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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]

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: 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: 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: 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: 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]

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 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]