Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
College of Global Public Health, New York University, New York, NY, USA.
Curr Atheroscler Rep. 2018 Apr 14;20(5):25. doi: 10.1007/s11883-018-0726-x.
Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local, and tribal levels; and categorized and characterized the key elements in their policy design.
Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium, and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g., level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food marketing domain) or policy-specific (e.g., earmarking for taxes) elements. Characteristics of certain elements were similarly defined (e.g., fruit and vegetable definition, warning language used in SSB warning labels), while others varied across cases within a policy (e.g., tax base for SSB taxes). Several key elements were not always sufficiently characterized in government documents, and dietary target selections and definitions did not consistently align with the evidence-base. These findings highlight recent action on dietary policies to improve cardiometabolic health in the US; and key elements necessary to design such policies.
饮食不合理是导致心血管代谢疾病和经济负担的主要原因。在 5 个领域（食品价格、配方调整、营销、标签和政府食品援助计划）内提出循证饮食政策，有望改善心血管代谢健康。然而，美国新饮食政策的采用程度以及设计此类政策的关键要素尚未得到充分确定。我们创建了一份最近美国改善心血管代谢健康的饮食政策案例清单，并评估了其在联邦、州、地方和部落各级的提案和采用程度；对政策设计中的关键要素进行了分类和描述。
为改善心血管代谢健康而通过的联邦饮食政策包括配方调整（消除反式脂肪）、营销（增加水果和蔬菜的大众媒体运动）、标签（营养成分标签更新，菜单卡路里标签）和食品援助计划（补充营养援助计划（SNAP）和妇女、婴儿和儿童（WIC）计划中水果和蔬菜的经济激励措施）。还为配方调整和儿童食品营销提出了联邦自愿准则。最近的州提案包括含糖饮料（SSB）税、营销限制和 SNAP 限制，但很少有提案被采纳。地方努力差异很大，某些地方在提出或通过相关政策方面一直处于领先地位。在所有司法管辖区，最常选择的饮食目标包括水果和蔬菜、SSB、反式脂肪、添加糖、钠和卡路里；其他健康（如坚果）或不健康（如加工肉类）因素在很大程度上没有得到解决。在设计这些政策时需要定义的关键政策要素包括跨领域通用的要素（如政府级别、目标人群、饮食目标、饮食定义、实施机制）以及特定领域（如食品营销领域的媒体渠道）或特定政策（如税收专款专用）的要素。某些要素的特征定义类似（如水果和蔬菜的定义，SSB 警告标签上使用的警告语言），而其他要素在政策内的案例中有所不同。在政府文件中，并非所有关键要素都能得到充分描述，饮食目标的选择和定义也不一致。这些发现突出了美国为改善心血管代谢健康而采取的饮食政策行动；并为设计此类政策提供了必要的关键要素。
