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Processed foods and the nutrition transition: evidence from Asia

Baker P, Friel S

Obes Rev, 2014 Jul;15(7):564-77.
PMID: 24735161 DOI: 10.1111/obr.12174

This paper elucidates the role of processed foods and beverages in the 'nutrition transition' underway in Asia. Processed foods tend to be high in nutrients associated with obesity and diet-related non-communicable diseases: refined sugar, salt, saturated and trans-fats. This paper identifies the most significant 'product vectors' for these nutrients and describes changes in their consumption in a selection of Asian countries. Sugar, salt and fat consumption from processed foods has plateaued in high-income countries, but has rapidly increased in the lower-middle and upper-middle-income countries. Relative to sugar and salt, fat consumption in the upper-middle- and lower-middle-income countries is converging most rapidly with that of high-income countries. Carbonated soft drinks, baked goods, and oils and fats are the most significant vectors for sugar, salt and fat respectively. At the regional level there appears to be convergence in consumption patterns of processed foods, but country-level divergences including high levels of consumption of oils and fats in Malaysia, and soft drinks in the Philippines and Thailand. This analysis suggests that more action is needed by policy-makers to prevent or mitigate processed food consumption. Comprehensive policy and regulatory approaches are most likely to be effective in achieving these goals.
Fulltext Policing Practices and Risk of HIV Infection Among People Who Inject Drugs

Baker P, Beletsky L, Avalos L, Venegas C, Rivera C, Strathdee SA, et al.

Epidemiol Rev, 2020 Jan 31;42(1):27-40.
PMID: 33184637 DOI: 10.1093/epirev/mxaa010

Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.
Fulltext The men's health gap: men must be included in the global health equity agenda

Baker P, Dworkin SL, Tong S, Banks I, Shand T, Yamey G

Bull World Health Organ, 2014 Aug 01;92(8):618-20.
PMID: 25197149 DOI: 10.2471/BLT.13.132795
Spatial patterns in the distribution of tropical tree species

Condit R, Ashton PS, Baker P, Bunyavejchewin S, Gunatilleke S, Gunatilleke N, et al.

Science, 2000 May 26;288(5470):1414-8.
PMID: 10827950

Fully mapped tree census plots of large area, 25 to 52 hectares, have now been completed at six different sites in tropical forests, including dry deciduous to wet evergreen forest on two continents. One of the main goals of these plots has been to evaluate spatial patterns in tropical tree populations. Here the degree of aggregation in the distribution of 1768 tree species is examined based on the average density of conspecific trees in circular neighborhoods around each tree. When all individuals larger than 1 centimeter in stem diameter were included, nearly every species was more aggregated than a random distribution. Considering only larger trees (>/= 10 centimeters in diameter), the pattern persisted, with most species being more aggregated than random. Rare species were more aggregated than common species. All six forests were very similar in all the particulars of these results.
Fulltext Breastfeeding, first-food systems and corporate power: a case study on the market and political practices of the transnational baby food industry and public health resistance in the Philippines

Baker P, Zambrano P, Mathisen R, Singh-Vergeire MR, Escober AE, Mialon M, et al.

Global Health, 2021 10 26;17(1):125.
PMID: 34702285 DOI: 10.1186/s12992-021-00774-5

BACKGROUND: The aggressive marketing of breastmilk substitutes (BMS) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (The Code), many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, commercial milk formula (CMF) markets have markedly expanded. In this paper, we adopt the Philippines as a case study to understand the battle for national Code implementation. In particular, we investigate the market and political strategies used by the baby food industry to shape the country's 'first-food system', and in doing so, promote and sustain CMF consumption. We further investigate how breastfeeding coalitions and advocates have resisted these strategies, and generated political commitment for a world-leading breastfeeding policy framework and protection law (the 'Milk Code'). We used a case study design and process tracing method, drawing from documentary and interview data.
RESULTS: The decline in breastfeeding in the Philippines in the mid-twentieth Century associated with intensive BMS marketing via health systems and consumer advertising. As regulations tightened, the industry more aggressively promoted CMFs for older infants and young children, thereby 'marketing around' the Milk Code. It established front groups to implement political strategies intended to weaken the country's breastfeeding policy framework while also fostering a favourable image. This included lobbying government officials and international organizations, emphasising its economic importance and threats to foreign investment and trade, direct litigation against the government, messaging that framed marketing in terms of women's choice and empowerment, and forging partnerships. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national breastfeeding policy framework and Milk Code, resulting in-turn, from collective actions by breastfeeding coalitions, advocates and mothers.
CONCLUSION: The Philippines illustrates the continuing battle for worldwide Code implementation, and in particular, how the baby food industry uses and adapts its market and political practices to promote and sustain CMF markets. Our results demonstrate that this industry's political practices require much greater scrutiny. Furthermore, that mobilizing breastfeeding coalitions, advocacy groups and mothers is crucial to continually strengthen and protect national breastfeeding policy frameworks and Code implementation.
Fulltext Antimicrobial Potential of Plastic Films Incorporated with Sage Extract on Chicken Meat

Aziman N, Jawaid M, Mutalib NAA, Yusof NL, Nadrah AH, Nazatul UK, et al.

Foods, 2021 Nov 16;10(11).
PMID: 34829093 DOI: 10.3390/foods10112812

The function of packaging is crucial in the maintenance of fresh meat product quality. This study aimed to assess the efficiency of six films added with coatings 2379L/220 and 2379L/221 (containing sage extracts) to inhibit Salmonella typhimurium, Staphylococcus aureus, and Escherichia coli, which showed that two of the six films had a significant effect. Additionally, the effects of the films on refrigerated skinless chicken breast meat were evaluated based on microbiological content, colour, weight loss, texture and pH. Four of the six films were examined could extend the storability of refrigerated chicken breast fillets for up to seven days. All six treated films improved the pH, colour stability, weight loss, and texture of the chicken fillets. Therefore, these findings suggested that the coatings containing sage extracts having different viscosities (2379L/220 and 2379L/221) were effective as antimicrobial adhesives in food packaging films and can be commercially applied in prolonging the storage of chicken breast meat without affecting their quality.
Fulltext The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress

Baker P, Smith JP, Garde A, Grummer-Strawn LM, Wood B, Sen G, et al.

Lancet, 2023 Feb 11;401(10375):503-524.
PMID: 36764315 DOI: 10.1016/S0140-6736(22)01933-X

Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0-36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.
Fulltext Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, et al.

BMJ, 2024 Feb 28;384:e077310.
PMID: 38418082 DOI: 10.1136/bmj-2023-077310

OBJECTIVE: To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.
DESIGN: Systematic umbrella review of existing meta-analyses.
DATA SOURCES: MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews and meta-analyses of cohort, case-control, and/or cross sectional study designs. To evaluate the credibility of evidence, pre-specified evidence classification criteria were applied, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). The quality of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorised as "high," "moderate," "low," or "very low" quality.
RESULTS: The search identified 45 unique pooled analyses, including 13 dose-response associations and 32 non-dose-response associations (n=9 888 373). Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low). Highly suggestive (class II) evidence indicated that greater exposure to ultra-processed foods was directly associated with higher risks of incident all cause mortality (risk ratio 1.21, 1.15 to 1.27; low), heart disease related mortality (hazard ratio 1.66, 1.51 to 1.84; low), type 2 diabetes (odds ratio 1.40, 1.23 to 1.59; very low), and depressive outcomes (hazard ratio 1.22, 1.16 to 1.28; low), together with higher risks of prevalent adverse sleep related outcomes (odds ratio 1.41, 1.24 to 1.61; low), wheezing (risk ratio 1.40, 1.27 to 1.55; low), and obesity (odds ratio 1.55, 1.36 to 1.77; low). Of the remaining 34 pooled analyses, 21 were graded as suggestive or weak strength (class III-IV) and 13 were graded as no evidence (class V). Overall, using the GRADE framework, 22 pooled analyses were rated as low quality, with 19 rated as very low quality and four rated as moderate quality.
CONCLUSIONS: Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorder, and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population based and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health. They also inform and provide support for urgent mechanistic research.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023412732.
Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group

Binns C, Lee MK, Yun Low W, Baker P, Bulgiba A, Dahlui M, et al.

Asia Pac J Public Health, 2020 05;32(4):179-187.
PMID: 32475150 DOI: 10.1177/1010539520931328

Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.
Fulltext Breastfeeding: crucially important, but increasingly challenged in a market-driven world

Pérez-Escamilla R, Tomori C, Hernández-Cordero S, Baker P, Barros AJD, Bégin F, et al.

Lancet, 2023 Feb 11;401(10375):472-485.
PMID: 36764313 DOI: 10.1016/S0140-6736(22)01932-8

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration.
Fulltext Marketing of commercial milk formula: a system to capture parents, communities, science, and policy

Rollins N, Piwoz E, Baker P, Kingston G, Mabaso KM, McCoy D, et al.

Lancet, 2023 Feb 11;401(10375):486-502.
PMID: 36764314 DOI: 10.1016/S0140-6736(22)01931-6

Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.
Rate of tree carbon accumulation increases continuously with tree size

Stephenson NL, Das AJ, Condit R, Russo SE, Baker PJ, Beckman NG, et al.

Nature, 2014 Mar 6;507(7490):90-3.
PMID: 24429523 DOI: 10.1038/nature12914

Forests are major components of the global carbon cycle, providing substantial feedback to atmospheric greenhouse gas concentrations. Our ability to understand and predict changes in the forest carbon cycle--particularly net primary productivity and carbon storage--increasingly relies on models that represent biological processes across several scales of biological organization, from tree leaves to forest stands. Yet, despite advances in our understanding of productivity at the scales of leaves and stands, no consensus exists about the nature of productivity at the scale of the individual tree, in part because we lack a broad empirical assessment of whether rates of absolute tree mass growth (and thus carbon accumulation) decrease, remain constant, or increase as trees increase in size and age. Here we present a global analysis of 403 tropical and temperate tree species, showing that for most species mass growth rate increases continuously with tree size. Thus, large, old trees do not act simply as senescent carbon reservoirs but actively fix large amounts of carbon compared to smaller trees; at the extreme, a single big tree can add the same amount of carbon to the forest within a year as is contained in an entire mid-sized tree. The apparent paradoxes of individual tree growth increasing with tree size despite declining leaf-level and stand-level productivity can be explained, respectively, by increases in a tree's total leaf area that outpace declines in productivity per unit of leaf area and, among other factors, age-related reductions in population density. Our results resolve conflicting assumptions about the nature of tree growth, inform efforts to undertand and model forest carbon dynamics, and have additional implications for theories of resource allocation and plant senescence.

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