Folate fortification : a case study of public health policy-making

This thesis investigates the use of scientific evidence in the process of making public health policy. A case study located within a food regulation setting is used. The aim is to test theory against this case study. The outcome is a theoretical understanding of the use of scientific evidence in the policy-making process in a food regulation setting. Food regulation can influence food composition and food labelling and thereby affect the population's dietary intake. Frequently there are contested values, beliefs, ideologies and interests among stakeholders regarding the use of food regulation as a policy instrument to effect public health outcomes. The protection of public health and safety, taking into account evidence based practice, is generally employed by food regulators as the priority objective during the policy-making process to adjudicate among the competing expectations of stakeholders. However, this policy objective has not been clearly defined and is vulnerable to interpretation and application. The process by which folate fortification policy was made in Australia, in response to epidemiological evidence of a relationship between folate intake during the periconceptional period and reduced risk of neural tube defects, was analysed as a case study of the policy-making process. The folate fortification policy created a precedent for both food fortification and subsequently health claims policy in Australia. A social constructivist method was used to analyse the case study. The method involved deconstructing the food regulatory system into three levels; decision-making process; procedural; and political environment. Data aligned with each level of analysis was collected from 22 key informant interviews, documentary sources, field notes and surveys of both a random sample of the Australian population's knowledge of folate and use of folic acid-containing supplements (n = 5422), and the implementation of folate fortified food products into stores (n = 60). The insights that emerged from each of the three levels of analysis were assessed iteratively to identify a pattern of interrelationships associated with the policy-making process within the food regulatory system. The identified pattern was interpreted against existing theory to gain a theoretical understanding of the public health policy-making process in this political setting. The central argument of this thesis extends Sabatier and Jenkins-Smith's Advocacy Coalition Framework theory to a food regulation setting. The argument is that within the contemporary political climates of neoliberalism and globalisation, a coalition between corporate interests and the values of scientists with a positivist-reductionist approach to public health research is privileged so as to invoke certain scientific evidence to, in turn, legitimise food regulation policy decisions. The theory will help to inform policy-makers about how and why the public health policy objective in a food regulation setting is interpreted and applied. This will contribute to improving policy practice intended to effect public health outcomes. It is concluded that irrespective of the quantity and quality of the scientific evidence that is being made available, scientific evidence cannot be assumed to speak for itself Policy-making is an inherently political and value-laden process and the potential for politically motivated interpretation and application of otherwise value-neutral scientific evidence can undermine the investment in its generation. From this perspective, evidence based practice, far from liberating policy-making from political influence, can itself become part of the problem rather than the solution. Nevertheless, rational evidence based practice is an ideal to strive for and a series of recommendations is proposed to help make the use of evidence in current food regulation policy processes more transparent and democratic.

Nutrient profiling interventions targeting obesity prevention : role and potential impact

This thesis outlined the role and potential impact of a range of policy options for obesity prevention. It provided evidence that population-wide interventions, such as changes to food labelling and taxes on unhealthy foods, are likely to offer excellent 'value for money' for governments from an obesity prevention perspective.

Jumping on the omega-3 bandwagon : distinguishing the role of long-chain and short-chain omega-3 fatty acids

Omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) are almost unanimously recognized for their health benefits, while only limited evidence of any health benefit is currently available specifically for the main precursor of these fatty acids, namely α-linolenic acid (ALA, 18:3n-3). However, both the n-3 LC-PUFA and the short-chain C18 PUFA (i.e., ALA) are commonly referred to as “omega-3” fatty acids, and it is difficult for consumers to recognize this difference. A current gap of many food labelling legislations worldwide allow products containing only ALA and without n-3 LC-PUFA to be marketed as “omega-3 source” and this misleading information can negatively impact the ability of consumers to choose more healthy diets. Within the context of the documented nutritional and health promoting roles of omega-3 fatty acids, we briefly review the different metabolic fates of dietary ALA and n-3 LC-PUFA. We also review food sources rich in n-3 LC-PUFA, some characteristics of LC-PUFA and current industry and regulatory trends. A further objective is to present a case for regulatory bodies to clearly distinguish food products containing only ALA from foods containing n-3 LC-PUFA. Such information, when available, would then avoid misleading information and empower consumers to make a more informed choice in their food purchasing behavior.

Progress on obesity prevention over 20 years in Australia and New Zealand

The lessons learned from over 20 years of obesity prevention efforts in Australia and New Zealand are presented. The obesity epidemic started in the 1980s but poor monitoring systems meant the rise in obesity prevalence initially went undetected. In the 1990s, experts started advocating for government action; however, it was the rapid increase in media reports on obesity in the early 2000s which created the pressure for action. Several, comprehensive reports produced some programme investment but no regulatory policies were implemented. The powerful food industry lobby ensured this lack of policies on front-of-pack food labelling, restrictions on unhealthy food marketing to children, or taxes on unhealthy foods. The New Zealand government even backpedalled by rescinding healthy school food guidelines and withdrawing funding for the comprehensive national obesity strategy. In 2007, Australian Governments started a major long term-investment in preventive health in order to improve economic productivity. Other positive initiatives, especially in Australia, were: the establishment of several advocacy organizations; successful, long-term, whole-of-community projects reducing childhood obesity; a national knowledge exchange system for practitioners; and some innovative programmes and social marketing. However, despite multiple reports and strong advocacy, key recommended regulatory policies remain unimplemented, largely due to the private sector interests dominating public policy development.

Nutritional guide for a modern woman: a strategy for health education

"In the present article, we introduce a Health Education instrument that stems from a refection on the lay knowledge, salutogenic habits and daily nutritional practices of modern women in our current society. We developed a guide aimed at modern women, where the different food groups and food hygiene and safety measures are addressed. The guide includes eleven original pictograms that help the reader to locate and look up specific issues. The guide employs the label reading and interpretation principles, following the nutrition traffic-light internationally instituted, for it renders scientific information on nutrition clear and accessible to the general population. We believe that using this guide as a central strategy in health promotion will lead its users to adopt essential changes in their eating patterns and, in so doing, contribute to prevent diseases associated to bad eating habits. We also emphasize the role of mass media in spreading the conveyed information."

Consumers knowledge about dietary fibre : Results of a survey questionnaire in Hungary and Romania

Dietary fi bres (DFs) are essential components of the balanced diet. Even though the adequate level of their consumption can be ensured from several natural (e.g. fruit, vegetables, legumes) and ‘artifi cial’ sources (e.g. functional foods), the consumed levels are below the recommendations. To analyse the Hungarian and Romanian consumers’ knowledge level, their perceptions of the health benefi ts associated with fi bre, as well as the recognition of the potential information sources, a survey questionnaire was conducted with the total of 713 consumers. Results showed that the level of knowledge about DFs was not adequate. Internet was found to be widely used and identifi ed as one of the most appropriate information sources to encourage the consumption of DF. It was a favourable result that three-quarter of the respondents was interested in the topic of healthy food consumption; however, just less than half of them took into consideration the label information during their shopping decisions. To increase the consumption of DF and to support the responsibility and conscious consumer decisions steps must to be done (e.g. education of children, pointing out of the sources). For this purpose, modern information technology and communication channels fi tting to the consumers’ cultural and personal particularities can be utilized.

Knowledge and attitudes towards dietary fibers - romania vs other european countries

Aim: The aim of our study was to evaluate the Romanian’s knowledge and attitudes regarding dietary fibers compared with other European countries. Materials and methods: We made a cross-sectional survey (part of multinational project from CI&DETS Research Centre, Instituto Politecnico Viseu, Portugal, with reference PROJ/CI&DETS/2014/0001) based on a questionnaire applied in 2015, over 670 Romanian consumers, focused on the attitudes and knowledge towards ingestion of foods rich in fibers. We used the software SPSS for statistics. Results: Our results showed that the knowledge about dietary fibers and also the ingestion of food products rich in fibers were low. The female participants ate more whole grains and fruits than males and pay more attention to food labelling, the Romanian people prefer to stay and eat home than at restaurants especially in rural areas, and the knowledge about fiber’s benefits was significantly related to high education and urban location. Comparing to other European countries, Romania had the highest level of knowledge about dietary fibers definition followed by Portugal, Turkey and Hungary, but the lowest regarding the fibers importance for health after Macedonia, Turkey and Latvia. Conclusion: We sustain the needs for more efficient community interventions and proper information about the importance of dietary fibers for our health and also for the dissemination of the nutritional standards among Romanian population.

Romanian Knowledge and Attitudes regarding Dietary Fibers

Presently, the scientists recognize the health benefits of food fibers in the menu and also plant food sources are at high interest both for general population and food companies. The food companies are responsible for a clear nutrition labelling that will assist consumers to make informed and healthy choices and health providers has to inform the population about the benefits of fibers.The aim of our study was to evaluate the Romanian knowledge and attitudes regarding dietary fibers from food products. We made a qualitative survey based on a questionnaire applied in 2015, over a period of 6 months, over 670 Romanian consumers. It was focused on testing the attitudes and knowledge towards ingestion of foods rich in fibers. For all data analysis we used the software SPSS, from IBM Inc. Our results showed that the knowledge about dietary fibers and also the ingestion of food products rich in fibers were low, and most of the subjects didn’t have any interest to read the nutritional information from food labels. The female participants ate more whole grains and fruits than males and pay more attention to food labelling. Romanian people prefer to stay and eat home than at restaurants especially in rural areas, and the knowledge about fibers benefits was significantly related to education and urban location. We underline the needs for more efficient community interventions and proper information about the importance of dietary fibers for our health and also to improve and disseminate nutritional standards and diet recommendation among population.

Atitudes da população portuguesa em relação à fibra alimentar

Introdução: A fibra dietética (FD) tem feito parte da dieta humana desde há milénios, embora os seus benefícios tenham sido reconhecidos, principalmente, nas últimas décadas. Objetivos: Porque a FD é um componente importante de uma dieta saudável, o objetivo deste trabalho foi avaliar os hábitos de consumo dos Portugueses, bem como o seu conhecimento sobre os alimentos ricos em fibras e as suas atitudes em relação à rotulagem dos alimentos. Métodos: Foi realizado um estudo descritivo transversal usando uma amostra não-probabilística de 382 participantes. Resultados: Os resultados mostraram que a ingestão de alimentos ricos em fibras, como frutas, vegetais e cereais, foi muito menor do que a ingestão recomendada. Os resultados também indicaram que a maioria das pessoas não presta a atenção desejada à rotulagem de alimentos ou à informação nutricional. Conclusões: O nível geral de conhecimento sobre FD foi considerado insatisfatório, e, portanto, é necessário mais educação nutricional e desenvolver esforços para informar as pessoas acerca da importância da FD como parte da sua dieta diária.

Evaluation of methodologies to determine vegetable oil species present in oil mixtures: Proposition of an approach to meet the EU legislation demands for correct vegetable oils labelling

Refined vegetable oils are widely used in the food industry as ingredients or components in many processed food products in the form of oil blends. To date, the generic term 'vegetable oil' has been used in the labelling of food containing oil blends. With the introduction of new EU Regulation for Food Information (1169/2011) due to take effect in 2014, the oil species used must be clearly identified on the package and there is a need for development of fit for purpose methodology for industry and regulators alike to verify the oil species present in a product. The available methodologies that may be employed to authenticate the botanical origin of a vegetable oil admixture were reviewed and evaluated. The majority of the sources however, described techniques applied to crude vegetable oils such as olive oil due to the lack of refined vegetable oil focused studies. Nevertheless, DNA based typing methods and stable isotopes procedures were found not suitable for this particular purpose due to several issues. Only a small number of specific chromatographic and spectroscopic fingerprinting methods in either targeted or untargeted mode were found to be applicable in potentially providing a solution to this complex authenticity problem. Applied as a single method in isolation, these techniques would be able to give limited information on the oils identity as signals obtained for various oil types may well be overlapping. Therefore, more complex and combined approaches are likely to be needed to identify the oil species present in oil blends employing a stepwise approach in combination with advanced chemometrics. Options to provide such a methodology are outlined in the current study.

A review of the global pesticide legislation and the scale of challenge in reaching the global harmonization of food safety standards

Pesticide use is important in agriculture to protect crops and improve productivity. However, they have the potential to cause adverse human health or environmental effects, dependent on exposure levels. This review examines existing pesticide legislation worldwide, focusing on the level of harmonisation, and impacts of differing legislation on food safety and trade. Pesticide legislation varies greatly worldwide as countries have different requirements guidelines and legal limits for plant protection. Developed nations have more stringent regulations than developing countries, which lack the resources and expertise to adequately implement and enforce legislation. Global differences in pesticide legislation act as a technical barrier to trade. International parties such as the European Union (EU), Codex Alimentarius Commission (Codex), and North American Free Trade Agreement (NAFTA) have attempted to harmonise pesticide legislation by providing maximum residue limits (MRLs), but globally these limits remain variable. Globally harmonised pesticide standards would serve to increase productivity, profits and trade, and enhance the ability to protect public health and the environment.