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National lockdowns and containment measures to control the spread of COVID-19 led to increased unemployment, lower household incomes and reduced access to affordable and nutritious foods globally. This study aimed to examine changes and correlates of household food insecurity experience and mitigation strategies adopted in peri-urban Peru during the COVID-19 pandemic. Low income households with children age < 2 years in Lima and Huánuco participated in three repeated cross-sectional surveys from 2020 to 2022 (n = 759). We assessed changes in household food insecurity experience using the Food Insecurity Experience Scale. Correlates of moderate-severe food insecurity were analysed using univariate and multivariable linear mixed-effect regressions. We also assessed perceived impacts of the pandemic on livelihoods, coping strategies and receipt of financial or food assistance. Moderate-severe food insecurity was 47.0% in 2020 (survey 1) decreasing to 31.1% in 2022 (survey 3). In adjusted analyses, food insecurity was higher in households with perceived reduced income (β = 12.69 [6.82; 18.56]); in the lower socio-economic status (SES) tertiles (compared to the relatively highest SES tertile; middle tertile (β = 20.91 [9.89; 31.93]), lowest tertile (β = 39.37 [28.35; 50.40]); in households with ≥ 2 children < 5 years (β = 8.78 [2.05; 15.50]); and in Lima (compared to Huánuco; β = 10.47 [1.27; 19.67]). Food insecurity improved more among the relatively lowest SES compared to the relatively highest SES households between survey 1 and 3 (interaction p= 0.007). In conclusion, almost half of households experienced moderate-severe food insecurity mid-pandemic with greater risk observed in the most socio-economically disadvantaged households. The inequality gap in food insecurity associated with SES narrowed over time likely due to household coping strategies and reduced poverty.

Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.

Consumption of fat as part of a cheese matrix may differentially affect blood lipid responses when compared with other dairy foods. This systematic review was conducted to compare the impact of consuming equal amounts of fat from cheese and other dairy products on blood lipid markers in the fasted and postprandial state. Searches of PubMed (Medline), Cochrane Central and Embase databases were conducted up to mid-June 2022. Eligible human randomized controlled trials (RCTs) investigated the effect of isoenergetic substitution of hard or semi-hard cheese with other dairy products on blood lipid markers. Risk of bias (RoB) was assessed using the Cochrane RoB 2.0 tool. Random-effects meta-analyses assessed the effect of ≥2 similar dietary replacements on the same blood lipid marker. Of 1491 identified citations, 10 articles were included (RoB: all some concerns). Pooled analyses of 7 RCTs showed a reduction in fasting total cholesterol, LDL-C and HDL-C concentrations after ≥14 d mean daily intake of 135 g cheese (weighted mean difference [WMD]: −0.24 mmol/L; 95% confidence interval (CI): −0.34, −0.15; I2= 59.8%, WMD: −0.19 mmol/L; 95% CI: −0.27, −0.12; I2= 42.8%, and WMD: −0.04 mmol/L; 95% CI: −0.08, −0.00; I2= 58.6%, respectively) relative to ∼52 g/d butter. We found no evidence of a benefit from replacing cheese for ≥14 d with milk on fasting blood lipid markers (n= 2). Limited postprandial RCTs, described in narrative syntheses, suggested that cheese-rich meals may induce differential fed-state lipid responses compared with some other dairy matrix structures, but not butter (n≤ 2). In conclusion, these findings indicate that dairy fat consumed in the form of cheese has a differential effect on blood lipid responses relative to some other dairy food structures. However, owing to considerable heterogeneity and limited studies, further confirmation from RCTs is warranted.

Both food safety and dietary behaviors are major contributors to the global burden of disease, especially in rapidly urbanising environments. The impact that food safety concerns have on dietary behaviors in low- and middle-income countries (LMICs) is insufficiently documented. Therefore, we examined whether food safety concerns influence consumer behaviors/diets in LMICs. A systematic review identified 46 relevant studies from 20 LMICs for inclusion. A socio-ecological food environment framework was used to map food safety factors that influence consumer behaviors (food acquisition/purchase, eating out of home, food preparation/storage) and diets (consumption of nutrient rich/poor foods). Several studies (n = 11) reported that despite food safety concerns, consumers could not always ensure that they consumed safe food; barriers were affordability, accessibility and appeal. Key concerns included fear of pesticides, fertilizers, hygiene in/around food outlets, unhygienic vendor practices and household storage/preparation methods. These concerns may reduce consumption of animal sourced food and fresh fruit and vegetables; and increase consumption of starchy staples and processed/packaged foods. Policies such as upgrading urban market infrastructure to enhance food safety, accompanied by nutrition and hygiene education, could lead to increased accessibility, affordability and appeal of safe, nutrient-rich foods. Thus, reducing the appeal of packaged/processed food as a means to mitigate food safety risk; thereby contributing to preventing foodborne disease and multiple forms of malnutrition.

Growing urbanisation in Africa is accompanied by rapid changes in food environments, with potential shifts towards unhealthy food/beverage consumption, including in socio-economically disadvantaged populations. This study investigated how unhealthy food and beverages are embedded in everyday life in deprived areas of two African countries, to identify levers for context relevant policy. Deprived neighbourhoods (Ghana: 2 cities, Kenya: 1 city) were investigated (total = 459 female/male, adolescents/adults aged ≥13 y). A qualitative 24hr dietary recall was used to assess the healthiness of food/beverages in relation to eating practices: time of day and frequency of eating episodes (periodicity), length of eating episodes (tempo), and who people eat with and where (synchronisation). Five measures of the healthiness of food/beverages in relation to promoting a nutrient-rich diet were developed: i. nutrients (energy-dense and nutrient-poor -EDNP/energy-dense and nutrient-rich -EDNR); and ii. unhealthy food types (fried foods, sweet foods, sugar sweetened beverages (SSBs). A structured meal pattern of three main meals a day with limited snacking was evident. There was widespread consumption of unhealthy food/beverages. SSBs were consumed at three-quarters of eating episodes in Kenya (78.5%) and over a third in Ghana (36.2%), with those in Kenya coming primarily from sweet tea/coffee. Consumption of sweet foods peaked at breakfast in both countries. When snacking occurred (more common in Kenya), it was in the afternoon and tended to be accompanied by a SSB. In both countries, fried food was an integral part of all mealtimes, particularly common with the evening meal in Kenya. This includes consumption of nutrient-rich traditional foods/dishes (associated with cultural heritage) that were also energy-dense: (>84% consumed EDNR foods in both countries). The lowest socio-economic groups were more likely to consume unhealthy foods/beverages. Most eating episodes were <30 min (87.1% Ghana; 72.4% Kenya). Families and the home environment were important: >77% of eating episodes were consumed at home and >46% with family, which tended to be energy dense. Eating alone was also common as >42% of eating episodes were taken alone. In these deprived settings, policy action to encourage nutrient-rich diets has the potential to prevent multiple forms of malnutrition, but action is required across several sectors: enhancing financial and physical access to healthier foods that are convenient (can be eaten quickly/alone) through, for example, subsidies and incentives/training for local food vendors. Actions to limit access to unhealthy foods through, for example, fiscal and advertising policies to dis-incentivise unhealthy food consumption and SSBs, especially in Ghana. Introducing or adapting food-based dietary guidelines to incorporate advice on reducing sugar and fat at mealtimes could be accompanied by cooking skills interventions focussing on reducing frying/oil used when preparing meals, including ‘traditional’ dishes and reducing the sugar content of breakfast.