Protein-energy malnutrition (PEM) is a growing concern on account of an aging population and its negative health consequences. While dietary protein plays a key role in the prevention of PEM, it also plays a pivotal role in the environmental impact of the human diet. In search for sustainable dietary strategies to increase protein intake in older adults, this study investigated the readiness of older adults to accept the consumption of the following alternative, more sustainable protein sources: plant-based protein, insects, single-cell protein, and in vitro meat. Using ordinal logistic regression modeling, the associations of different food-related attitudes and behavior and sociodemographics with older adults’ acceptance to consume such protein sources were assessed. Results were obtained through a consumer survey among 1825 community-dwelling older adults aged 65 years or above in five EU countries (United Kingdom, the Netherlands, Poland, Spain, and Finland). Dairy-based protein was generally the most accepted protein source in food products (75% of the respondents found its consumption acceptable or very acceptable). Plant-based protein was the most accepted alternative, more sustainable protein source (58%) followed by single-cell protein (20%), insect-based protein (9%), and in vitro meat-based protein (6%). We found that food fussiness is a barrier to acceptance, whereas green eating behavior and higher educational attainment are facilitators to older adults’ acceptance to eat protein from alternative, more sustainable sources. Health, sensory appeal, and price as food choice motives, as well as gender and country of residence were found to influence acceptance, although not consistently across all the protein sources. Findings suggest that there is a window of opportunity to increase older adults’ acceptance of alternative, more sustainable protein sources and in turn increase protein intake in an environmentally sustainable way in EU older adults.

Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax. Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions. Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38–0.47) supports an SSBs tax, 39% (0.29–0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60–0.72) supports an SSBs tax if revenue is used for health initiatives. Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation.

Food waste generated at the household level represents about half of the total food waste in high-income countries, making consumers a target for food waste reduction strategies. To successfully reduce consumer food waste, it is necessary to have an understanding of factors influencing food waste behaviors (FWB). The objective of this study was to investigate socio-demographic predictors of FWB among consumers in two European countries: Denmark and Spain. Based on a survey involving 1518 Danish and 1511 Spanish consumers, we examined the associations of age, sex, education, marital status, employment status, and household size with FWB. By using structural equation modeling based on confirmatory factor analysis, we created the variable FWB from self-reported food waste and two activities that have been correlated with the amount of food wasted in previous studies: namely, shopping routines and food preparation. Results show that being older, unemployed, and working part-time were associated with less food waste behavior in both countries. In Denmark, being male was associated with more food waste behavior, and living in a household with four or more people was associated with less food waste behavior. These results underscore the modest role of socio-demographic characteristics in predicting food waste behavior in Europe.

Substituting sugar-free for sugar-sweetened beverages reduces weight gain. This effect may be more pronounced in children with a high body mass index (BMI) because their sensing of kilocalories might be compromised. We investigated the impact of sugar-free versus sugary drinks separately in children with a higher and a lower initial BMI z score, and predicted caloric intakes and degree of compensation in the two groups. This is a secondary, explorative analysis of our double-blind randomized controlled trial (RCT) which showed that replacement of one 250-mL sugary drink per day by a sugar—free drink for 18 months significantly reduced weight gain. In the 477 children who completed the trial, mean initial weights were close to the Dutch average. Only 16% were overweight and 3% obese. Weight changes were expressed as BMI z-score, i.e. as standard deviations of the BMI distribution per age and sex group. We designated the 239 children with an initial BMI z-score below the median as ‘lower BMI’ and the 238 children above the median as ‘higher BMI’. The difference in caloric intake from experimental beverages between treatments was 86 kcal/day both in the lower and in the higher BMI group. We used a multiple linear regression and the coefficient of the interaction term (initial BMI group times treatment), indicated whether children with a lower BMI responded differently from children with a higher BMI. Statistical significance was defined as p ≤ 0.05. Relative to the sugar sweetened beverage, consumption of the sugar—free beverage for 18 months reduced the BMI z-score by 0.05 SD units within the lower BMI group and by 0.21 SD within the higher BMI group. Body weight gain was reduced by 0.62 kg in the lower BMI group and by 1.53 kg in the higher BMI group. Thus the treatment reduced the BMI z-score by 0.16 SD units more in the higher BMI group than in the lower BMI group (p = 0.04; 95% CI -0.31 to -0.01). The impact of the intervention on body weight gain differed by 0.90 kg between BMI groups (p = 0.09; 95% CI -1.95 to 0.14). In addition, we used a physiologically-based model of growth and energy balance to estimate the degree to which children had compensated for the covertly removed sugar kilocalories by increasing their intake of other foods. The model predicts that children with a lower BMI had compensated 65% (95% CI 28 to 102) of the covertly removed sugar kilocalories, whereas children with a higher BMI compensated only 13% (95% CI -37 to 63). The children with a BMI above the median might have a reduced tendency to compensate for changes in caloric intake. Differences in these subconscious compensatory mechanisms may be an important cause of differences in the tendency to gain weight. If further research bears this out, cutting down on the intake of sugar-sweetened drinks may benefit a large proportion of children, especially those who show a tendency to become overweight. ClinicalTrials.gov NCT00893529

Limited and inconsistent evidence exists on the associations between dietary patterns and overweight during childhood. The present study describes dietary patterns of three-year-old Dutch children and associations between childhood overweight and body mass index (BMI) development between 3 and 10 years. In the GECKO Drenthe birth cohort (N = 1306), body height and weight were measured around the age of 3, 4, 5, and 10 years, and overweight was defined according to Cole and Lobstein. A validated food frequency questionnaire (FFQ) was used to measure diet at 3 years. Dietary patterns were derived using principal components analysis (PCA). Using logistic regression analyses, pattern scores were related to overweight at 3 and 10 years. A linear mixed-effect model was used to estimate BMI-SDS development between 3 to 10 years according to quartiles of adherence to the pattern scores. Two dietary patterns were identified: (1) ‘minimally processed foods’, indicating high intakes of vegetables/sauces/savory dishes, and (2) ‘ultra-processed foods’, indicating high intakes of white bread/crisps/sugary drinks. A 1 SD increase in the ‘ultra-processed foods’ pattern score increased the odds of overweight at 10 years (adjusted OR: 1.30; 95%CI: 1.08, 1.57; p = 0.006). The ‘minimally processed foods’ pattern was not associated with overweight. Although a high adherence to both dietary patterns was associated with a higher BMI-SDS up to 10 years of age, a stronger association for the ‘ultra-processed foods’ pattern was observed (p < 0.001). A dietary pattern high in energy-dense and low-fiber ultra-processed foods at 3 years is associated with overweight and a high BMI-SDS later in childhood.

Poor sleep health is common in older adults and is associated with negative health outcomes. However, the relationship between caffeine consumption and sleep health at an older age is poorly understood. This study investigated the association between caffeine consumption and sleep health in community-dwelling older males and females in The Netherlands. Cross-sectional analyses were performed using data from 1256 participants aged 61–101 years from the Longitudinal Ageing Study Amsterdam. Self-reported questions assessed sleep disturbances (including sleep latency, continuity, and early awakening), sleep duration, and perceived sleep quality. Caffeine consumption was determined with questions about frequency, quantity, and type of coffee and tea consumption. Logistic and linear regression models were used, controlling for potential confounders, and interaction by sex and age was tested. Caffeine consumption showed significant interactions with sex (p < 0.005) in association with sleep health outcomes. Older females who abstained from caffeine consumption reported more sleep disturbances (β = 0.64 [95%CI 0.13; 1.15]) and had greater odds of short sleep duration (8 h/day) and perceived sleep quality. No associations were observed in older males. Caffeine abstinence was associated with more sleep disturbances and short sleep duration in older females, but not in males. The observed association in older females may reflect reverse causation, suggesting that females may have different motivations for discontinuing caffeine consumption than males.