A recent Food-PRICE systematic review and meta-analysis of interventional studies - led by researchers from the Friedman School of Nutrition Science and Policy at Tufts University and published in the American Journal of Preventive Medicine – has assessed the effectiveness of multiple types of food labels. The researchers found that these approaches can impact some targets, but not others, for both consumer and industry behavior. Over the past two decades, labels such as the U.S. Nutrition Facts Panel on packaged foods, calorie counts on national restaurant menus, front-of-pack labels encouraging healthier eating, and “low-sodium” or “fat-free” identifiers have been developed in order to promote healthier choices. But do they work?
Sixty interventional studies were reviewed. They comprised of two million unique observations, including consumer reported dietary intakes, purchases, and sales receipts, and were published between 1990 and 2014. “Many old and new food policies focus on labeling, whether on food packages or restaurant menus,” says senior and corresponding author Dariush Mozaffarian, M.D., Dr.P.H., dean of the Friedman School. “Remarkably, the effectiveness of these labels, whether for changing consumers’ choices or industry product formulations, has not been clear. Our findings provide new evidence on what might work, and what might not, when implementing food labeling.”
In a pooled analysis of studies that included food labeling on menus, product packaging, or other point-of-purchase materials such as placards on supermarket shelves, the researchers found that labeling reduced consumers’ intake of calories by 6.6 percent, total fat by 10.6 percent, and other unhealthy food options by 13 percent. Labeling also increased consumers’ vegetable consumption by 13.5 percent. In contrast, labeling did not significantly impact consumer intakes of other targets such as total carbohydrate, total protein, saturated fat, fruits, whole grains, or other healthy options. When industry responses were evaluated, the researchers found that labeling led to reductions of both trans fat and sodium in packaged foods by 64.3 percent and 8.9 percent, respectively.
However, no significant effects of labeling were identified for industry formulations of total calories, saturated fat, dietary fiber, other healthy components such as protein and unsaturated fat, or other unhealthy components such as total fat, sugar, and dietary cholesterol, although relatively few studies evaluated these endpoints. “For industry responses, it’s interesting that the two altered components - trans fat and sodium - are additives,” said Mozaffarian. “This suggests that industry may be more readily able to alter additives, as opposed to naturally occurring ingredients such as fat or calories, in response to labeling. It will be interesting to see whether this will translate to added sugar, newly added to the Nutrition Facts Panel on food labels in the United States.”
Considering The Consumer
The researchers also examined the effects of label type, placement, and other characteristics. No consistent differential effects were found by label placements - menu, package, other points-of-purchase - label types such as traffic light, nutrient content, type of labeled products, whether labeling was voluntary or mandatory, or several other factors. The researchers concluded that this suggests that the general presence or absence of information may be more relevant to consumers and industry than the specific type of label.
Limitations were noted. While all studies were interventional, many were non-randomized. Restaurant labeling studies often assessed consumer effects for a single meal, rather than long-term effects. Too few studies evaluated obesity or metabolic risk factors to draw any meaningful conclusions on the effects of labeling on health outcomes. The authors also noted that the studies included in the review were heterogeneous, due to the nature of interventions.
However, by merging findings from 60 interventional studies, the researchers were able to evaluate differences in both consumer and industry responses across 111 intervention arms in 11 countries across four continents. The studies were conducted in the United States/Canada, Europe/Australia, and Asia, and the majority included both genders; most evaluated adults. Most studies evaluated specific meals or products. The findings were centrally pooled in a meta-analysis. Analyses were completed in 2017.
A study, conducted by a team of UK based researchers led by the University of Liverpool known as the ENIGMA Project, revealed the levels of bad behaviors in UK kitchens which increase the public's risk of getting food poisoning. The survey of over 200 chefs revealed that a third of chefs had worked in kitchens which served meat 'on the turn,' over 30 percent had worked in a kitchen within 48 hours of suffering from diarrhea and/or vomiting, 16 percent had served barbeque chicken when not sure it was fully cooked, and seven percent did not always wash their hands immediately after handling raw meat or fish.
The ENIGMA Project is a large collaborative program of research into the most common bacterial cause of diarrheal disease in the developed world, Campylobacter. Undercooked barbeque chicken is associated with Campylobacter, and in addition, chefs returning to work too soon after suffering from diarrhea and/or vomiting have been implicated in high-profile food poisoning outbreaks such as the one at Heston Blumenthal's Fat Duck restaurant.
The research was led by Professor Sarah O'Brien, from the University's Institute of Psychology, Health and Society and was published in journal PLOS ONE. The researchers found that avoiding eating where such behaviors take place is not easy for the public, because chefs working in award-winning kitchens were more likely to have returned to work within 48 hours of suffering from diarrhea and vomiting, and not washing hands was more likely in upmarket establishments. This was despite over a third of the public agreeing that the more expensive a meal was, the safer they would expect it to be.
Chefs working in restaurants with a good Food Hygiene Rating Scheme score were just as likely to have committed the risky behaviors at some time in their career or to have worked with others who had. Among the public sample, the team found over 20 percent had served meat on the turn, 13 percent had served chicken at a barbeque when not sure it was fully cooked, and 14 percent did not always wash their hands immediately after handling raw meat or fish.
Randomized Response Technique
The behaviors involved were embarrassing or potentially incriminating to reveal, so the researchers used something called the Randomized Response Technique (RRT) to cope with the fact that people might not want to reveal the truth about their dark kitchen secrets. This involved those surveyed rolling two dice in secret, and switching their answers according to the values they rolled. The technique makes people more prepared to reveal the truth than just asking them directly, and the researchers were able to recover the true rates of the bad behaviors from the data. "We know that food handling behaviors can create or worsen food safety hazards,” says Professor Sarah O'Brien. “By bringing together researchers from different scientific disciplines in the ENIGMA project we now have a much better idea of what really goes on."
"Foodborne illnesses impose a huge burden to the UK population, and these results indicate a high prevalence of behaviors which can give people food poisoning,” says Professor Dan Rigby from the University of Manchester, one of the lead authors of the study. "Masking the smell and taste of meat on the turn is an old industry trick, and the ability to do it means restaurants can cut costs. Showing you can do it shows a potential employer you are experienced in the industry."
"It is notable that chefs in fine dining establishments were more likely to have returned to work too soon after suffering diarrhea and/or vomiting, contravening UK regulations - this may be that fear of losing a prestigious job, or a desire not to let the team down, is causing people to not to stay away for long enough, putting the public at risk," Rigby added. “Staff currently working in kitchens with higher prices, more awards or a good Food Hygiene Rating Scheme were no less likely to have committed the bad behaviors or have worked with colleagues who had in the past - meaning that the public face a difficult challenge to protect themselves from these bad kitchen behaviors."
"Whilst this may appear to be an unexpected use of dice, it has been repeatedly demonstrated that it is the most effective method for obtaining honest answers to very sensitive questions,” added Dr. Paul Cross from Bangor University. "We're therefore confident in the reliability of the data we've collected and the implications this holds for food safety practices."
Improving Food Safety With Sensor Design
In the U.S., more than 100 food recalls were issued in 2017 because of contamination from harmful bacteria such as Listeria, Salmonella or E. coli. A new sensor design could one day make it easier to detect pathogens in food before products hit the supermarket shelves, thus preventing sometimes-deadly illnesses from contaminated food. In the journal Optical Materials Express, researchers report a new design for a sensor that can simultaneously detect multiple substances including dangerous bacteria and other pathogens.
In addition to food safety, the new design could improve detection of gases and chemicals for a wide range of other applications. "Our design is based on graphene sheets, which are two-dimensional crystals of carbon just one atom thick," says research team member Bing-Gang Xiao, from China Jiliang University. "The sensor is not only highly sensitive but can also be easily adjusted to detect different substances." The excellent optical and electronic properties of graphene make it attractive for sensors that use electromagnetic waves known as plasmons that propagate along the surface of a conducting material in response to light exposure. A substance can be detected by measuring how the refractive index of the sensor changes when a substance of interest is close to the graphene's surface.
Researchers have taken advantage of graphene's unique properties to create sensors and materials for a range of applications in recent years. Compared to metals like gold and silver, graphene exhibits stronger plasmon waves with longer propagation distances. In addition, the wavelength at which graphene is responsive can be changed by applying a polarization voltage instead of recreating the whole device. However, few previous research efforts have demonstrated sensitive graphene sensors that work with the infrared wavelengths necessary to detect bacteria and biomolecules.
For the new sensor, the researchers used theoretical calculations and simulations to design an array of nanoscale graphene disks that each contain an off-center hole. The sensor includes ion-gel and silicon layers that can be used to apply a voltage to tune the graphene's properties for detection of various substances. The interaction between the disks and their holes creates what is known as the plasmon hybridization effect, which increases the sensitivity of the device. The hole and the disk also create different wavelength peaks that can each be used to detect the presence of different substances simultaneously.
Simulations performed by the researchers using mid-infrared wavelengths showed that their new sensor platform would be more sensitive to substances present in gases, liquids or solids than using discs without holes. The researchers are now working to improve the process that would be used to make the array of nanoscale discs. The accuracy at which these structures are fabricated will greatly impact the performance of the sensor. "We also want to explore whether the graphene plasmon hybridization effect could be used to aid the design of dual-band mid-infrared optical communication devices," Xiao said.
Link Between Food Allergies And Childhood Anxiety
Researchers at Columbia University's Mailman School of Public Health and Ferkauf Graduate School of Psychology and Albert Einstein College of Medicine studied the link between food allergies and childhood anxiety and depression among a sample of predominantly low socioeconomic status minority children. The results showed that children with a food allergy had a significantly higher prevalence of childhood anxiety. Food allergies were not associated with symptoms of childhood depression or with symptoms of anxiety or depression among their caregivers. The results were published in the Journal of Pediatrics.
Food allergies are increasingly common among youth in the U.S. with recent estimates as high as eight percent. Until now little was known about the prevalence of food allergy in low socioeconomic ethnic minority populations. The researchers studied 80 pediatric patients ages four to 12 years - eight years old on average - with and without food allergy and their caregivers from urban pediatric outpatient clinics in the Bronx, New York. They controlled for an asthma diagnosis in the children, as anxiety and mood disorders are more prevalent among youth with asthma and especially more common in low socioeconomic minority children.
Among the children with a food allergy, 57 percent reported having symptoms of anxiety compared to 48 percent of children without a food allergy. Approximately 48 percent of the children had symptoms of depression with or without a food allergy. "Management of a food allergy can be expensive both in terms of food shopping, meal preparation, and the cost of epinephrine auto-injectors, which expire annually," says Renee Goodwin, Ph.D., in the Department of Epidemiology at the Mailman School of Public Health and lead author. "These demands could result in higher levels of anxiety for those with fewer financial resources and further heighten anxiety symptoms in children and their caregivers."
The results suggest that food allergy is particularly linked to elevated social anxiety and fear of social rejection and humiliation. "There are a number of possible explanations for the relationship found between food allergy diagnosis and increased social anxiety issues in this sample of pediatric patients," Goodwin said. "Management of a potentially life-threatening condition may be anxiety provoking, and some children may experience increased social anxiety about being "different" from other children depending on their age and how the food allergy is managed by adults in a particular setting."
The researchers also point out a possible explanation for not finding a link between the food allergy and depression in children. The sample was young, and the mean age of onset for depression is significantly later than anxiety. "It would be worthwhile to examine these relationships among older adolescents and young adults with food allergy who are at the peak of risk for depression onset, especially because early anxiety is associated with increased risk for subsequent onset of depression," says Jonathan Feldman, Ph.D., professor of Psychology at Ferkauf Graduate School of Psychology, Yeshiva University. "With the high prevalence of food allergies today, education in schools remains a priority," Goodwin added. "Given the strong association between a food allergy and social anxiety in children, future investigations on the food allergy-mental health relationship are also warranted in clinical, school, and community-based settings which could aid in the development of interventions."
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