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A student and staff collaborative audit exploring the food and drinks available from a dental teaching hospital outlet

Abstract

Introduction NHS England's Commissioning for Quality and Innovation (CQUIN) standard 1b sets targets for food and drinks high in fat, sugar or salt (HFSS) that should be sold in hospitals.

Aims To assess the products that were available in a dental hospital food outlet and to explore the cost and placement of HFSS products.

Design and setting A prospective audit of the food outlet in a dental hospital in London, UK carried out by staff and students in May 2018 benchmarked against CQUIN 1b.

Materials and methods Staff and students collected data on food and drinks that were available over a two-week period.

Results Only cold and hot drinks met the CQUIN target that 80% of drinks should contain less than five grams of sugar/100 ml. A third of packaged biscuits and 50% of cakes and pastries contained more than 250 kcal per portion. HFSS products were visible in front of customers at the checkout till. Packaged fruits were more expensive than packaged biscuits.

Discussion and conclusion This audit showed inconsistencies between the food and drinks available for staff, students and patients at a dental hospital and the healthy eating messages that staff and students relay to support patients' oral health.

Key points

  • Dental hospitals are important out-of-home food environments that should encourage healthy eating.

  • Dental hospitals should offer food and drink options that are consistent with evidence-based dietary guidelines.

  • Dental hospitals should work with food outlets to create 'tooth-friendly' food environments for staff, students and patients.

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References

  1. 1.

    Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol (N Y) 2017; DOI: 10.1097/IJ9.0000000000000017.

  2. 2.

    NHS Digital. Statistics on Obesity, Physical Activity and Diet, England, 2019. 2019. Available online at https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2019 (accessed October 2020).

  3. 3.

    Watt R G, Daly B, Allison P et al. Ending the neglect of global oral health: time for radical action. Lancet 2019; 394: 261-72.

  4. 4.

    Peres M A, Macpherson L M D, Weyant R J et al. Oral diseases: a global public health challenge. Lancet 2019; 394: 249-60.

  5. 5.

    Steele J G, Treasure ET, O'Sullivan I, Morris J, Murray J J. Adult Dental Health Survey 2009: transformations in British oral health 1968-2009. Br Dent J 2013; 213: 523-527.

  6. 6.

    Murray J J, Vernazza C R, Holmes R D. Forty years of national surveys: An overview of children's dental health from 1973-2013. Br Dent J 2015; 219: 281-285.

  7. 7.

    Steele J, O' Sullivan I. Executive Summary: Adult Dental Health Survey 2009. 2011. Available online at http://qna.files.parliament.uk/qna-attachments/873000/original/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf (accessed October 2020).

  8. 8.

    Health and Social Care Information Centre. Children's Dental Health Survey: Executive Summary - England, Wales and Northern Ireland, 2013. 2015. Available at https://files.digital.nhs.uk/publicationimport/pub17xxx/pub17137/cdhs2013-executive-summary.pdf (accessed October 2020).

  9. 9.

    Sheiham A, Watt R. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000; 28:399-406.

  10. 10.

    Moynihan P. Sugars and Dental Caries: Evidence for Setting a Recommended Threshold for Intake. Adv Nutr 2016; 7: 149-156.

  11. 11.

    Department for Environment, Food & Rural Affairs. National Statistics - Family Food 2016/17: Purchases. 2018. Available at https://www.gov.uk/government/publications/family-food-201617/purchases (accessed October 2020).

  12. 12.

    Adams J, Goffe L, Brown T et al. Frequency and socio-demographic correlates of eating meals out and take-away meals at home: cross-sectional analysis of the UK national diet and nutrition survey, waves 1-4 (2008-12). Int J Behav Nutr Phys Act 2015; 12: 51.

  13. 13.

    Public Health England. Why 5%? 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/769482/Why_5__-_The_Science_Behind_SACN.pdf (accessed October 2020).

  14. 14.

    Scientific Advisory Committee on Nutrition. Carbohydrates and Health. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf (accessed October 2020).

  15. 15.

    Public Health England. Sugar Reduction: The evidence for action - Annexe 3: A mixed method review of behaviour changes resulting from marketing strategies targeted at high sugar food and non-alcoholic drink. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/470174/Annexe_3._Marketing_evidence_review.pdf (accessed October 2020).

  16. 16.

    Public Health England. Sugar Reduction: The evidence for action - Annexe 4: An analysis of the role of price promotions on the household purchases of food and drinks high in sugar. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/470175/Annexe_4._Analysis_of_price_promotions.pdf (accessed October 2020).

  17. 17.

    Nakamura R, Pechey R, Suhrcke M, Jebb S A, Marteau T M. Sales impact of displaying alcoholic and non-alcoholic beverages in endofaisle locations: an observational study. Soc Sci Med 2014; 108: 68-73.

  18. 18.

    NHS England. Five Year Forward View. 2014. Available at https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed October 2020).

  19. 19.

    NHS England. NHS staff health & wellbeing: CQUIN 2017-19 Indicator 1 Implementation Support. 2018. Available at https://www.england.nhs.uk/wp-content/uploads/2018/05/staff-health-wellbeing-cquin-2017-19-implementation-support.pdf (accessed October 2020).

  20. 20.

    Public Health England. Delivering better oral health: an evidence-based toolkit for prevention (Third Edition). 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf (accessed October 2020).

  21. 21.

    Public Health England. The Eatwell Guide. 2018. Available online at https://www.gov.uk/government/publications/the-eatwell-guide (accessed October 2020).

  22. 22.

    Health Research Authority. Defining Research. 2013. Available at https://www.clahrc-eoe.nihr.ac.uk/wp-content/uploads/2014/04/defining-research.pdf (accessed October 2020).

  23. 23.

    Mela D J, Woolner E M. Perspective: Total, Added, or Free? What Kind of Sugars Should We Be Talking About? Adv Nutr 2018; 9: 63-69.

  24. 24.

    Swan G E, Powell N A, Knowles B L, Bush M T, Levy L B. A definition of free sugars for the UK. Public Health Nutr 2018; 21: 1636-1638.

  25. 25.

    World Health Organisation. Guideline: Sugars Intake for Adults and Children. 2015. Available online at https://www.who.int/publications/i/item/9789241549028 (accessed October 2020).

  26. 26.

    Public Health England. Salt Reduction Targets for 2017. 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604338/Salt_reduction_targets_for_2017.pdf (accessed October 2020).

  27. 27.

    Public Health England. Sugar reduction: juice and milk based drinks - A technical report outlining guidelines for industry, 2017 baseline levels for drinks in scope and next steps. 2018. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/708930/Sugar_reduction_juice_and_milk_based_drinks.pdf (accessed October 2020).

  28. 28.

    Gill J M, Sattar N. Fruit juice: just another sugary drink? Lancet Diabetes Endocrinol 2014; 2: 444-446.

  29. 29.

    Lohner S, Toews I, Meerpohl J J. Health outcomes of non-nutritive sweeteners: analysis of the research landscape. Nutr J 2017; 16: 55.

  30. 30.

    Giacaman R A, Campos P, Muñoz-Sandoval C, Castro R J. Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel. Arch Oral Biol 2013; 58: 1116-1122.

  31. 31.

    Castro I A, Majmundar A, Williams C B, Baquero B. Customer Purchase Intentions and Choice in Food Retail Environments: A Scoping Review. Int J Environ Res Public Health 2018; 15: 2493.

  32. 32.

    Andreyeva T, Long M W, Brownell K D. The Impact of Food Prices on Consumption: A Systematic Review of Research on the Price Elasticity of Demand for Food. Am J Public Health 2010; 100: 216-222.

  33. 33.

    Allan J, Heddle M, McKenzie F, Webb S, Johnston M. Mapping the snack and drink landscape in a large UK hospital site. 2019. Available online at https://psyarxiv.com/m3nwa/ (accessed October 2020).

  34. 34.

    Waterlander W E, de Boer M R, Schuit A J, Seidell J C, Steenhuis I H M. Price discounts significantly enhance fruit and vegetable purchases when combined with nutrition education: a randomized controlled supermarket trial. Am J Clin Nutr 2013; 97: 886-895.

  35. 35.

    Walmsley R, Jenkinson D, Saunders I, Howard T, Oyebode O. Choice architecture modifies fruit and vegetable purchasing in a university campus grocery store: time series modelling of a natural experiment. BMC Public Health 2018; DOI: 10.1186/s12889-018-6063-8.

  36. 36.

    Nabec L. Improving dietary behaviour with nutrition labelling: Towards a research agenda that serves consumer well-being. Recherche Appl Mark (Engl Ed) 2017; 32: 71-97.

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Acknowledgements

Nirmalan Patkunan and Meera Galaiya who, in addition to the authors, helped to collect the data for the audit.

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Correspondence to Vanessa Muirhead.

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Mohindra, A., Jie, J., Lim, L. et al. A student and staff collaborative audit exploring the food and drinks available from a dental teaching hospital outlet. Br Dent J 230, 32–38 (2021). https://doi.org/10.1038/s41415-020-2506-6

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