Search

Objective: To assess differences between traditional paper bag ordering and online ordering from primary school canteens in terms of menu, usage and lunch order characteristics.Design: A cross-sectional study.Setting: New South Wales (NSW) primary schools that offered both paper bag and online canteen ordering.Participants: Students (aged 5-12 years) with a lunch order on the day of the observation.Results: Across the six school canteens, 59-90 % of all available items were listed on both the online and paper menus, with no significant differences in the nutritional quality ('Everyday'/'Occasional') or nutritional content (kJ/saturated fat/sugar/sodium) of menu items. In total, 387 student lunch orders were placed, containing 776 menu items. Most orders (68 %) were placed online. There were no significant differences between order modality in the quantity of items ordered or the cost of orders, or the nutritional quality of orders based on the classification system of the NSW Healthy School Canteen Strategy ('Everyday'/'Occasional'). However, nutritional analysis revealed that paper bag orders contained 222 fewer kJ than online orders (P = 0·001), 0·65 g less saturated fat (P = 0·04) and 4·7 g less sugar (P < 0·001).Conclusions: Online canteens are commonly used to order canteen lunches for primary school children. This is the first study to investigate differences between traditional paper bag ordering and online ordering in this setting. Given the rapid increase in the use of online ordering systems in schools and other food settings and their potential to deliver public health nutrition interventions, additional research is warranted to further investigate differences in ordering modalities. [ABSTRACT FROM AUTHOR]

Objective: Professional sport occupies a prominent cultural position in societies across the globe and commercial organisations make use of this to promote their products. The present scoping review explores existing academic literature on the relationship between professional sports clubs and food and drink marketing and considers how this relationship may impact upon the public's health.Design: The scoping review searched six databases. Experts were also consulted. Records written in languages other than English were excluded. We also excluded records relating to mega events (e.g. Olympics, Football World Cup) and alcohol marketing, because of the attention already given to these.Setting: Professional sports clubs.Results: We identified 18 166 titles, reviewed 163 abstracts and read twenty-six full texts. We included six papers in the review. Four were from Australia and New Zealand. The Australasian literature focused largely on the marketing of foods and beverages to children and the potential impact on consumption. Single papers from researchers in Turkey and the USA were identified. The Turkish paper analysed shirt sponsorship in football leagues internationally and showed food and beverage (including alcohol) companies were the most common sponsors. The US paper examined a mixed reaction to a football team named after an energy drink.Conclusions: Commercial relationships between professional sports clubs and Big Food corporations have largely eluded scrutiny in much of the world. The current review highlights the lack of public health research on these relationships. Research exploring the interdependent commercial practices of food and drink companies and professional sports clubs is urgently needed. [ABSTRACT FROM AUTHOR]

ObjectiveMalnutrition in Africa has not improved compared with other regions in the world. Investment in the build-up of a strong African research workforce is essential to provide contextual solutions to the nutritional problems of Africa. To orientate this process, we reviewed nutrition research carried out in Africa and published during the last decade.DesignWe assessed nutrition research from Africa published between 2000 and 2010 from MEDLINE and EMBASE and analysed the study design and type of intervention for studies indexed with major MeSH terms for vitamin A deficiency, protein–energy malnutrition, obesity, breast-feeding, nutritional status and food security. Affiliations of first authors were visualised as a network and power of affiliations was assessed using centrality metrics.SettingAfrica.SubjectsAfricans, all age groups.ResultsMost research on the topics was conducted in Southern (36 %) and Western Africa (34 %). The intervention studies (9 %; n 95) mainly tested technological and curative approaches to the nutritional problems. Only for papers on protein–energy malnutrition and obesity did lead authorship from Africa exceed that from non-African affiliations. The 10 % most powerfully connected affiliations were situated mainly outside Africa for publications on vitamin A deficiency, breast-feeding, nutritional status and food security.ConclusionsThe development of the evidence base for nutrition research in Africa is focused on treatment and the potential for cross-African networks to publish nutrition research from Africa remains grossly underutilised. Efforts to build capacity for effective nutrition action in Africa will require forging a true academic partnership between African and non-African research institutions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify and meta-analyse the neuroimaging data and hence synthesise a brain map showing the neural correlates of watching food commercials.Design: Published studies were retrieved and included into the analysis if they evaluated brain responses to food commercials with functional MRI and reported results based on whole-brain analysis in standard brain coordinates.Setting: No additional restriction was placed on the search, such as the publication year and age of participants.Participants: Seven papers that composed of a total of 442 participants fulfilled the inclusion criteria. All of them recruited children or adolescents.Results: Food commercials caused larger brain responses than nonfood counterparts in the cuneus on both hemispheres, which played a role in dietary self-control and modulation of food craving. Other brain regions involved in food commercials processing included the left culmen, left middle occipital gyrus and the right superior parietal lobule, which could be related to reward, emotional responses and habit formation.Conclusion: These neural correlates may help explain the food choice and eating behaviours of children and adolescents that might be relevant to the development of obesity. [ABSTRACT FROM AUTHOR]

Objective: Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding.Design: A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors' outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies.Setting: Upper-middle- and high-income countries.Participants: Parents with a child below the age of 3 years.Results: A total of forty-seven studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: (1) factors related to introduction of complementary foods; (2) factors related to the type of complementary foods and (3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents' views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods and perceived value in advice received from health professionals and grandmothers.Conclusions: This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines, and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting. [ABSTRACT FROM AUTHOR]

Objective: Chronic aflatoxin exposure has been associated with childhood stunting (length-for-age/height-for-age < -2 sd), while data lacks for Bangladesh, a country with substantial burden of childhood stunting. This paper examined the association between aflatoxin exposure and childhood stunting in a slum setting of Dhaka city.Design: In this MAL-ED aflatoxin birth cohort study, plasma samples were assayed for aflatoxin B1-lysine adduct (AFB1-lys) by MS at 7, 15, 24 and 36 months of age for 208, 196, 173 and 167 children to assess chronic aflatoxin exposure. Relationship between aflatoxin exposure and anthropometric measures was examined by mixed-effects logistic regression models.Setting and Participants: The study was conducted in Mirpur, Dhaka, where children were followed from birth to 36 months.Results: Prevalence of stunting increased from 21 % at 7 months to 49 % at 36 months of age. Mean AFB1-lys concentrations at 7, 15, 24 and 36 months were 1·30 (range 0·09-5·79), 1·52 (range 0·06-6·35), 3·43 (range 0·15-65·60) and 3·70 (range 0·09-126·54) pg/mg albumin, respectively, and the percentage of children with detectable AFB1-lys was 10, 21, 18 and 62 %, respectively. No association was observed between aflatoxin exposure and stunting in multivariable analyses. Factors associated with childhood stunting were age, low birth weight, maternal height, stool myeloperoxidase and number of people sleeping in one room.Conclusions: A relatively lower exposure to aflatoxin may not influence the linear growth of children. This finding indicates a threshold level of exposure for linear growth deficit and further investigation in other areas where higher concentrations of aflatoxin exposure exist. [ABSTRACT FROM AUTHOR]

Objective: Even though sub-Saharan African women spend millions of person-hours per day fetching water and pounding grain, to date, few studies have rigorously assessed the energy expenditure costs of such domestic activities. As a result, most analyses that consider head-hauling water or hand pounding of grain with a mortar and pestle (pilão use) employ energy expenditure values derived from limited research. The current paper compares estimated energy expenditure values from heart rate monitors v. indirect calorimetry in order to understand some of the limitations with using such monitors to measure domestic activities.Design: This confirmation study estimates the metabolic equivalent of task (MET) value for head-hauling water and hand-pounding grain using both indirect calorimetry and heart rate monitors under laboratory conditions.Setting: The study was conducted in Nampula, Mozambique.Participants: Forty university students in Nampula city who recurrently engaged in water-fetching activities.Results: Including all participants, the mean MET value for head hauling 20 litres (20·5 kg, including container) of water (2·7 km/h, 0 % slope) was 4·3 (sd 0·9) and 3·7 (sd 1·2) for pilão use. Estimated energy expenditure predictions from a mixed model were found to correlate with observed energy expenditure (r2 0·68, r 0·82). Re-estimating the model with pilão use data excluded improved the fit substantially (r2 0·83, r 0·91).Conclusions: The current study finds that heart rate monitors are suitable instruments for providing accurate quantification of energy expenditure for some domestic activities, such as head-hauling water, but are not appropriate for quantifying expenditures of other activities, such as hand-pounding grain. [ABSTRACT FROM AUTHOR]

Objective: Cash transfer programmes targeting children are considered an effective strategy for addressing child poverty and for improving child health outcomes in developing countries. In South Africa, the Child Support Grant (CSG) is the largest cash transfer programme targeting children from poor households. The present paper investigates the association of the duration of CSG receipt with child growth at 2 years in three diverse areas of South Africa.Design: The study analysed data on CSG receipt and anthropometric measurements from children. Predictors of stunting were assessed using a backward regression model.Setting: Paarl (peri-urban), Rietvlei (rural) and Umlazi (urban township), South Africa, 2008.Subjects: Children (n 746), median age 22 months.Results: High rates of stunting were observed in Umlazi (28 %), Rietvlei (20 %) and Paarl (17 %). Duration of CSG receipt had no effect on stunting. HIV exposure (adjusted OR=2·30; 95 % CI 1·31, 4·03) and low birth weight (adjusted=OR 2·01, 95 % CI 1·02, 3·96) were associated with stunting, and maternal education had a protective effect on stunting.Conclusions: Our findings suggest that, despite the presence of the CSG, high rates of stunting among poor children continue unabated in South Africa. We argue that the effect of the CSG on nutritional status may have been eroded by food price inflation and limited progress in the provision of other important interventions and social services. [ABSTRACT FROM AUTHOR]

ObjectiveCluster analysis is widely applied to identify dietary patterns. A new method based on Gaussian mixture models (GMM) seems to be more flexible compared with the commonly applied k-means and Ward’s method. In the present paper, these clustering approaches are compared to find the most appropriate one for clustering dietary data.DesignThe clustering methods were applied to simulated data sets with different cluster structures to compare their performance knowing the true cluster membership of observations. Furthermore, the three methods were applied to FFQ data assessed in 1791 children participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants) Study to explore their performance in practice.ResultsThe GMM outperformed the other methods in the simulation study in 72 % up to 100 % of cases, depending on the simulated cluster structure. Comparing the computationally less complex k-means and Ward’s methods, the performance of k-means was better in 64–100 % of cases. Applied to real data, all methods identified three similar dietary patterns which may be roughly characterized as a ‘non-processed’ cluster with a high consumption of fruits, vegetables and wholemeal bread, a ‘balanced’ cluster with only slight preferences of single foods and a ‘junk food’ cluster.ConclusionsThe simulation study suggests that clustering via GMM should be preferred due to its higher flexibility regarding cluster volume, shape and orientation. The k-means seems to be a good alternative, being easier to use while giving similar results when applied to real data. [ABSTRACT FROM PUBLISHER]

Objective: The eButton takes frontal images at 4s intervals throughout the day. A three-dimensional manually administered wire mesh procedure has been developed to quantify portion sizes from the two-dimensional images. The present paper reports a test of the inter-rater reliability and validity of use of the wire mesh procedure.Design: Seventeen foods of diverse shapes and sizes served on plates, bowls and cups were selected to rigorously test the portion assessment procedure. A dietitian not involved in inter-rater reliability assessment used standard cups to independently measure the quantities of foods to generate the 'true' value for a total of seventy-five 'served' and seventy-five smaller 'left' images with diverse portion sizes.Setting: The images appeared on the computer to which the digital wire meshes were applied.Subjects: Two dietitians and three engineers independently estimated portion size of the larger ('served') and smaller ('left') images for the same foods.Results: The engineers had higher reliability and validity than the dietitians. The dietitians had lower reliabilities and validities for the smaller more irregular images, but the engineers did not, suggesting training could overcome this limitation. The lower reliabilities and validities for foods served in bowls, compared with plates, suggest difficulties with the curved nature of the bowls.Conclusions: The wire mesh procedure is an important step forward in quantifying portion size, which has been subject to substantial self-report error. Improved training procedures are needed to overcome the identified problems. [ABSTRACT FROM AUTHOR]

Objective: High Na intake has been associated with different health problems. However, serious controversies exist over studies investigating associations of Na intake with mortality from all-causes and CVD. The present systematic review and meta-analysis was done to investigate, for the first time, the dose-response association of dietary Na intake with all-cause and CVD mortality among prospective studies.Design: Relevant papers published up to August 2017 were searched in MEDLINE, EMBASE and Google Scholar databases. Prospective cohort studies on the association of dietary Na intake with all-cause or/and CVD mortality were included. Linear and non-linear dose-response associations between Na intake and CVD and all-cause mortality were examined.Results: Overall, twenty publications met inclusion criteria. A significant non-linear association (P<0·001) was found between Na intake and CVD mortality risk among studies assessing urinary Na excretion, with a relatively steep slope at Na intakes above 2400mg/d. However, the association was not significant in studies using dietary Na intake (P=0·61). Additionally, the non-linear association of Na intake with all-cause mortality was also non-significant. No linear association (effect size; 95 % CI; I 2) was seen between 100mg/d increment in Na intake and CVD mortality (1·01; 0·97, 1·05; 98·4 %) or all-cause mortality (1·01; 1·00, 1·02; 89·2 %). Following subgroup analyses, the association between Na intake and CVD mortality was observed only among studies conducted in the USA (0·99; 0·99, 1·00; 20·0 %).Conclusions: The study showed a direct association between urinary Na excretion and CVD mortality which was more considerable at intakes above 2400mg/d. In contrast, no significant association was found between Na intake and all-cause mortality. Further long-term prospective studies on different populations are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: Children's dietary intake impacts weight status and a range of short- and long-term health outcomes. Accurate measurement of factors that influence children's diet is critical to the development and evaluation of interventions designed to improve children's diets. The purpose of the current paper is to present the development of the Table Talk observational tool to measure early care and education teachers' (ECET) verbal feeding communications.Design: An observational tool to assess ECET verbal communication at mealtimes was deigned based on the extant literature. Trained observers conducted observations using the tool during lunch for both lead and assistant ECET. Descriptive statistics, test-retest for a subgroup, interclass correlations for each item, and comparisons between leads and assistants were conducted.Setting: Head Start centres, Southern USA.Subjects: Seventy-five Head Start educators.Results: On average, 17·2 total verbal feeding communications (sd 8·9) were observed per ECET. For lead ECET, the most prevalent Supportive Comment was Exploring Foods whereas for assistants Making Positive Comments was the most prevalent. Overall, lead ECET enacted more Supportive Comments than assistant ECET (F(2,72)=4·8, P=0·03). The most common Unsupportive Comment was Pressuring to Eat, with a mean of 3·8 (sd 4·3) and a maximum of 25. There was no difference in Unsupportive Comments between lead and assistant ECET.Conclusions: Table Talk may be a useful tool to assess verbal feeding communications of ECET, with potential applications such as informing ECET training and assessing intervention efforts. [ABSTRACT FROM AUTHOR]

Objective: Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child's death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya.Design: Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis.Setting: Two slum communities in Nairobi, Kenya.Subjects: Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90).Results: Participants demonstrated an understanding of undernutrition in children.Conclusions: Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling. [ABSTRACT FROM AUTHOR]

Objective: To analyse the evolution of the soft drink industry's use of self-regulation as a response to obesity and examine the motivations driving its development and the strategies used to promote it to policy makers.Design: We used a data set of industry documents published by the Australian Beverages Council (ABC) between 1998 and 2016. We analysed how the ABC voiced its political motivations about self-regulation and what internal nutrition policies it developed prior to its public launch of self-regulation. We also analysed two promotional strategies: funding research and writing policy submissions.Setting: Australia.Results: Between 1998 and 2006, the ABC shifted from a defensive strategy that denied the role of its products in obesity to more conciliatory strategy that emphasised the role of the soft drink industry in solutions to obesity. The ABC deliberately timed the launch of its self-regulation to coincide with an international public health congress. Following its launch, the ABC funded research demonstrating the efficacy of self-regulation and wrote submissions to government nutrition policies arguing that further regulation was unnecessary.Conclusions: The soft drink industry uses self-regulation to bolster its reputation and influence nutrition policy. Strategic timing plays a key role in the political influence of self-regulation. [ABSTRACT FROM AUTHOR]

Objective: To meet some of the UN's seventeen Sustainable Development Goals by 2030, there is a need for more effective policy to reduce food insecurity in low-income and lower-middle-income countries (LMIC). Measuring progress towards these goals requires reliable indicators of food security in these countries. Routinely conducted household consumption and expenditure surveys (HCES) provide potentially valuable and nationally representative data sets for this purpose. The present study aimed to assess methods used to determine national food security status using proxy measures from HCES data in LMIC globally.Design: A scoping literature review was conducted using electronic databases. Of the 929 abstracts identified, a total of twenty articles were reviewed against strict inclusion and exclusion criteria and included for further analysis.Results: Fourteen LMIC globally were represented in the twenty articles. The simplest metric used to indicate food insecurity compared household food expenditure against a level of expenditure considered to be below the poverty line. Data on acquisition of food was commonly converted to available energy for the household using local food composition tables and expressed as a proportion of household total energy requirements. Dietary diversity was also assessed in some studies as well as experience of food insecurity.Conclusions: The review demonstrated that routinely collected HCES data sets provide a useful resource for the measurement of household food security in often resource-limited LMIC. Standardisation of methods used to assess food security is needed to allow for more useful comparisons between countries, as well as to assess temporal trends. [ABSTRACT FROM AUTHOR]

Objective: To identify the corporate political activity (CPA) strategies used by food industry actors during the development of two public health nutrition policies in Central America: Law #570 (taxation of sugar-sweetened beverages) in Panama and Bill #5504 (labelling and food marketing regulations) in Guatemala.Design: We triangulated data from publicly available information from 2018 to 2020, (e.g. industry and government materials; social media material) with semi-structured interviews with key stakeholders.Setting: Guatemala and Panama.Participants: Government, academia and international organisations workers in health and nutrition.Design: CPA strategies were categorised according to an existing internationally used taxonomy into action-based, instrumental strategies (coalition management, information management, direct involvement and influence in policy, legal action) and discursive strategies.Results: Instrumental strategies included the establishment of relationships with policymakers and direct lobbying against the proposed public policies. Discursive strategies were mainly criticising on the unfounded ground that they lacked evidence of effectiveness and will imply negative impacts on the economy. The industry pointed at individuals for making their own food choices, in order to shift the focus away from the role of its products in contributing to ill health.Conclusion: We provide evidence of the political practices used by the food industry to interfere with the development and implementation of public health nutrition policies to improve diets in Central America. Policymakers, public health advocates and the public should be informed about those practices and develop counterstrategies and arguments to protect the public and policies from the vested interests of the food industry. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between market concentration and diversity, as indicators of market structure, and the healthiness of food and beverage sales across Europe.Design: Market share (MS) data per country were used to calculate market concentration, assessed by the four-firm concentration ratio and market diversity, and by the number of companies with ≥1 % MS and the number of companies uniquely present in one European country. The healthiness of food sales was assessed by applying the NOVA classification (level of processing). Simple and multiple linear regressions were performed to assess the relationship between market concentration, diversity and the healthiness of food and beverage sales.Setting: The European single market.Participants: The twenty-seven European single market member states for which Euromonitor sales data were available at the most fine-grained Euromonitor packaged food and non-alcoholic beverage product subcategory level.Results: Increased market concentration with a country and a product category fixed effect significantly predicted increased sales of ultra-processed packaged food products. There was insufficient data variability in the level of processing of non-alcoholic beverage product categories to formulate conclusions for non-alcoholic beverages. Increased market diversity in turn significantly predicted reduced country-level sales of ultra-processed products.Conclusions: The results indicated a relationship between market structure and the healthiness of packed food products sold on the European market. However, more research with detailed nutritional data is warranted to document and quantify this interaction. [ABSTRACT FROM AUTHOR]

Objective: In many countries, the provision of water in the early months of a baby's life jeopardises exclusive breast-feeding (EBF). Using a behavioural theory, this study assessed the impact of a behaviour change intervention on mothers' intention to act and, in turn, on the water provision in addition to breast milk to their infants under 6 months of age (IU6M) in two regions of Guinea.Design: A quasi-experimental design. Data on individual and environmental factors of the theoretical framework, sociodemographic and outcomes were collected using validated questionnaires before and after the intervention. The outcomes examined were the intention to provide water to IU6M, the provision of water and EBF. Path analyses were performed to investigate pathways by which psychosocial and environmental factors influenced the water provision in addition to breast milk.Setting: Four health centres were assigned randomly to each study's arm (one control/CG and one intervention group/IG per region).Participants: The sample included 300 mothers of IU6M: 150 per group.Results: In IG, the proportion of mothers providing water decreased from 61 % to 29 % before and after the intervention (P < 0·001), while no difference was observed in CG (P = 0·097). The EBF rate increased in IG (from 24·0 % to 53·8 %, P < 0·001) as opposed to CG (36·7 % to 45·9 %, P = 0·107). An association (P < 0·001) between the intention and the behaviour was observed in both groups.Conclusions: An intervention developed using a sound framework reduces the provision of water among IU6M and improves EBF. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the association between body roundness index (BRI) and all-cause mortality and cardiovascular mortality in general population.Design: A retrospective cohort study.Setting: The status of cardiovascular mortality and all-cause mortality of participants were followed through 31 December 2015. Multivariate adjusted Cox restricted cubic spline regression models and Kaplan-Meier survival curves were used to evaluate the relationship between BRI and cardiovascular mortality and all-cause mortality.Participants: A sample of 47 356 participants from the National Health and Nutrition Examination Surveys 1999-2014 with aged ≥18 years.Results: Mean age was 47 years and female were 49·9 %. During a median follow-up of 92 months, 4715 participants died from any cause, with 985 died of CVD. In multivariate adjusted Cox regression, compared with the lowest quartile of Body roundness index (BRI), the hazard ratios (HR) for all-cause mortality from other quartiles were 0·83, 95 % CI (0·75, 0·92), 0·73, 95 % CI (0·65, 0·81) and 0·80, 95 % CI (0·72, 0·89), respectively (Pfor trend < 0·05) and the HR for cardiovascular mortality from other quartiles were 0·79, 95 % CI (0·62, 1·00), 0·78, 95 % CI (0·62, 0·99) and 0·79, 95 % CI (0·62, 1·01), respectively (P for trend > 0·05). In the restricted cubic spline regression models, the relationship was showed U-shaped between BRI and all-cause mortality and cardiovascular mortality. In Kaplan-Meier survival curves, the lowest cumulative survival rate of cardiovascular mortality and all-cause mortality was recorded in the highest BRI quartile.Conclusions: The U-shaped association between BRI and all-cause mortality and cardiovascular mortality in a large population-based cohort was observed. [ABSTRACT FROM AUTHOR]

Objective: To identify food purchase patterns and to assess their carbon footprint and expenditure.Design: Cross-sectional.Setting: Purchase patterns were identified by factor analysis from the annual purchases of 3435 product groups. The associations between purchase patterns and the total purchases' carbon footprints (based on life-cycle assessment) and expenditure were analysed using linear regression and adjusted for nutritional energy content of the purchases.Participants: Loyalty card holders (n 22 860) of the largest food retailer in Finland.Results: Eight patterns explained 55 % of the variation in food purchases. The Animal-based pattern made the greatest contribution to the annual carbon footprint, followed by the Easy-cooking, and Ready-to-eat patterns. High-energy, Traditional and Plant-based patterns made the smallest contribution to the carbon footprint of the purchases. Animal-based, Ready-to-eat, Plant-based and High-energy patterns made the greatest contribution, whereas the Traditional and Easy-cooking patterns made the smallest contribution to food expenditure. Carbon footprint per euros spent increased with stronger adherence to the Traditional, Animal-based and Easy-cooking patterns.Conclusions: The Animal-based, Ready-to-eat and High-energy patterns were associated with relatively high expenditure on food, suggesting no economic barrier to a potential shift towards a plant-based diet for consumers adherent to those patterns. Strong adherence to the Traditional pattern resulted in a low energy-adjusted carbon footprint but high carbon footprint per euro. This suggests a preference for cheap nutritional energy rather than environment-conscious purchase behaviour. Whether a shift towards a plant-based pattern would be affordable for those with more traditional and cheaper purchase patterns requires more research. [ABSTRACT FROM AUTHOR]

Objective: To assess in 2021 the acceptance and perception of the French tax on sweetened beverages, following its revision in 2018, and factors associated with a higher level of acceptance.Design: A cross-sectional survey within the NutriNet-Santé cohort study. Participants were invited to complete a self-reported questionnaire in March 2021. Weighting was applied to the sample to allow inferences on the French population. Individual characteristics associated with support for the tax were investigated using logistic regression modelling.Settings: NutriNet-Santé prospective cohort study.Participants: Adults engaged in the NutriNet-Santé cohort, aged 18 years or older (n 28 344), living in mainland France.Results: Almost two-thirds (63·4 %) of the participants were aware of the existence of a tax on sweetened beverages, although less than a quarter had specific knowledge regarding its design and the 2018 revision. In turn, 64·7 % of participants expressed a favourable opinion towards the taxation scheme. This proportion was higher if tax revenues were used to finance health-related measures (respectively 68·8 % of favourable opinion if used to finance a reduction in prices of healthy products and 76·4 % if used to finance the healthcare system). Multivariable analyses showed that support towards the tax varied among subgroups of the population. Groups who tended to be less financially affected by the measure and those who perceived sugar-sweetened beverages as having detrimental effects were more likely to support the tax.Conclusion: The revised French sugar-sweetened beverage tax appeared to be favourably received and perceived by the public. [ABSTRACT FROM AUTHOR]

Our dominant food system is a primary driver of worsening human and planetary health. Held in March 2022, the Public Health Association of Australia's Food Futures Conference was an opportunity for people working across the food system to connect and advocate for a comprehensive, intersectoral, whole-of-society food and nutrition policy in Australia to attenuate these issues. Conference themes included food systems for local and global good; ecological nutrition; social mobilisation for planetary and public good; food sovereignty and food equity. Students and young professionals are integral in transforming food systems, yet they are under-represented in the academic workforce, across publishing, scientific societies and conference plenaries. A satellite event was held to platform initiatives from early career researchers (ECR) in areas integral for improving planetary and public good. The research topics discussed in this commentary reflect sub-themes of the conference under investigation by ECR: food systems governance and regulation; local food policies; commercial determinants of health; sustainable healthy diets; and food equity and sovereignty. [ABSTRACT FROM AUTHOR]

Objective: Monitoring population salt intake is operationally and economically challenging. We explored whether a questionnaire assessment and a prediction of Na intake from spot-urine could replace or complement the recommended measurement of Na in 24-h urine (24-h U).Design: Compare the agreement of a Na-specific food record checklist (FRCL) and a late-afternoon spot-urine measurement (PM-spot) with 24-h U measurement in estimating Na intake at group level. Each participant's use of these methods extended over 3 d. Agreement was assessed using mean (95 % CI) differences, linear regression models and Bland-Altman plots.Setting: The validation study was part of a 1-year workplace intervention trial to lower salt intake in Switzerland.Participants: Seventy women and 71 men, aged 21-61 years, completed three FRCL, and acceptable PM-spot and 24-h U samples at baseline (April-October 2015).Results: Mean Na intake estimates varied slightly across methods (3·5-3·9 g/d). Mean Na intake differences from 24-h U were 0·2 (95 % CI (0, 0·5)) g/d for FRCL and 0·4 (95 % CI (0·2, 0·6)) g/d for PM-spot. Linear regression models and Bland-Altmann plots more clearly depicted differences by sex and discretionary salt use.Conclusions: Although 24-h U remains the best reference method for monitoring Na intake at the population level, PM-spot and FRCL might be more practical instruments for frequent, periodic Na intake assessments. Population-specific prediction models to estimate 24-h U could be developed and evaluated. [ABSTRACT FROM AUTHOR]

Objective: To identify determinants of egg consumption in infants and young children aged 6-23·9 months in Ethiopia.Design and Setting: Data used were from the cross-sectional baseline survey of an egg campaign in Ethiopia implemented by the Global Alliance for Improved Nutrition.Participants: Children aged 6-23·9 months (n 453) were sampled. Data on socio-demographic characteristics, economic resources, caregiver's behaviour, child health and feeding practices, and egg consumption in the last 7 d were collected using interviewer-administered questionnaires. Multivariable ordinal logistic regression was used to examine the association between explanatory variables and egg consumption in the last 7 d.Results: About half of children (53·4 %) did not consume eggs in the last 7 d. The odds of children consuming eggs were 4·33 (P < 0·002) times higher when their caregivers had some college education compared with no education. Wealth was positively (OR, 1·13, P = 0·029) and household food insecurity was negatively (OR, 0·96, P = 0·117) associated with child egg consumption. Purchasing eggs (OR, 9·73, P < 0·001) and caregiver's positive behavioural determinants (OR, 1·37, P = 0·005) were associated with child egg consumption. The associations of socio-demographic characteristics and economic resources with egg consumption provide evidence of partial mediation through caregiver behaviour and child health.Conclusions: About half of children aged 6-23·9 months consumed eggs. Availability of eggs in households, mainly through purchase, was strongly associated with egg consumption. Education of caregivers and household heads and economic resources were associated with egg consumption and may operate through caregiver behaviour. [ABSTRACT FROM AUTHOR]

Objective: This study investigated associations between types and food sources of protein with overweight/obesity and underweight in Ethiopia.Design: We conducted a cross-sectional dietary survey using a non-quantitative FFQ. Linear regression models were used to assess associations between percentage energy intake from total, animal and plant protein and BMI. Logistic regression models were used to examine the associations of percentage energy intake from total, animal and plant protein and specific protein food sources with underweight and overweight/obesity.Setting: Addis Ababa, Ethiopia.Participants: 1624 Ethiopian adults (992 women and 632 men) aged 18-49 years in selected households sampled using multi-stage random sampling from five sub-cities of Addis Ababa.Results: Of the surveyed adults, 31 % were overweight or obese. The majority of energy intake was from carbohydrate with only 3 % from animal protein. In multivariable-adjusted linear models, BMI was not associated with percentage energy from total, plant or animal protein. Total and animal protein intake were both associated with lower odds of overweight/obesity (OR per 1 % energy increment of total protein 0·92; 95 % CI: 0·86, 0·99; P = 0·02; OR per 1 % energy increment of animal protein 0·89; 95 % CI: 0·82, 0·96; P = 0·004) when substituted for carbohydrate and adjusted for socio-demographic covariates.Conclusion: Increasing proportion of energy intake from total protein or animal protein in place of carbohydrate could be a strategy to address overweight and obesity in Addis Ababa; longitudinal studies are needed to further examine this potential association. [ABSTRACT FROM AUTHOR]

Objective: Ready to eat fried liver meat balls (LMB) were developed to fight anaemia and vitamin A deficiency and promote cognitive function.Design: Randomised controlled trial consisting of two arms: control group with no supplement and LMB group receiving LMB supplement three times a week for 90 d. Criteria of evaluations included dietary assessment, anthropometric measurements, laboratory investigations and cognitive function by Wechsler test.Setting: Kinder Garten and primary school in Urban Giza.Participants: Sixty boys and girls aging 3-9 years.Results: The LMB supplement contributed to significant increases in the intakes of high bioavailable Fe and vitamin A in the diets of all children. Initial overall prevalence of mild and moderate anaemia was 43 %, which disappeared completely from all children aging < 72 months and from 88 % of children ≥ 72 months after the 90 d dietary intervention with the LMB. Faecal systemic immune globulin A, urinary hydroxyproline index and urinary iodine excretion increased significantly (P < 0·05) only after the dietary intervention with the LMB supplement for 90 d. The standard scores of verbal and non-verbal cognitive function tests (Δ day 90-day 0) increased significantly (P < 0·05) among the LMB group compared with the respective changes observed among the control group. The increase in height-for-age Z score and blood Hb were good predictors for improvement in cognitive function.Conclusion: LMB supplement is effective sustainable nutritious biotherapeutic food in fighting hidden hunger and promoting the cognitive function. [ABSTRACT FROM AUTHOR]

Objective: About one-third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children.Design: Using the 2015 Philippine National Nutrition Survey, we conducted a linear probability model to examine the determinants of child stunting and then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children.Setting: Philippines.Participants: 1881 children aged 6-23 months participated in this study.Results: The overall stunting prevalence was 38·5 % with a significant gap between poor and non-poor (45·0 % v. 32·0 %). Maternal height, education and maternal nutrition status account for 26 %, 18 % and 17 % of stunting inequality, respectively. These are followed by quality of prenatal care (12 %), dietary diversity (12 %) and iron supplementation in children (5 %).Conclusions: Maternal factors account for more than 50 % of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of PASOS SALUDABLES, a culturally tailored lifestyle intervention to prevent obesity and diabetes among Latino farmworkers, when implemented at large scale in the worksite.Design: This study was a two-arm parallel group, cluster randomised controlled trial, where participants received either a twelve-session lifestyle intervention (intervention) or six-session leadership training (control) at their worksite. The intervention was delivered by Promotoras in Spanish. All sessions were conducted at the worksites (ranches) during meal breaks. Blinded, trained research assistants collected socio-demographic and outcome data (i.e. BMI as primary outcome and waist circumference, glycated Hb (HbA1c), cholesterol and blood pressure as secondary outcomes) at baseline and follow-up assessments (i.e. 3 months, 6 months, 1 year and 1·5 years).Setting: Recruitment and intervention delivery occurred at twelve study ranches in Oxnard, California.Participants: We enrolled farmworkers hired by a large berry grower company, who were ≥18 years old, spoke Spanish and were free of diabetes at screening.Results: A total of 344 workers were enrolled in the intervention and 271 in the control group. The intervention resulted in attenuated increase of BMI over time; however, the difference in trend between groups was not significant (β = -0·01 for slope difference, P = 0·29). No significantly different trend by group was observed in secondary outcomes (P > 0·27).Conclusions: The worksite intervention, implemented during meal breaks, did not reduce BMI or other clinical indicators. Nevertheless, this study supports the feasibility of recruiting and engaging the Latino farmworker population in workplace health promotion interventions. [ABSTRACT FROM AUTHOR]

Objective: The objective of the current study was to evaluate the impact of the Market to MyPlate (M2MP) program on participants' reported farmers' market (FM) attitudes and shopping behaviours, frequency of serving vegetables to their families, food resource management behaviours and food security. A secondary objective was to identify facilitators and barriers to shopping at FM and food waste reduction techniques used by low-income families.Design: The current study used a mixed methods evaluation embedded within a cluster randomised trial of the M2MP intervention.Setting: The 7-week M2MP program was delivered at Extension offices and community centres in central Illinois.Participants: Participants included 120 adults and their families. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45).Results: Compared with control participants, PAE participants were significantly more likely to report shopping at FM (P = 0·029) and reported serving more vegetables to their families (P = 0·010) (EO participants did not differ from the control group on any outcomes). There were no differences between conditions in survey-based measures of food security or food resource management behaviours. Interview results describe facilitators and barriers to shopping at FM and a variety of food waste reduction techniques (including food placement and food resource management).Conclusions: These findings suggest that fresh produce provision coupled with nutrition and culinary education can positively impact shopping and dietary behaviours. [ABSTRACT FROM AUTHOR]

Objective: The current paper describes Diet In Nutrients Out (DINO), an integrated dietary assessment system incorporating dietary data entry and nutritional analysis within one platform for use in dietary assessment in small-scale intervention studies to national surveys. Design: DINO contains >6000 food items, mostly aggregated composites of branded foods, across thirty-one main food groups divided into 151 subsidiary groups for detailed reporting requirements, with fifty-three core nutrient fields. Setting: MRC Human Nutrition Research (HNR), Cambridge, UK and MRC Keneba, Gambia. Subjects: DINO is used across dietary assessment projects at HNR and MRC Keneba. Results: DINO contains macro- and micronutrients as well as additional variables of current research and policy interest, such as caffeine, whole grains, vitamin K and added sugars. Disaggregated data are available for fruit, vegetables, meat, fish and cheese in composite foods, enabling greater accuracy when reporting food consumption or assessing adherence to dietary recommendations. Portion sizes are categorised in metric and imperial weights, with standardised portion sizes for each age group. Regular reviews are undertaken for portion sizes and food composition to ensure contemporary relevance. A training programme and a checking schedule are adhered to for quality assurance purposes, covering users and data. Eating context questions are integrated to record where and with whom the respondent is eating, allowing examination between these factors and the foods consumed. Conclusions: An up-to-date quality-assured system for dietary assessment is crucial for nutritional surveillance and research, but needs to have the flexibility to be tailored to address specific research questions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a nutritional intervention to promote fruit and vegetable (FV) intake.Design: A randomised controlled community trial was conducted to evaluate the effectiveness of a 7-month nutritional intervention and to promote FV intake, separately and together. All participants attended physical exercise sessions. The intervention was based on the transtheoretical model and Paulo Freire's pedagogy. The interventions included group educational sessions, motivational cards and informational materials. The primary outcome was a change in FV intake (g/d), and secondary outcomes included stages of change, self-efficacy, decisional balance and knowledge on FV. All data were collected face-to-face; and FV intake was assessed using a validated brief questionnaire.Setting: Health promotion services of Brazilian Primary Health Care.Participants: 3414 users of Brazilian Primary Health Care (1931 in the control group and 1483 in the intervention group (IG)).Results: At baseline, the average daily FV intake was 370·4 g/d (95 % CI 364·2, 376·6). The increase in FV intake (23·4 g/d; 95 % CI 6·7, 40·0) and fruit intake (+17·3 g/d; 95 % CI 5·1, 29·4; P = 0·01) was greater in the IG among participants in the lowest baseline intake. Participants in the IG also showed progression in the stages of change (P < 0·001), increased self-efficacy (P < 0·001) and improved knowledge of FV crops (P < 0·001).Conclusions: The nutritional intervention was effective in increasing FV intake and fruits intake among individuals with a lower intake at baseline and in maintaining FV intake among those who reported consuming FV as recommended (400 g/d). [ABSTRACT FROM AUTHOR]

Objective: Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk.Design: Prospective cohort study.Setting: We followed participants in the Hordaland Health Study, Norway from 1997-1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410-414 and ICD10 codes I20-I25).Participants: 2995 men and women, aged 46-49 years.Results: Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90).Conclusions: Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD. [ABSTRACT FROM AUTHOR]

Objective: Diets high in red and processed meat (RPM) contribute substantially to environmental degradation, greenhouse gas emissions and the global burden of chronic disease. High-profile reports have called for significant global RPM reduction, especially in high-income settings. Despite this, policy attention and political priority for the issue are low.Design: The study used a theoretically guided framing analysis to identify frames used by various interest groups in relation to reducing RPM in online news media articles published in the months around the release of four high-profile reports by authoritative organisations that included a focus on the impacts of high RPM production and/or consumption.Setting: Four major RPM producing and consuming countries - USA, United Kingdom, Australia and New Zealand.Participants: None.Results: Hundred and fifty news media articles were included. Articles reported the views of academics, policymakers, industry representatives and the article authors themselves. RPM reduction was remarkably polarising. Industry frequently framed RPM reduction as part of a 'Vegan Agenda' or as advocated by an elite minority. Reducing RPM was also depicted as an infringement on personal choice and traditional values. Many interest groups attempted to discredit the reports by citing a lack of consensus on the evidence, or that only certain forms of farming and processing were harmful. Academics and nutrition experts were more likely to be cited in articles that were aligned with the findings of the reports.Conclusions: The polarisation of RPM reduction has led to a binary conflict between pro- and anti-meat reduction actors. This division may diminish the extent to which political leaders will prioritise this in policy agendas. Using nuanced and context-dependent messaging could ensure the narratives around meat are less conflicting and more effective in addressing health and environmental harms associated with RPM. [ABSTRACT FROM AUTHOR]

Objective: To translate and validate the Child Three-Factor Eating Questionnaire (CTFEQr17), assessing cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE), among French-speaking Canadian young individuals.Design: Phase 1 comprised a translation and the evaluation of the comprehension of the questionnaire. Phase 2 comprised a confirmatory factor analysis (CFA), the evaluation of internal consistency (Cronbach's α), test-retest reliability (intra-class correlation coefficients (ICC)) and construct validity, including correlations among the CTFEQr17 and Eating Attitudes Test (EAT-26), anthropometrics, dietary intake and diet quality.Setting: Primary and secondary schools, Québec City, Canada.Participants: Phases 1 and 2 included 20 (40 % boys, mean age 11·5 (sd 2·4) years) and 145 (48 % boys, mean age 11·0 (sd 1·9) years) participants, respectively.Results: Phase 1 resulted in the questionnaire to be used in Phase 2. In Phase 2, the CFA revealed that the seventeen item, three-factor model (CTFEQr17) provided an excellent fit. Internal consistency was good (Cronbach's α: 0·81-0·90). Test-retest reliability was moderate to good (ICC = 0·59, (95 % CI 0·48, 0·70), ICC = 0·78, (95 % CI 0·70, 0·84), ICC = 0·50, (95 % CI 0·38, 0·62) for CR, UE and EE, respectively). CR correlated with EAT-26 score (r = 0·43, P < 0·0001). UE and EE correlated negatively with BMI Z-scores (r = -0;·26, P = 0·003; r = -0;·19, P = 0·03, respectively). CR correlated with the proportion of energy intake from protein and diet quality (r = 0·18, P = 0·04; r = 0·20, P = 0·02, respectively).Conclusion: The CTFEQr17 is suitable to use among French-speaking Canadian young individuals. [ABSTRACT FROM AUTHOR]

Objective: To understand the factors influencing the implementation of salt reduction interventions in low- and middle-income countries (LMIC).Design: Retrospective policy analysis based on desk reviews of existing reports and semi-structured stakeholder interviews in four countries, using Walt and Gilson's 'Health Policy Triangle' to assess the role of context, content, process and actors on the implementation of salt policy.Setting: Argentina, Mongolia, South Africa and Vietnam.Participants: Representatives from government, non-government, health, research and food industry organisations with the potential to influence salt reduction programmes.Results: Global targets and regional consultations were viewed as important drivers of salt reduction interventions in Mongolia and Vietnam in contrast to local research and advocacy, and support from international experts, in Argentina and South Africa. All countries had population-level targets and written strategies with multiple interventions to reduce salt consumption. Engaging industry to reduce salt in foods was a priority in all countries: Mongolia and Vietnam were establishing voluntary programs, while Argentina and South Africa opted for legislation on salt levels in foods. Ministries of Health, the WHO and researchers were identified as critical players in all countries. Lack of funding and technical capacity/support, absence of reliable local data and changes in leadership were identified as barriers to effective implementation. No country had a comprehensive approach to surveillance or regulation for labelling, and mixed views were expressed about the potential benefits of low sodium salts.Conclusions: Effective scale-up of salt reduction programs in LMIC requires: (1) reliable local data about the main sources of salt; (2) collaborative multi-sectoral implementation; (3) stronger government leadership and regulatory processes and (4) adequate resources for implementation and monitoring. [ABSTRACT FROM AUTHOR]

Objective: To assess the price promotions offered by major quick service restaurant (QSR) chains in Australia from an obesity prevention perspective.Design: Cross-sectional audit of ten of the largest QSR chains in Australia. We collected information regarding temporary price promotions and 'combination deals' offered by each chain over thirteen consecutive weeks in 2019-2020. We assessed the type of promotions, the magnitude of discount, and the energy content and healthiness of items promoted (based on Victorian Government criteria).Setting: Melbourne, Australia.Participants: Ten major QSR chains.Results: Temporary price promotions (n 196) and combination deals (n 537 on regular menus, n 36 on children's menus) were observed across the ten selected QSR chains. In relation to temporary price promotions, the mean magnitude of discount for main menu items (n 75) was 41·7 %. The price reductions and energy content of combination deals varied substantially the by chain, the meal size and the sides/drinks selected as part of the 'deal'. When the lowest-energy options (e.g. small chips, small sugar-free drink) were included as part of each combination deal, the mean energy content was 2935 kJ, compared to 5764 kJ when the highest-energy options (e.g. large fries, large sugar-sweetened drink) were included. Almost all available products were classified as unhealthy.Conclusion: Price promotions are ubiquitous in major QSR chains in Australia and provide incentives to consume high levels of energy. The action to restrict price promotions on unhealthy foods and ensure lower-energy default items as part of combination deals should be included as part of efforts to improve population diets and address obesity in Australia. [ABSTRACT FROM AUTHOR]

Objective: In 2019, California and Wilmington, Delaware' implemented policies requiring healthier default beverages with restaurant kids' meals. The current study assessed restaurant beverage offerings and manager perceptions.Design: Pre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t tests. Post-implementation, managers were interviewed.Setting: Inside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7-12 months after policy implementation.Participants: Restaurant observations (California n 110; Wilmington n 14); managers (California n 75; Wilmington n 15).Results: Pre-implementation, the most common kids' meal beverages on California menus were unflavoured milk and water (78·8 %, 52·0 %); in Wilmington, juice, milk and sugar-sweetened beverages were most common (81·8 %, 66·7 % and 46·2 %). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9·7 % to 66·1 %, P < 0·0001), but remained constant in Wilmington (30·8 %). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5·0 % to 1·0 %, P = 0·002). Few managers (California 29·3 %; Wilmington 0 %) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff.Conclusions: While the proportion of menus offering only policy-consistent kids' meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions, managers lacked policy knowledge, and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids' meal beverage policies. [ABSTRACT FROM AUTHOR]

Objective: To investigate family structure differences in adolescents' consumption of fruit, vegetables, sweets and sugar-added soft drinks with adjustments for socio-demographic and socio-economic variables.Design: Cross-sectional data from the Health Behaviour in School-aged Children survey.Setting: Norwegian primary and secondary schools.Participants: Adolescents (n 4475) aged 11, 13, 15 and 16 years.Results: After adjusting for covariates, living in a single-mother family was associated with lower vegetable consumption (OR 0·76, 95 % CI 0·63, 0·91) and higher soft drink consumption (OR 1·29, 95 % CI 1·06, 1·57). Living in a mother and stepfather family was negatively associated with fruit (OR 0·71, 95 % CI 0·54, 0·95) and vegetable (OR 0·72, 95 % CI 0·54, 0·97) consumption. Living in a single-father family was associated with lower sweets consumption (OR 0·48, 95 % CI 0·32, 0·72). No significant interactions were demonstrated between family structure and socio-demographic or socio-economic covariates.Conclusions: The study suggests that an independent association between family structure and adolescents' food habits exists. [ABSTRACT FROM AUTHOR]

Objective: To characterise different meal types by examining the contribution of specific meals to the total intakes and the nutritional quality of each meal.Design: A cross-sectional analysis was conducted based on dietary data collected using 4-d dietary record. Diet quality was assessed by the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9.3.Setting: Japan.Participants: Adults aged 20-81 years (n 639).Results: Diet quality was, on average, highest for dinner, followed, in order, by lunch, breakfast and snacks. Breakfast, lunch, dinner and snacks, on average, accounted for 21 %, 32 %, 40 % and 11 % of total energy intake, respectively. For many nutrients, the percentage contribution to total intake did not vary within each meal, broadly in line with that for energy: 18-24 % for breakfast, 26-35 % for lunch, 35-49 % for dinner and 4-15 % for snacks. However, intakes of many foods largely depended on one meal type. The foods mainly eaten at dinner were potatoes, pulses, total vegetables, fish, meat and alcoholic beverages (52-70 %), in contrast to noodles (58 %) at lunch and bread (71 %) and dairy products (50 %) at breakfast. The foods mainly eaten at snacks were confectioneries (79 %) and sugar-sweetened beverages (52 %). Conversely, rice and eggs were more evenly distributed across three main meals (19-41 % and 30-38 %, respectively), while fruit and non-energetic beverages were more evenly distributed across all meal types (17-30 % and 19-35 %, respectively).Conclusions: These findings provide the background information on each meal type in Japanese and may help inform the development of meal-based guidelines and public health messages. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and socio-economic inequalities in breast milk, breast milk substitutes (BMS) and other non-human milk consumption, by children under 2 years in low- and middle-income countries (LMIC).Design: We analysed the prevalence of continued breast-feeding at 1 and 2 years and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-h dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socio-economic inequalities.Setting: Nationally representative surveys from 2010 onwards from eighty-six LMIC.Participants: 394 977 children aged under 2 years.Results: Breast-feeding declined sharply as children became older in all LMIC, especially in upper-middle-income countries. BMS consumption peaked at 6 months of age in low/lower-middle-income countries and at around 12 months in upper-middle-income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breast-feeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breast-feeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breast-feeding.Conclusions: Breast-feeding falls sharply as children become older, especially in wealthier families in upper-middle-income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences. [ABSTRACT FROM AUTHOR]

Objective: This study explored social and behavioural factors associated with a home fortification of complementary foods program among families of undernourished children in 14 rural communities in Honduras.Design: We collected and analysed survey data from a convenience sample of 196 households participating in a nutritional program using home fortification of complementary foods in 2017. The program supplied families with a soy-based atole powder fortified with micronutrients. A research team completed a face-to-face survey exploring social and behavioural factors associated with nutritional supplement use. Anthropometric measurements for participating children were abstracted from health clinic records of previous quarterly appointments.Setting: The study took place in San Jose del Negrito, Honduras.Participants: Participants were parents or guardians of children enrolled in the nutrition program.Results: Nearly half of participant families shared the nutritional supplement with other family members besides the index child, while 10 % reported using the supplement as a meal replacement for the child. Low education level of mothers was associated with improper use of the supplement (P = 0·005). Poorer families were more likely to share the supplement (P = 0·013).Conclusions: These results highlight the challenges of programs using home fortification of complementary foods in the context of food scarcity. Findings highlight the importance of increasing rural children's overall caloric intake, perhaps by increasing access to locally available protein sources. Results also suggest transitioning nutritional programs to family-based interventions to increase overall intended compliance to nutrition programming. [ABSTRACT FROM AUTHOR]

Objective: Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016-2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments.Design: A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model.Setting: Australia.Participants: Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020.Results: The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies.Conclusions: Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes. [ABSTRACT FROM AUTHOR]

Objective: Approximately 50 % of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on the protein intake of Dutch community-dwelling older adults.Design: The Dutch National Food Consumption Survey-Older Adults 2010-2012 (DNFCS-OA) was used for scenario modelling. Dietary intake was estimated based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2) and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was < 1·0 g/kg BW/d (n 391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-d intake data.Setting: A simulation study based on the DNFCS-OA.Participants: 727 Dutch community-dwelling older adults aged 70+.Results: Mean protein intake of the total population increased from 1·0 to 1·2 g/kg BW/d (scenarios 1 and 2) and to 1·3 g/kg BW/d (scenario 3). The percentage of participants with intakes of ≥ 1·0 g/kg BW/d increased from 47·1 % to 91·4 %, 90·2 % and 94·6 %, respectively, in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups: yoghurt, cream desserts and pudding, potatoes, vegetables and legumes and non-alcoholic beverages and milk in scenario 1 and bread; yoghurt, cream desserts and pudding and soups in scenario 2.Conclusions: This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counselling. [ABSTRACT FROM AUTHOR]

Objective: The Democratic Republic of the Congo (DRC) has one of the highest levels of child undernutrition globally; however, little information exists on the underlying socio-economic inequalities resulting in undernutrition. This study aims to examine the differences in the nutritional statuses of children across different wealth quintiles and explores the association between malnutrition in children and related factors.Design: We utilised the 2018 Multiple Indicator Cluster Survey data. We estimated the prevalence of malnutrition across all twenty-six provinces. The study used the WHO 2006 child growth standards to measure stunting, underweight and wasting. We employed a mixed-effect linear model to analyse the association between nutritional status and healthcare accessibility, domestic sanitation, and socio-demographic factors.Setting: Twenty-six provinces in the DRC.Participants: 21 477 children under 5 years of age and 21 828 women of childbearing age in the DRC.Results: The national prevalence of underweight, stunting and wasting was found to be 23·33 %, 42·05 % and 5·66 %, respectively. Household wealth and mother's education level were significantly positively associated with the nutritional statuses of children. Among households in the lowest wealth quintile, residence in urban areas was a protective factor against undernutrition.Conclusion: The findings of this study indicate considerable socio-economic inequalities in the nutritional statuses of children under 5 years of age in the DRC, highlighting the need for nutrition promotion as part of maternal and child healthcare. Interventions and policies should include improving nutrition education for less-educated mothers, in particular, in the central provinces of the DRC. [ABSTRACT FROM AUTHOR]

Objective: Feeding practices used by educators in Early Childhood Education and Care (ECEC) settings can influence the diet quality of young children. However, Australian data is scarce and limited to describing barriers to responsive feeding. This study describes the use of feeding practices amongst a group of Australian educators.Design: Direct observation of feeding practices and assessment of centre policy were conducted using the 'Environment and Policy Assessment and Observation' tool. Self-reported feeding practices and demographic data were collected via online survey using the Childcare Food and Activity Practices Questionnaire.Setting: Ten centre-based ECEC services in South East Queensland, Australia.Participants: Educators working in ECEC.Results: A total of 120 meals were observed and 88 educators provided self-report data (n 84 female). Centre policy supported the use of responsive feeding practices, and this was reflected in the high frequency with which children could decide what and how much to eat, across both observed and self-report data as well as low levels of pressure to eat and use of food as a reward (observed at 19·9 % and 0 % of meals). The only apparent discrepancy was regarding modelling. Median score for self-reported role-modelling was 5·0 (4·3-5·0) and educators were observed to sit with children at 75 % of meals, however observed occasions of enthusiastic role modelling was only 22 % (0-33·3) of meals.Conclusions: Research addressing how educators conceptualise feeding practices, as well under what circumstances they are used, particularly in centres with different models of food provision, may shed light on why modelling is rarely implemented in practice. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this study was to evaluate the impact of the Market to MyPlate (M2MP) program on fruit and vegetable consumption and cooking behaviours. Secondary objectives were to examine factors that affected participant retention and program completion, and analyse program feedback provided by participants.Design: This study conducted a mixed methods evaluation embedded within a cluster randomised controlled trial of the M2MP intervention. Adult participants completed a pre- and post-program survey reporting on their fruit and vegetable consumption and cooking behaviours. A subsample participated in structured interviews, providing feedback about M2MP and the impact of the program.Setting: Seven weekly classes took place in community centres and extension offices in central Illinois.Participants: 120 adults and their families participated. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45).Results: Compared to control, PAE participants reported larger increases from pre- to post-intervention in fruit (P = 0·001) and vegetable consumption (P = 0·002), with no differences in cooking frequency. Interview analyses identified key themes in behaviour changes due to M2MP, including reported increases in dietary variety, cooking self-efficacy and children's participation in cooking.Conclusions: PAE participants who received an intervention that directly increased their access to fresh produce (via produce allocations) increased their reported fruit and vegetable consumption. Though participants' cooking frequency did not change, interviewees reported increased variety, cooking confidence and family participation in cooking. [ABSTRACT FROM AUTHOR]

Objective: Chefs have the potential to influence diet quality and food systems sustainability through their work. We aimed to assess the attitudes and perceptions of culinary students about nutrition and sustainability as part of their roles, responsibilities and future work as chefs.Design: We surveyed students attending the Culinary Institute of America (CIA) in the fall of 2019 (n 546). Descriptive statistics compared food priority rankings and Likert-scale distributions of nutrition and sustainability attitudes and beliefs. Adjusted generalised linear models were used to evaluate whether there were differences in attitudes and beliefs across demographic groups.Setting: The CIA, a private, not-for-profit college and culinary school with US campuses in New York, California and Texas.Participants: Students >18 years old currently enrolled in any of the school's associate's or bachelor's degree programs.Results: Students agreed that chefs should be knowledgeable about nutrition (96·0 %) and the environmental impact of their ingredients (90·8 %) but fewer considered healthfulness (57·8 %) and environmental impact (60·2 %) of their food to be primary considerations in their career as a chef. Taste was the primary factor influencing culinary students' food choices but food priorities differed by race/ethnicity.Conclusions: Culinary students believe nutrition and sustainability are important. Opportunities exist to empower them with knowledge and skills for promoting public health and sustainable food systems in their future work as chefs. [ABSTRACT FROM AUTHOR]

Objective: To simulate the impact - effectiveness and safety - of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program.Design: This is a secondary analysis of national or sub-national dietary intake databases.Setting and Participants: Uganda, Lao People's Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy.Results: We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19-31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy.Conclusions: We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake. [ABSTRACT FROM AUTHOR]

Objective: The US Dietary Guidelines for Americans recommends increased consumption of the dairy group to three daily servings for ages 9+ years to help achieve adequate intakes of prominent shortfall nutrients. Identifying affordable, consumer-acceptable foods to replace dairy's shortfall nutrients is important especially for people who avoid dairy.Design: Linear programming identified food combinations to replace dairy's protein and shortfall nutrients. We examined cost, energy and dietary implications of replacing dairy with food combinations optimised for lowest cost, fewest kJ or the smallest amount of food by weight.Setting: National Health and Nutrition Examination Survey (2011-2014).Participants: Nationally representative sample of US population; 2 years and older (n 15 830).Results: Phase 1 (only dairy foods excluded): when optimised for lowest cost or fewest kJ, all non-dairy food replacements required large amounts (2·5-10 cups) of bottled/tap water. Phase 2 (dairy and unreasonable non-dairy foods excluded (e.g. baby foods; tap/bottled water): when intake of non-dairy foods was constrained to <90th percentile of current intake, the lowest cost food combination replacements for dairy cost 0·5 times more and provide 5·7 times more energy; the lowest energy food combinations cost 5·9 times more, provide 2·5 times more energy and require twice the amount of food by weight; and food combinations providing the smallest amount of food by weight cost 3·5 times more and provide five times more energy than dairy.Conclusions: Identifying affordable, consumer-acceptable foods that can replace dairy's shortfall nutrients at both current and recommended dairy intakes remains a challenge. [ABSTRACT FROM AUTHOR]