%) and sensory descriptors (OR = 2.64, 95% CI = 1.39% to 5.04%); ads with explicit flavors were more likely to feature premium branding (OR = 2.84, 95% CI = 1.53% to 5.41%). Conclusions Cigar ads that featured implicit health claims and premium branding, and sensory selling propositions are present at retailer stores near schools. Implications We document the presence of implied health claims, premium branding, and sensory descriptors on cigar ads found in retail settings near schools. This study adds to the body of evidence that supports the development of federal labeling and advertising requirements for cigar products to reduce their appeal among vulnerable groups.

Objective:To explore how some of the largest food companies involved in producing alternative proteins (AP) use health and nutrition claims to market their products.Design:We identified the largest food manufacturers, meat processors and AP companies selling plant-based AP products in the USA. Using publicly available data, we analysed the voluntary health and nutrition claims made on front-of-pack labels (FOPL) and company webpages. We also analysed company websites for further nutrition and health-related statements about their products or AP more generally. Claim classification was guided by the INFORMAS (International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring, and Action Support) taxonomy for health-related food labelling.Setting:USA.Participants:Not applicable.Results:1394 health and nutrition-related FOPL claims were identified on 216 products, including 685 nutrition claims and 709 ‘other health-related’ claims. No FOPL health claims were identified. Most nutrient claims were for nutrients associated with meat, with 94 % of products carrying a protein claim and 30 % carrying a cholesterol claim. 74 % of products carried a GMO-free claim, and 63 % carried a plant-based claim. On their websites, some companies expanded on these claims or discussed the health benefits of specific ingredients.Conclusions:Companies involved in this category appear to be using nutritional marketing primarily to position their products in relation to meat. There is a focus on nutrient and ingredient claims, with discussion of processing largely avoided. The findings highlight the challenges companies face in positioning AP products as healthy against the backdrop of debates about ultra-processed foods.

Background Health claims data may be an efficient and easily accessible source to study chronic kidney disease (CKD) prevalence in a nationwide population. Our aim was to study Dutch claims data for their ability to identify CKD patients in different subgroups. Methods From a laboratory database, we selected 24 895 adults with at least one creatinine measurement in 2014 ordered at an outpatient clinic. Of these, 15 805 had ≥2 creatinine measurements at least 3 months apart and could be assessed for the chronicity criterion. We estimated the validity of a claim-based diagnosis of CKD and advanced CKD. The estimated glomerular filtration rate (eGFR)-based definitions for CKD (eGFR Results In general, sensitivity of claims data was highest in the population with the chronicity criterion as reference group. Sensitivity was higher in advanced CKD patients than in CKD patients {51% [95% confidence interval (CI) 47–56%] versus 27% [95% CI 25–28%]}. Furthermore, sensitivity was higher in young versus elderly patients. In patients with advanced CKD, sensitivity was 72% (95% CI 62–83%) for patients aged 20–59 years and 43% (95% CI 38–49%) in patients ≥75 years. The specificity of CKD and advanced CKD was ≥99%. Positive predictive values ranged from 72% to 99% and negative predictive values ranged from 40% to 100%. Conclusion When using health claims data for the estimation of CKD prevalence, it is important to take into account the characteristics of the population at hand. The younger the subjects and the more advanced the stage of CKD the higher the sensitivity of such data. Understanding which patients are selected using health claims data is crucial for a correct interpretation of study results.

Aim Clinical evidence on cardiovascular health metrics of couples, as defined by the American Heart Association (AHA), remains to be scarce. This study aims to explore the correlation of the AHA-defined cardiovascular health metrics within couples using a nationwide epidemiological database. Methods We examined the modified cardiovascular health metrics among 87,160 heterosexual couples using the health claims database from the Japan Medical Data Center. The ideal cardiovascular health metrics is comprised of (1) nonsmoking, (2) body mass index ＜25 kg/m2, (3) physical activity at goal, (4) untreated blood pressure ＜120/80 mm Hg, (5) untreated fasting glucose ＜100 mg/dL, and (6) untreated total cholesterol ＜200 mg/dL. Results A correlation was noted on the ideal modified cardiovascular health metrics between couples. The prevalence of meeting ≥ 5 ideal components in the female partners increased from 32 % in the male partners meeting 0-1 ideal component to 56 % in those meeting 6 ideal components. The same trend has been observed in all generations (20-39 years, 40-49 years, 50-59 years, ≥ 60 years). The association between couples is found to be better in terms of smoking status, blood pressure, and fasting glucose level. Conclusion There was an intracouple correlation of the ideal modified cardiovascular health metrics, suggesting the importance of couple-based intervention to improve cardiovascular health status.

There have been seven qualified health claims (QHCs) in the marketplace about the relationship between the consumption of green tea and the reduced risk of breast and/or prostate cancers that were written by three stakeholders (the U.S. Food and Drug Administration (FDA), Fleminger, Inc. (tea company), and the Federal Court). This paper evaluates assertions about the effects of these claims on consumers, which were contested in a federal lawsuit. Using a 2 × 7 experimental design, 1,335 Americans 55 years and older were randomized to view one QHC about green tea and cancer, or an identical QHC about a novel diet-disease relationship; yukichi fruit juice and gastrocoridalis. The results show that differing stakeholder descriptions of the same evidence significantly affected consumer perceptions. For example, QHCs written by Fleminger, Inc. were rated as providing greater evidence for the green tea-cancer claim. An FDA summary statement implied mandatory (vs. voluntary) labelling and greater effectiveness, and qualitative descriptions suggested that greater evidence existed for the claims (vs. quantitative descriptions). Greater evidence was also inferred for familiar claims (green tea and cancer).

Background Over the recent past, consumption of probiotic fermented milks has been accruing due to its health claims. These health claims are not limited to gastrointestinal health, but it also improves immunity and, most recently, cognitive growth. Recent scientific advances have unraveled their positive impact on mood improvement, vaginal health, and metabolic homeostasis. A raft of in vivo studies has claimed their ameliorative, curative and prophylactic potential against noxious disorders in humans. Scope and approach This review shall succinctly summarize the in vivo studies conducted since 2015 to seek the impact of solely probiotic fermented milks (instead of probiotics alone) to prevent and mitigate various pathophysiological insults and cognitive impairments. This review article may promote commercially feasible applications of probiotic fermented milks as a natural remedy to various ailments. Key findings and conclusions Notwithstanding the limited contradictory results of probiotic fermented milks, it was unraveled through studies that overall probiotic fermented milks had promising prophylactic and ameliorative impact on various pathophysiological disorders. However, more well-designed studies on larger groups should be conducted to substantiate their application.

Aim The Prevention of Arrhythmia Device Infection Trial (PADIT) infection risk score, developed based on a large prospectively collected data set, identified five independent predictors of cardiac implantable electronic device (CIED) infection. We performed an independent validation of the risk score in a data set extracted from U.S. healthcare claims. Methods and results Retrospective identification of index CIED procedures among patients aged ≥18 years with at least one record of a CIED procedure between January 2011 and September 2014 in a U.S health claims database. PADIT risk factors and major CIED infections (with system removal, invasive procedure without system removal, or infection-attributable death) were identified through diagnosis and procedure codes. The data set was randomized by PADIT score into Data Set A (60%) and Data Set B (40%). A frailty model allowing multiple procedures per patient was fit using Data Set A, with PADIT score as the only predictor, excluding patients with prior CIED infection. A data set of 54 042 index procedures among 51 623 patients with 574 infections was extracted. Among patients with no history of prior CIED infection, a 1 unit increase in the PADIT score was associated with a relative 28% increase in infection risk. Prior CIED infection was associated with significant incremental predictive value (HR 5.66, P, Graphical Abstract

Cold-water swimming is all the rage, but do the health claims stand up to scrutiny? Alison George investigates

Benign paroxysmal positional vertigo (BPPV) is among the most common inner ear diseases. Although BPPV is one of the most common causes of dizziness, its pathogenesis remains unknown. Air pollutants might reach the middle ear through the eustachian tube and be absorbed into the inner ear through the round window membrane, increasing the risk of BPPV. We investigated the relationship between air pollution and BPPV risk. Data were extracted from the Korean Health Insurance Review and Assessment Service database, which contains health claims information of the entire South Korean population. Variables of interest included the number of patients diagnosed with BPPV in Seoul, South Korea, patients' clinical and demographic characteristics, and osteopenia status. Seoul's daily air pollution indicators, including SO2, CO, O3, NO2, PM10, and PM2.5, were obtained from the Korea Environment Corporation website. Overdispersed Poisson regression analysis was performed. In the multivariable analysis, NO2 air concentration (ppb) was associated with increased incidence of BPPV. In analysis stratified by gender, levels of NO2 were associated with increased incidence of BPPV in both men and women. In the analysis stratified by age, NO2 air concentration was associated with increased incidence of BPPV among all adults over the age of 19 years. In the analysis stratified by osteopenia status, NO2 was associated with increased incidence of BPPV in patients with and without osteopenia. Air levels of NO2 were associated with increased incidence of BPPV in the present study. This finding contributes toward a better understanding of BPPV pathogenesis and improved prevention and management of this condition.

To develop algorithms to identify metastatic castration-sensitive prostate cancer (mCSPC) patients and castration-resistant prostate cancer (mCRPC) patients, using health claims data and laboratory test results.A targeted literature review summarized mCSPC and mCRPC patient selection criteria previously used in real-world retrospective studies. Novel algorithms to identify mCSPC and mCRPC were developed based on diagnosis codes indicating hormone sensitivity/resistance, prostate-specific antigen (PSA) test results, and claims for castration and mCRPC-specific treatments. These algorithms were applied to claims data from Optum Clinformatics Extended DataMart (Date of Death) Databases (commercial insurance/Medicare Advantage [COM/MA]; 01 January 2014-31 July 2019) and Medicare Fee-for-Service (Medicare-FFS; 01 January 2014-31 December 2017).Previous real-world studies identified mCSPC primarily based on metastasis diagnosis codes, and mCRPC based on mCRPC-specific drugs. Using the current study's algorithms, 7034 COM/MA and 19,981 Medicare-FFS patients were identified as having mCSPC, and 2578 COM/MA and 11,554 Medicare-FFS as having mCRPC. Most mCSPC patients were identified based on evidence of being hormone/castration-naive. Patients were identified as having mCRPC most commonly based on rising PSA (COM/MA), or at the metastasis diagnosis date if it occurred after castration (Medicare-FFS). Among patients with mCSPC, 14-17% had evidence of progression to castration resistance during a median 1-year follow-up period, mostly based on use of mCRPC-specific drugs.Comprehensive algorithms based on claims and laboratory data were developed to identify and distinguish patients with mCSPC and mCRPC. This will facilitate appropriate identification of mCSPC and mCRPC patients based on health claims data and better understanding of patient unmet needs in real-world settings.

PurposeThe purpose of this research is to trace the evolution of the claims used for advertising food products in Italian magazines, by analysing the content and structure of the claims, the target audiences and the elements that have the greatest influence on the presence of the claims in food advertising.Design/methodology/approachOn the basis of the research conducted by Pratt and Pratt (1995), revised and adapted to the Italian food context, the authors designed a matrix of 1,316 advertisements, which were selected based on the analysis of 67,340 advertisements and using the reference to the food sector as a discriminator. The advertisements were extrapolated from a sample of six Italian magazines, so as to determine the extent to which the various demographic groups in Italy are exposed to print advertising for food, beverages and food supplements. The authors examined the frequency of the relevant advertising forms over a period of four years, from January 2014 to December 2017.FindingsThe results revealed the main types of claims used in the four-year period, as well as the statistically significant differences between the different magazine panels, as concerns the frequency and the types of messages. Moreover, a strong relationship between the number of advertisements in the magazines and the time of the year was also ascertained, as well as significant gender variations.Originality/valueThis study introduces the trends and dynamics of the Italian printed advertising for food to the relevant scientific literature. The results yielded by this research have added further implications and contributions to the existing studies, as concerns claim diffusion based on type, gender and seasonality, and the authors also provide important insights to various socio-economical stakeholders.

This paper presents an analysis of the underlying assumptions and choices of the European regulatory process for health claims. The latter are scientifically substantiated statements, usually in th...

Introduction Waterpipe tobacco (WT) smoking is associated with misperceptions of harm, especially among users. WT packaging contains imagery, flavor descriptors, and text claims that may contribute to misperceptions. The study goal was to characterize visual and text elements of WT packaging. Aims and Methods Using data from the U.S. Population Assessment on Tobacco and Health Study Wave 2 (October 2014–October 2015), we identified the 10 most popular WT brands. For each brand, we identified available flavors, including flavor collections with unique packaging elements. We randomly selected 10 flavors per brand for purchase (March–April 2018). We conducted descriptive content analysis to code all textual and visual design elements of each package. Results Over half (54%) of WT packages had modified risk tobacco product (MRTP) claims prohibited by federal law, including substance-free MRTP claims (43%) and the descriptor “natural” (11%). No MRTP reduced exposure or reduced risk claims were found. Over a quarter (26%) of packaging including one or more of terms that may imply reduced harm including “fresh,” “premium,” “quality,” and “pure.” All packages included a text-only warning, yet none appeared on the primary display panel. Almost all packaging (99%) included imagery, with 72% including flavor imagery. The majority of packages (72%) included a smoking cue. The most popular marketing appeals were “well-made” (57%), “enjoyable” (55%), and “patriotic” (47%). Conclusions Prohibited MRTP claims, other descriptors, and flavor imagery are common on WT packaging, despite federal law. Future research is needed to evaluate if this marketing contributes to misperceptions of reduced harm. Implications Tobacco packaging is used to convey health-related messages, both explicitly and implicitly; however, information about WT packaging is virtually nonexistent. We conducted a content analysis of WT packaging from the 10 most popular US brands. Over half (54%) of packages had prohibited MRTP claims and over a quarter (26%) included one or more descriptors that may be perceived as implying reduced harm. Use of imagery, including smoking cues, was common. The widespread use of prohibited MRTP claims, other descriptors, and imagery on WT packaging may contribute to misperceptions of reduced harm.

Supplements for smoking-related lung diseases are considered as nonfood products and thought to improve health. Multivitamins and antioxidants are the most commonly dietary supplements used by cancer and asthma patients. There are currently no clear regulatory guidelines that include dietary supplements and their effect on lung cancer and asthma patients, particularly in smokers. Several countries have taken steps to overcome challenges in regulating dietary supplements in the marketplace. These challenges include inadequate assurance of safety/efficacy, inaccuracy of product labeling, misleading health claims, and lack of analytical techniques for dietary supplements. There is a need to establish standards and regulation of dietary supplement use in patients with lung cancer and asthma. The aim of this entry is to expand knowledge on dietary supplements use and smoking-related lung diseases (lung cancer and asthma).

Graphical abstract, Highlights • Silver nanoparticles and silver ions in colloidal silver are toxic. • Internet marketing of colloidal silver included false claims. • Internal use of colloidal silver was promoted by companies and users. • Distrust in authorities expressed in websites and Facebook nulled interventions., Aims The aim was to investigate the marketing practices, beliefs and health claims regarding the use of colloidal silver in Finland. Silver nanoparticles (AgNPs) are potentially toxic due to their small size and Ag+-release capabilities, and the use of colloidal silver products containing AgNPs can cause a wide variety of adverse effects such as argyria. Methods Contents of three company websites selling colloidal silver were reviewed, and the claims used in the marketing of colloidal silver were compared to the scientific information about silver. In Facebook posts and discussion about colloidal silver were analyzed. Results In Finland, the marketing of colloidal silver products on websites selling the products did not follow the regulations of authorities; several scientifically unfounded claims about the efficacy and medical use of colloidal silver were found. After the Finnish Broadcasting Company (Yle) documentary and an intervention by authorities, contents of the websites were changed, but still questionable information and misleading claims could be found. In the analyzed Facebook groups attitudes towards medical use of colloidal silver were uncritically positive, internal use was highly promoted and the restrictions of use were considered unjustified. Conclusions The use of quackery products such as colloidal silver can be dangerous, and their use and marketing should be controlled and restricted.

Análisis teórico de las regulaciones de las declaraciones de salud estadounidense y europea. Desde los estudios sobre comunicación y comprensión públicas de la ciencia, identificamos las estrategias base de sus normativas sobre presentación de este tipo de información en el etiquetado alimentario. Atendiendo a investigaciones empíricas sobre percepción e intención de compra, valoramos en qué medida sus enfoques comunicativos ayudan a alcanzar los objetivos reguladores. Resultados: ambas regulaciones tienen diferencias de enfoque dependientes de distintos objetivos políticos; los estudios disponibles apuntan al fracaso de tales objetivos en ambos casos; ello parece deberse a subyacentes concepciones clásicas sobre comunicación y enculturación científicas. A theoretical analysis of the American and European Health claims regulations. Following the studies on public communication and understanding of science, I identify the underlying regulatory strategies for the regulations on the presentation of this kind of information on food labelling. Based on empirical studies on perception and purchase intention, I assess the extent to which their communicative approaches contribute to achieving the regulatory objectives. Results: Both regulations follow different approaches depending on their different political objectives; The available studies point to the failure of these objectives in both cases; This seems to be due to underlying classical conceptions about science communication and enculturation.

The Food Act of 1980 is the main legislation governing food safety in Sri Lanka. Along with its regulations, the act provides a strong basis to ensure safety of food consumed. However, to achieve its objectives, the act needs to be properly implemented. For that, the food industry needs to adhere to food laws while law enforcing officers need to initiate legal proceedings for law violations. A good knowledge on food laws is needed among food industries, law enforcing officers and consumers contributes towards successive implementation of food laws. The present review examines the available research literature on knowledge on food regulations and practice of food industries, law enforcing officers (Public Health Inspectors) and consumers in Sri Lanka which helps to identify weaknesses in current law enforcement. Most of research on the Sri Lankan Food Act of 1980 has focused on food labels. Very few labels have been found to conform with existing laws and some include outrageous health claims. Knowledge and practice of food regulations by food industry, law enforcing officers and consumers in Sri Lanka are not satisfactory which has led to a failure in achieving the intended objectives of the legislature.

The revised version of Canada’s Food Guide, released in January 2019, issued new guidance by combining meat and alternatives with milk and alternatives into a single group called “protein foods” and emphasized selecting plant-based foods from this category more often. Though the changes represent a simple depiction of a healthy plate, the new Food Guide has opened knowledge gaps about protein foods and exposed new concerns about the interpretation and implementation of the Food Guide among vulnerable groups, particularly children and the elderly. To address key knowledge and research gaps, nutrition leaders need to reach a consensus on key messages to best inform the development of tools and resources to support practitioners in translating messages to consumers, including foodservice standards. Among consumers, families with young children are a primary target for these resources as they develop their life-long habits to ensure they have the knowledge and skills to select, prepare, and consume nutrient-rich protein foods. The new Food Guide provides an opportunity to address the existing knowledge gaps, develop tools and resources to support health professionals, and design interventions that will help Canadian families choose, prepare, and eat nutrient-rich protein foods. Novelty An updated Canadian regulatory framework is needed for protein labelling and content/health claims. There are knowledge gaps about protein foods consumption and food literacy needed to optimize nutritional health. Mandatory nutrition policies are needed to safeguard the provision of high-quality protein foods across institutions that serve children and older adults.

The objective of this study was to evaluate the nutritional, sensorial and microbiological characteristics of pizzas with the inclusion of dehydrated mix of salmon and tilapia in the dough. Tilapia and salmon carcasses were cooked, pressed, ground, dehydrated and crushed, and a mixture of salmon (20%) and tilapia (80%) was made. This mix was included in the pizza dough at different levels (0%, 5%, 10%, 15% and 20%) and afterwards the toppings were added.In the dough composition, protein, ash and phosphorus levels rose linearly, while lipids, carbohydrates and caloric value of the dough samples decreased linearly as the mix levels increased. In pizzas, the moisture, lipids and carbohydrates contents were not different. Protein and ash contents presented a linear behavior. The inclusion of the mix was effective in reducing the saturated fatty acids and raising the content of polyunsaturated fatty acids. There was no difference between the pizzas for the sensorial attributes analysed. Therefore, the inclusion of up to 20% of dehydrated mix of tilapia and salmon added protein, minerals, and polyunsaturated fatty acids and maintained the acceptance of the pizza dough samples, which makes possible the preparation of a food product with health claims and good sensorial quality.

In this study, the crude protein of animal product samples was measured through determination of total nitrogen content using the Kjeldahl method. Measurement of total nitrogen by Kjeldahl procedure is the universal reference method for estimation of protein content in animal and plant products and is used for both calibration and validation of alternative methods in protein determination. The animal protein sources analysed in this study were samples of veal meat, chicken meat, egg and beef hot dog. Based on the results found in this research, the sequence of protein content in the samples was: chicken breast> fresh silverside > fresh thigh > frozen silverside > egg-yolk > beef hot dog > egg-albumin. We also concluded that the health claim of protein percentage that declared on the can of beef hot dog, as well the results of egg-albumin and fresh thigh chicken showed no significance differ compared to the standards.

In order to identify the attitudes of consumers towards innovative food products, including functional foods, qualitative research was carried out in 2019 to find out what are the components of these attitudes in relation to innovative food, on the example of functional food, in the conditions of the growing global tendency to care for health and convenience. As a result of the research carried out using the focus group interview (FGI) methodology, it was found that innovative food is associated with a new taste or packaging, increased nutritional value, as well as health related attributes. Often, in studies, consumers also referred to the reduction or complete elimination of allergenic ingredients and other chemical ingredients, e.g. preservatives, flavor enhancers. Consumers accept these innovations in different ways, generally showing skepticism about “improving” food by enriching it with various ingredients, while positively referring to changes related to the reduction in the content of nutrients considered harmful to health, e.g. fat, sugar or salt. It was also noted that innovativeness treated as a personality trait is accompanied by such features as: openness, tolerance, optimism, life satisfaction, while people lacking tendency to accept innovation are usually pessimistic about the world, attached to tradition or thrifty. It was also noted that consumers similarly perceive innovative and functional food, indicating that functional products are food with a specific health purpose, with a modified composition. The interviewees also indicated that it is possible to increase the interest of consumers in purchasing new food products or functional food through, inter alia, well targeted marketing messages, and it is necessary to take into account the legal regulations regarding their wording when formulating them. This applies in particular to the possibility of using nutrition and health claims in the case of products enriched with ingredients with a declared health-related effect.

Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy.Cross-sectional study.Health claims database from a third-party payer.Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression.A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types (A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

Barley (Hordeum vulgare L.) is an important cereal crop and ranks fourth among the total cereals production but very little of this grain is used as human food. However, these days it is gaining popularity as "functional grain" because it contains higher amounts of bioactive compounds including β-glucan (4-11%) and phytochemicals. The health benefits of barley β-glucan and other bioactive compounds have been well documented. β-Glucan is the most unique polysaccharide of barley which is associated with numerous health benefits including reduction of cholesterol, manage post postprandial blood glucose levels and acts as an anti-cancerous agent. Since food grains including barley are consumed after processing and it may alter the solubility, molecular weight and extractability of β-glucan affecting the health benefits. Therefore, it is important to know the processing effects on β-glucan to confirm such health claims for barley. Most of the review papers published are focused on the health benefits of β-glucan. To the best of our knowledge, no comprehensive report is available on the effects of barley processing on β-glucan content, molecular weight and β-glucan extractability. The present article reviews the literature on processing effects on barley β-glucan.

Seung Heon Lee,1 So-Youn Park,2 Jeong-Yeon Seon,3 Woo-Hwi Jeon,3 Sung-Il Nam,4 Jong-Hak Park,5 Jae Seok Park,6 Hae-Young Kim,7 Niket Thakkar,8 Prashanth Selvaraj,8 Anna Bershteyn,7 In-Hwan Oh3 1Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; 2Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul, Republic of Korea; 3Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea; 4Department of Otolaryngology-Head & Neck Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea; 5Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; 6Division of Pulmonology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea; 7Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; 8Institute for Disease Modeling, Seattle, WA, USACorrespondence: In-Hwan Oh Department of Preventive MedicineSchool of Medicine, Kyung Hee University, Seoul, Republic of KoreaFax +82-2-969-0792Email ihoh@khu.ac.krObjective: To identify risk factors for intensive care unit (ICU) admission and mechanical ventilator usage among confirmed coronavirus disease (COVID-19) patients and estimate the effects of mitigation efforts on ICU capacity in Korea.Patients and Methods: Data on profiles and medical history of all confirmed COVID-19 patients in the past 1 year were extracted from the Korean National Health Insurance System’s claims database to assess risk factors for ICU admission and ventilator use. We used a time-series epidemic model to estimate the ICU census in Daegu from the reported hospital data.Findings: Multivariate regression analysis revealed male sex, old age, and residing in Daegu city as significant risk factors for ICU admission. The number of patients requiring ICU admission exceeded the bed capacity across all Daegu hospitals before March 9, 2020, and therefore, critically ill patients were transferred to nearby hospitals outside Daegu. This finding was consistent with our prediction that the ICU census in Daegu would peak on March 16, 2020, at 160 through mitigation efforts, without which it would have reached 300 by late March 2020.Conclusion: Older age and male sex were risk factors for ICU admission. In addition, the geographic location of the hospital seems to contribute to the severity of the COVID-19 patients admitted to the ICU and to the ICU capacity.Keywords: COVID-19 pandemic, ICU admission, Korea, risk factors

The phenomenal commercial success of many nutraceutical products, dietary and health supplements indicate increasing levels of consumer acceptance to the usage of health supplements in Malaysia. As much as these products are consumed for health purposes, lack of effective control by drug authority leaves much to be desired. Legal issues such as marketing approval, product liability, safety, advertising, trade description (nutrition labelling & health claims) would undoubtedly emerge as direct implications from widespread sales and consumption of such products. Consumers' health and safety are at risk where nutraceuticals can easily penetrate into the market without any need of undergoing clinical studies, as opposed to pharmaceuticals. This article was written based on research that has identified several causal factors to the above-mentioned issues. First, nutraceuticals are loosely classified as in between food and drugs. Due to the loose classification scheme, manufacturers tend to opt that their products be classified as food to escape strict clinical evaluations. This leads to the issue of misleading health claims made on its labels and advertisements. The article examines regulation of nutraceuticals in Malaysia and identifies significant issues therein. Comparative analysis with Japanese nutraceutical regulations was made to learn how Japanese classifies its nutraceuticals under specific categories known as ‘Food for Specified Health Uses (FOSHU)’. Products bearing the FOSHU logo went through strict clinical tests and are allowed to make health claims on their labels – and were proven effective and safe for consumption as claimed. The article made several recommendations for the establishment of a legal framework to regulate nutraceutical products in Malaysia.

Personalised nutrition, the tailoring of nutrition products, services or advice to individual characteristics such as genetics, phenotype, nutritional intake and/or exercise routine, is increasingly attracting the interest of industry, consumers and researchers. This article provides an overview of the current European Union (EU) regulatory framework as applying to personalised nutrition and draws attention to the important role of EU food law in the regulation of this innovative approach to nutrition. It is argued that personalised nutrition challenges the regulatory borderline between health and lifestyle products or services and, furthermore, also pushes the boundaries of current food safety and health claims legislation.

This Perspectives of the published essential medicinal chemistry of cannabidiol (CBD) provides evidence that the popularization of CBD-fortified or CBD-labelled health products, and associated health claims, lack a rigorous scientific foundation. CBD’s reputation as a cure-all puts it in the same class as other “natural” panaceas, where valid ethnobotanicals are reduced to single, purportedly active ingredients. Such reductionist approaches oversimplify useful, chemically complex mixtures in an attempt to rationalize the commercial utility of natural compounds and exploit the “natural” label. Literature evidence associates CBD with certain semi-ubiquitous, broadly-screened, primarily plant-based substances of undocumented purity that interfere with bioassays and have a low likelihood of becoming therapeutic agents. Widespread health challenges and pandemic crises such as SARS-CoV-2 create circumstances under which scientists must be particularly vigilant about healing claims that lack solid foundational data. Herein, we offer a critical review of the published medicinal chemistry properties of CBD, as well as precise definitions of CBD-containing substances and products, distilled to reveal the essential factors that impact its development as a therapeutic agent.

Recommendations to increase whole grain consumption are part of dietary guidelines around the world. To assist consumers in meeting this recommendation, some countries, and health-promoting organizations, have defined qualifying criteria for a whole grain food for product labeling or health claims. Other countries have not yet developed similar guidelines. Existing whole grain definitions and health claims are reviewed here. While there appears to be increasing consensus for defining a whole grain, significant disparity exists in defining a whole grain food when a product is not 100% whole grain. Moreover, while whole grain health claims have been approved in a few countries, other countries have concluded there is insufficient evidence to substantiate such claims.

Objective:The present study aimed at surveying the nutritional quality of prepacked biscuits and sweet snacks sold on the Italian market, and at identifying whether the product type and other information reported on the pack could discriminate the overall quality of products analysed.Design:Data on energy, nutrient and salt content of the products from two different categories of prepacked sweet cereal products (i.e. biscuits and sweet snacks) were collected from thirteen retailers present on the Italian market. Based on the product type, nutrition and health claim (NHC) and gluten-free (GF) declaration, a comparison of nutrient profile within each category was performed.Setting:This work is part of the Food Labelling of Italian Products (FLIP) study that aims at systematically investigating the overall quality of the prepacked foods sold on the Italian market.Results:A total of 1290 products were analysed (63 % biscuits and 37 % sweet snacks). After comparing different product types within each category, a high intra-type product variability was evidenced, which was more pronounced for biscuits. Overall, NHC-carrying products seemed to have a better nutrition profile than those without claims, except for salt content. Conversely, a comparison between GF and gluten-containing products did not show consistent results within the two categories analysed.Conclusions:Due to the high intra-type variability within each category, the different characteristics and regulated information reported on the pack do not seem to be a clear marker of the overall nutritional quality of biscuits and snacks.

OBJECTIVE: This article presents proven, promising, and potential therapeutic uses for cannabidiol (CBD) in the treatment of psychiatric and neurologic conditions and diseases. It presents popular, but scientifically unproven health and therapeutic claims of CBD supporting the beneficial homeostatic effects of the intrinsic or endogenous cannabinoid system. It includes a review of cannabinoid pharmacology; it compares properties and the legal status of CBD and THC (delta 9-tetrahydrocannabinol) as well as the hemp and marijuana varieties of Cannabis, and it reviews the historic 2018 U.S. Food and Drug Administration approval of Epidiolex, an oral solution of cannabidiol for two rare treatment-resistant childhood epilepsies, as the first Cannabis-derived drug. METHOD: We reviewed literature on cannabidiol, CBD, the endocannabinoid neuropharmacology system, and hemp and marijuana varieties of Cannabis sativa. RESULTS: The proven and promising medical uses and deficiencies of unproven health claims for CBD, legal implications for Cannabis-derived drugs, and comparisons of CBD and THC and hemp and marijuana are summarized objectively with pertinent references. CONCLUSION: CBD and CBD and THC combinations have potential to provide safe, effective therapy for several psychiatric and neurologic conditions and diseases. However, such achievement will require a uniform standard of CBD purity and strength, and corroboration from adequately large and rigorously controlled clinical research studies.

Background To this day, many species of peppers, genus Capsicum, have been identified and are the subject of several researches. However, only 5 are commonly used: C. annuum; C. baccatum; C. chinense; C. frutescens and C. pubescens. When associated with a healthy diet, the frequent intake of peppers has been positively correlated to improvements in human health. Most effects are due to the presence of a wide range of bioactive compounds, responsible for their functional properties as well as their technological potential as a food additive. Among the bioactive compounds present in these fruits are capsaicinoids, phenolic compounds, carotenoids, vitamins C and E. Scope and approach The goal of this review is to summarize the main findings regarding the bioactive compounds found in peppers and their technological and functional applications. Key Findings and Conclusions: Results show that despite all health claims and technological potential reported, not all species were thoroughly studied and their potential is still unclear.

Introduction: Postpartum warming is widely practiced among women in Asian countries despite unsubstantiated health claims. This study aimed to identify sources of knowledge and explore the practices of postpartum warming among mothers in Brunei. Methods: A cross-sectional study using a self-administered questionnaire was conducted on 124 mothers who had experience in postpartum warming. Results: Coal was commonly used for heat. Main source of knowledge came from family members. Older women had significantly lower intention to perform the practice in future pregnancies. Women who lived in nuclear families practiced it to a significantly higher frequency compared with those living in extended families. Discussion: Women still practice warming to adhere with family expectations and traditions although noticeable changes have been observed as society modernizes. It still poses a risk of carbon monoxide poisoning and fire hazard from burning coal. Future studies should focus on health and safety aspects to provide evidence on the actual health benefits and ameliorate risk factors.

Chronic illness is a global epidemic and places significant economic and social burdens on societies. Research has shown that a healthy diet can be used to mitigate or significantly reduce the risk of many chronic illnesses. Health authorities around the world have begun regulating health claims on foods to encourage the consumption of healthy foods. However, the “ex post” efficacy of health claims regulations on consumers demand for healthy foods has not been assessed. The demand for fats and meats in Canada is estimated using a linear‐approximate almost ideal demand system. The results indicate health claims decreased unhealthy food demand between 1.41% and 7.10% and increased healthy food demand between 1.95% and 8.50%. Les maladies chroniques sont une epidemie mondiale et font peser des charges economiques et sociales importantes sur les societes. La recherche a montre qu'une alimentation saine peut etre utilisee pour attenuer ou reduire considerablement le risque de nombreuses maladies chroniques. Les autorites sanitaires du monde entier ont commence a reglementer les allegations sante sur les aliments pour encourager la consommation d'aliments sains. Cependant, l'efficacite «ex post» de la reglementation sur les allegations sante sur la demande des consommateurs en aliments sains n'a pas ete evaluee. La demande de matiere grasse et de viandes au Canada est estimee a l'aide d'un systeme de demande lineaire‐de type AIDS. Les resultats indiquent que les allegations sante ont diminue la demande d'aliments malsains entre 1,41% et 7,10% et augmente la demande d'aliments sains entre 1,95% et 8,50%.

Obesity and type 2 diabetes are major health problems affecting hundreds of millions of people. Caloric overfeeding with calorie-dense food ingredients like sugars may contribute to these chronic diseases. Sugar research has also identified mechanisms via which conventional sugars like sucrose and fructose can adversely influence metabolic health. To replace these sugars, numerous sugar replacers including artificial sweeteners and sugar alcohols have been developed. Rare sugars became new candidates to replace conventional sugars and their health effects are already reported in individual studies, but overviews and critical appraisals of their health effects are missing. This is the first paper to provide a detailed review of the metabolic health effects of rare sugars as a group. Especially allulose has a wide range of health effects. Tagatose and isomaltulose have several health effects as well, while other rare sugars mainly provide health benefits in mechanistic studies. Hardly any health claims have been approved for rare sugars due to a lack of evidence from human trials. Human trials with direct measures for disease risk factors are needed to allow a final appraisal of promising rare sugars. Mechanistic cell culture studies and animal models are required to enlarge our knowledge on understudied rare sugars.

Background: Poor recognition of medicine‐induced dry mouth can have a number of adverse effects, including difficulties with speech, chewing and swallowing dry foods, gum disease, dental caries and oral candidosis. This study examined the prevalence of use of medicines that cause dry mouth and claims for dental services funded by the Department of Veterans’ Affairs (DVA) in an Australian cohort. Methods: We used the DVA administrative health claims data to identify persons using medicines that can cause dry mouth at 1st of September 2016 and determine their DVA dental claims in the subsequent year. Results were stratified by gender, residence in community or residential aged cared facility, and number of medicines. Results: We identified 50,679 persons using medicines known to cause dry mouth. Of these, 72.6% were taking only one medicine that may cause dry mouth, and 21.6% were taking two. Less than half (46.2%) of all people taking at least one of these medicines had a dental claim in the following year. A smaller proportion of women (35.9%) made claims than men (56.9%), χ2 = 2248.77, p

This chapter discusses margarine as well as vegetable oil margarine and butter substitutes containing less than 80% fat. These products are referred to as table spreads. The table spread category has undergone great changes in recent years and continues to change rapidly. The market for table spreads, which was originally driven by cost, has now been impacted mainly by health concerns. Claims relative to the cholesterol content, polyunsaturated fats, saturated fats, total fat, and trans-fat content have become important issues. Historical production of spreads and their relationship to butter are discussed. Legal requirements for the composition and labeling of margarine and table spreads are given. Such information is necessary for formulating products to meet specific demands. Labeling is regulated and set forth in the Code of Federal Regulations. Labels concerning health and nutrient content are detailed. Product characteristics of importance are spreadability, oil separation, and melting. The various oils sources in vegetable oil margarines and spreads are discussed in terms of their properties, blending, and specifications. There is a wide range of formulations used in the margarine industry. However, there are five basic processing operations: emulsification, cooling, working, resting, and packaging. Attention is given to the factors impacting on the deterioration and shelf life of the products. Keywords: margarine; spreads; butter; labels; nutrition; health claims; spreadability; source oils; blending; specifications; formulations; flavor; vitamins; processing; low-calorie spreads; deterioration; shelf life

Background People of all ages are flooded with health claims about treatment effects (benefits and harms of treatments). Many of these are not reliable, and many people lack skills to assess their reliability. Primary school is the ideal time to begin to teach these skills, to lay a foundation for continued learning and enable children to make well-informed health choices, as they grow older. However, these skills are rarely being taught and yet there are no rigorously developed and evaluated resources for teaching these skills. Objectives To develop the Informed Health Choices (IHC) resources (for learning and teaching people to assess claims about the effects of treatments) for primary school children and teachers. Methods We prototyped, piloted, and user-tested resources in four settings that included Uganda, Kenya, Rwanda, and Norway. We employed a user-centred approach to designing IHC resources which entailed multiple iterative cycles of development (determining content scope, generating ideas, prototyping, testing, analysing and refining) based on continuous close collaboration with teachers and children. Results We identified 24 Key Concepts that are important for children to learn. We developed a comic book and a separate exercise book to introduce and explain the Key Concepts to the children, combining lessons with exercises and classroom activities. We developed a teachers’ guide to supplement the resources for children. Conclusion By employing a user-centred approach to designing resources to teach primary children to think critically about treatment claims and choices, we developed learning resources that end users experienced as useful, easy to use and well-suited to use in diverse classroom settings.

Background Fiber intake has been associated with a lower risk of developing various chronic diseases such as metabolic diseases (e.g. obesity, diabetes, dyslipidemia). In this line, psyllium presents a high content of soluble fiber, associated with health benefits. Scope and approach The aim of this review is to evaluate the scientific evidence of psyllium health benefits. The nutritional properties of psyllium are presented, as well as its various applications in food products. The main functional benefits of psyllium are presented in topics, as follows: the effect on cholesterol control, on type 2 diabetes, and on obesity and satiety. Key findings and conclusions Products containing psyllium can be an effective alternative to improve the functionality and produce healthy foods. The addition of psyllium to a food product (e.g. bakery goods, dairy, meat and gluten-free products). Can provide the health claim for a fiber-containing product, which is an important advantage in the market. In addition, it may allow consumers to ingest adequate amounts of fiber without increasing calorie intake, as well as contributing to other health benefits such as cholesterol control, glycemic control, satiety, among others. Psyllium can be easily added to food formulations and does not change the flavor perception of the product. Thus, the food industry may play an important role in the prevention of chronic non-communicable diseases when using psyllium in food products.