Purpose: Cardiovascular health is linked to sugar- and artificially-sweetened beverages (SSBs and ASBs). Previous US studies document declines in SSB purchases, but it is unclear if similar trends exist in convenience and other small stores where SSB and ASB purchasing is common and point-of-sales data are difficult for researchers to obtain. We examined trends (2014-2017) in observed SSB and ASB purchases at convenience and other small food stores as well as differences in purchasing by customer characteristics.

Methods: We used observational food and beverage purchase data collected annually (2014-2017) from 3039 customers at 147 randomly-sampled stores in Minneapolis/St. Paul, USA. Customers >=18 years who made a food/beverage purchase were recruited. SSB sub-types included any ready-to-drink sweetened soda, fruit, sport, energy, tea, or other drink, and ASBs included artificially-sweetened versions. Mixed regression models examined purchase trends over time and associations with customer characteristics, accounting for customers nested within stores and stores repeated over time.

Results: Nearly 50% of customers purchased SSBs with 25% of all customers purchasing soda. There was no evidence of change over time in the proportion of customers purchasing SSBs overall or across beverage sub-types. A similar pattern was observed for ASBs, though <10% of customers purchased ASBs. SSB purchasing was highest among men, those 18-39 years, customers with lower educational attainment and income, and customers that shopped daily (vs. less frequently) at the store. SSB purchasing overall did not vary by race/ethnicity, but did by sub-type (e.g., non-Hispanic White had higher purchasing of energy drinks and lower purchasing of fruit and soda drinks than non-Hispanic Black). ASB purchasing was highest among women, those 40-59 years, non-Hispanic White, Hispanic, and customers with higher educational attainment and income.

Conclusions: Despite research indicating promising trends in reduced SSB consumption and purchasing in the US, we identified a flat trend over time (2014-2017) at convenience and other small food stores with nearly half of customers continuing to purchase SSBs. SSBs and ASBs are growing targets for public policy and health campaigns. Results demonstrate additional work is needed curb sweetened beverage purchasing at convenience and other small food stores.

Purpose: This study aims to estimate the probability and volume of sugar-sweetened beverage (SSB) purchases among urban households in Peru in 2016-2017, prior to the SSB tax implemented in 2018. The 2018 regulation increased the tax on high-sugar (>6 g/100 mL) beverages containing added sugar, sweeteners, or flavors from 17% to 25%, while the tax on lower sugar beverages remained at 17%. Additionally, we examine differences in purchases by socioeconomic status (SES) to understand which groups are most likely to be impacted by the tax and 2019 front-of-package warning label law.

Methods: The dataset includes monthly household purchase data from 5145 households (91,599 household-month observations), collected by Kantar WorldPanel Peru from January 2016 to December 2017. We used logistic regression to estimate the probability of purchase in a month by beverage type and tax status (under the 2018 regulation), overall and by SES. SES was determined based on an assets index and key sociodemographic characteristics and ranged from high (A/B) to low (E). Using two-part models, we estimated volume purchases of each beverage type overall and by SES among purchasers, with robust standard errors. Models included fixed effects for month, year, and region, and adjusted for head of household education, household size, and number of children (≤12 years).

Results: The predicted probability of purchasing any taxed high-sugar (>6 g/100 mL) beverage in a month was 92.1% (95% CI: 91.7, 92.5). An estimated 85.7% (85.1, 86.3) of households purchased regular soda, the most commonly purchased beverage type, with no significant differences by SES. Regular soda purchases also comprised the largest quantity of any beverage type by volume for all groups, except the high SES group, which purchased more water. Estimated volume purchases of regular soda were highest in the high SES group [2517 (95% CI: 2367, 2666) mL/capita/household/month] and lowest in the low SES group [1905 (95% CI: 1785, 2026) mL/capita/household/month].

Conclusions: SSB purchases, particularly sodas, are ubiquitous across all levels of SES in urban Peru, although high SES households purchase the largest volume. Impact evaluations of recent tax and warning label policies should consider potential differential effects by SES.

Purpose: In response to concerns about the health and environmental effects of animal-based food consumption, the market for plant-based proteins has grown substantially in recent years. Households that purchase these products have not been well-characterized. We used nationally-representative data to describe sociodemographic characteristics associated with plant-based protein purchases.

Methods: Data were from 91,445 US households in the Nielsen Homescan Consumer Survey, 2015-2018. Volume of plant-based protein purchases (tofu, tempeh, seitan, and meat analogues) was used to classify households as purchasers or non-purchasers. Multivariate generalized linear models with year fixed-effects were used to model likelihood of plant-based protein purchase over time and associations with household income, education, and race/ethnicity. Two-part models were used to assess continuous per-capita purchase volume over the same time period and associations with the same sociodemographic characteristics. All analyses accounted for complex survey design.

Results: From 2015-2018, an estimated 13.0% (95% CI: 12.7-13.2%) of households purchased plant-based protein within a given year, with a mean volume of 145.1 (95%CI: 137.3-152.9) grams/capita/year. There was no change in estimated prevalence or volume of plant-based protein purchases from 2015-2018. Non-Hispanic Asians had a higher likelihood of purchasing plant-based proteins than any other racial/ethnic group [30.5% (28.6-32.4%), all p<0.001], and purchased an estimated 360.5 (314.5-406.4) grams/capita/year (all p<0.001). There were no significant differences in likelihood or volume of plant-based protein purchases between Non-Hispanic white, Non-Hispanic Black, and Hispanic-identifying households. Low-income households were more likely to purchase plant-based proteins [15.4% (14.9-16.0%)] than middle- [12.8% (12.4-13.1%), p<0.001] and high-income households [11.1% (10.7-11.6%), p<0.001]. Low-income households also purchased greater volume of plant-based proteins than those with higher income [200.4 (181.4-219.5) grams/capita/year for low-income households vs. 138.2 (129.2-147.2) for middle- and 110.1 (100.4-119.8) for high-income households, all p<0.001]. There were no consistent associations between education and plant-based protein purchases. 

Conclusions: A small proportion of US households purchased plant-based proteins and, surprisingly, this did not increase between 2015 and 2018 in a large, national sample. Low-income households were more likely to purchase plant-based proteins, suggesting a need to target policies and marketing strategies to high-income groups to increase uptake of sustainable protein alternatives.

Purpose: High intake of sugary soft drinks (SSDs or sodas) contributes to detrimental cardio-metabolic indicators in youth. Monitoring SSD consumption is informative for risk assessment but lacking in Eastern Europe. This study aims to describe time trends in the national prevalence of daily consumption of SSDs and related socioeconomic differences among Eastern European adolescents between 2002 and 2018.

Methods: We used 2002, 2006, 2010, 2014 and 2018 data of the ‘Health Behaviour in School-aged Children’ school-based study. Nationally representative samples of adolescents aged 11, 13 and 15 years were included (n=325,184 from 14 countries; 51.2% girls). Adolescents completed a standardized questionnaire in class, including a short, validated food frequency questionnaire. We categorised adolescents into three socioeconomic groups based on the relative family affluence scale (FAS, 20% lowest, 60% middle and 20% highest). Adjusted prevalence of daily SSD consumption by survey year and time trends between 2002 and 2018 were computed at the country level using multilevel logistic models (overall and stratified by FAS groups; clusters were schools).

Results: In 2018, the prevalence of adolescents consuming SSDs everyday varied considerably between countries [range, 5.1%-28.1%], with prevalence higher than 20% in 5/14 countries. Between 2002 and 2018, the prevalence of daily SSD consumption declined in 10/14 countries (P for linear trends ≤0.004). The largest reductions were observed in Slovenia (OR 0.48, 95%CI: 0.45-0.50) and the Russian Federation (OR 0.67, 95%CI: 0.64-0.70). Daily SSD consumption reduced at faster rates among the most affluent adolescents (who were more frequent consumers 2002 however) than in the least affluent adolescents in 11/14 countries (P≤0.004). Thus, differences between FAS groups narrowed over time, or even reversed. In 2018, larger proportions of daily consumers were found among the least affluent adolescents in 2018 in 5/14 countries (P≤0.05). Social patterning was similar among boys and girls, and in all three age categories.

Conclusions: Daily adolescent consumption of SSDs decreased between 2002 and 2018 in most Eastern European countries, mainly driven by larger declines among more affluent adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

Purpose: U.S. urban and rural communities face different challenges in accessing healthy food.Previous studies have examined differences in fruit and vegetable availability between urban and rural communities, but few have examined how the intersection of urban/rural status and Supplemental Nutrition Assistance Program (SNAP) participation affects food purchasing at the household level. This study aimed to address this gap by assessing fruit and vegetable purchasing at the intersection of SNAP participation status and urban/rural status among a nationally representative sample of U.S. households. 

Methods: Cross-sectional data from the USDA’s National Household Food Acquisition and Purchase Survey was used to assess fruit and vegetable purchasing among 1,149 rural households (32.44%) and 3,001 urban households (67.56%). SNAP participation status was categorized as follows: SNAP household, eligible non-SNAP household, and ineligible non-SNAP household. Stratified linear regression models were used to identify significant associations between SNAP status and total amount of money ($US) spent on fruits and vegetables by urban/rural status. All models were controlled for covariates such as race/ethnicity, education level, and car access.

Results: Rural household heads were more likely to be older, female, non-Hispanic White, and have lower educational attainment compared to urban household heads. SNAP households, regardless of urban/rural status, spent less money on fresh and frozen fruit and vegetables compared to ineligible non-SNAP households. For urban households, SNAP households spent more money on shelf-stable fruit and vegetables than ineligible non-SNAP households. For rural households, SNAP households spent less on shelf-stable fruits and vegetables than ineligible non-SNAP households. Further, among rural households, SNAP households and eligible non-SNAP households spent significantly less money on fruits (p<0.0001 & p=0.0003, respectively) and vegetables (p<0.0001 & p=0.03, respectively) compared to ineligible non-SNAP households. Among urban households, only SNAP households spent significantly less money on fruit (p<0.0001) and vegetables (p<0.0001) compared to ineligible non-SNAP households.

Conclusions: Associations between SNAP status and fruit and vegetable purchasing differed by urban/rural status, with low-income rural households purchasing less fruits and vegetables. Future studies should examine how these disparities influence risk for poor diet quality and chronic disease.

Purpose: To report on the adherence to national food-based dietary guidelines (FBDGs) in high-income (HIC) and low-and-middle-income countries (LMIC).

Methods: The protocol for this systematic review was registered with PROSPERO and has been reported according to PRISMA guidelines. Systematic review with searches in six databases was performed up to June 2020. Peer-reviewed, English language articles were included if they investigated a population of healthy children and adults (7-65 years), used an observational or experimental study design evaluating adherence to own country FBDGs. Two reviewers independently extracted data and assessed their quality using a designed appraised tool developed by Effective Public Health Practice Project (EPHPP).

Results:  Almost 40% of the population in both HIC and LMIC had diets that did not adhere to their national FBDGs. Fruit and vegetables (FV) were the most reported and the prevalence of meeting FV guidelines was between 7% to 67.3%. Discretionary foods were reported by 11 (22.4%) studies. HIC have a higher consumption of discretionary foods, while results were mixed for LMIC. Grains and dairy were consumed below the recommendations in both HIC and LMIC. Consumption of animal proteins, particularly read meat in LMIC and Spain, exceeded the recommendations.

Conclusion: Dietary guidelines are useful tools to promote a healthy diet for different age groups. Individuals from HIC and LMIC may be falling short of at least one dietary recommendation from their country’s guidelines. A number of socio-demographic factors may influence guideline adherence. Future health policies, behavioral-change strategies, and dietary guidelines may consider these results in their development.