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Nearly one fifth of the world's children are experiencing overweight or obesity--that is, an estimated 39 million children younger than five years and 340 million children aged 5-19 years. (1) [...]

Objective: To compare the frequency and healthfulness of foods being advertised to children and adolescents in four countries of WHO European region. Design: Cross-sectional quantitative study, guided by an adapted version of the WHO protocol. All recorded food advertisements were categorised by categories and as either 'permitted' or 'not permitted' for advertising to children in accordance with WHO Regional Office for Europe Nutrient Profile Model. Settings: Four countries: Russia, Turkey, Kazakhstan and Kyrgyzstan Participants: TV channels most popular among children and adolescents Results: Analysis included 70 d of TV broadcasting for all channels, during which time there were 28 399 advertisements. The mean number of advertisements per hour varied from eleven in Turkey and Kazakhstan to eight and two in Russia and Kyrgyzstan. In all countries, the majority of the food and beverages advertised should not be permitted for advertising to children according to the WHO Nutrient Profile Model. The mean number of non-permitted food and beverage advertisements per hour was high in Turkey and Kazakhstan (8·8 and 8·5 ads) compared with Russia (5·1) and Kyrgyzstan (1·9). Turkey was the only country where nutritional information was fully available, and no values were missing that prevented coding for some product categories. Conclusions: Results revealed that children and adolescents in four countries are exposed to a considerable volume of food and beverage advertisements, including sugary products on broadcast television. As such, policymakers should consider protecting youth by developing regulations to restrict these marketing activities within media popular with children. [ABSTRACT FROM AUTHOR]

Low- and middle-income countries are increasingly faced with a triple burden of malnutrition: endemic underweight, micronutrient deficiencies and rising prevalence of overweight. This study aimed to address existing knowledge gaps and to identify priority policy options in Mongolia, the Philippines and Vietnam. A landscape analysis approach was adopted using methods set out in a UNICEF global toolkit. Quantitative and qualitative data were compiled from a range of global and national sources on childhood overweight and obesity, risk factors and policy responses. Key informant interviews and validation workshops were undertaken with key food and nutrition stakeholders from government and non-government organizations to identify priority policy options for the prevention of overweight and obesity among children. Overweight and obesity among children are increasing in all three countries. Associated risk factors are related to maternal nutrition, birthweight, breastfeeding, as well as diets and physical activity shaped by increasingly obesogenic environments. Key informants identified undefined policy approaches, poor community understanding and food and beverage industry influence as barriers to addressing overweight and obesity. Key policy priorities include restricting the marketing of unhealthy food and beverages, unhealthy food and beverage taxation, introduction of front-of-pack nutrition labels and improving school nutrition environments. Mongolia, the Philippines and Vietnam are all facing an increasing burden of childhood overweight and obesity. Despite differing national contexts, similar environmental factors are driving this rise. A suite of evidence-based policies can effectively be introduced to address obesogenic environments. [ABSTRACT FROM AUTHOR]

Summary: Despite efforts to curb the rise in Mexico's child and adolescent overweight and obesity rates, prevalence in Mexico has grown by 120% since 1990 to 43.3% in 2022. This investment case identifies policies that will produce the largest returns for Mexico. The investment case model builds beyond a cost‐of‐illness analysis by predicting the health and societal economic impact of implementing child and adolescent overweight and obesity interventions in a cohort aged 0–19 from 2025 to 2090. The Markov model's impacts include healthcare expenditures, years of life lost, and reduced wages and productivity. We projected and compared costs in a status quo scenario to an intervention scenario to estimate cost savings and calculate return‐on‐investment (ROI). Total lifetime health and economic costs amount to USD 1.8 trillion—USD 30 billion on average per year. Implementing five interventions can reduce lifetime costs by approximately 7%. Each intervention has a low cost per disability‐adjusted life year averted over 30‐year, 50‐year, and lifetime horizons. The findings demonstrate that a package of interventions mitigating child and adolescent overweight and obesity offers a strong ROI. The novel investment case methods should be applied to other countries, particularly low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Background: Taxation on sugar-sweetened beverages (SSBs) has been adopted in more than 40 countries but remained under discussion in Vietnam. This study aimed to estimate the health impacts of different SSBs tax plans currently under discussion to provide an evidence base to inform decision-making about a SSBs tax policy in Vietnam. Method & findings: Five tax scenarios were modelled, representing three levels of price increase: 5%, 11% and 19–20%. Scenarios of the highest price increase were assessed across three different tax designs: ad valorem, volume-based specific tax & sugar-based specific tax. We modelled SSBs consumption in each tax scenario; how this reduction in consumption translates to a reduction in total energy intake and how this relationship in turn translates to an average change in body weight and obesity status among adults by applying the calorie-to weight conversion factor. Changes in type 2 diabetes burden were then calculated based on the change in average BMI of the modelled cohort. A Monte Carlo simulation approach was applied on the conversion factor of weight change and diabetes risk reduction for the sensitivity analysis. We found that the taxation that involved a 5% price increase gave relatively small impacts while increasing SSBs' price up to 20% appeared to impact substantially on overweight and obesity rates (reduction of 12.7% and 12.4% respectively) saving 27 million USD for direct medical cost. The greatest reduction was observed for overweight and obesity class I. The decline in overweight and obesity rates was slightly higher for women than men. Conclusion: This study supports the SSB tax policy in pursuit of public health benefits, especially where the tax increase involves around a 20% price increase. The health benefit and revenue gains were evident across all three tax designs with the specific tax based on sugar density achieving greatest effects. [ABSTRACT FROM AUTHOR]

Background Evidence based health policy, such as that put forward in the European Food and Nutrition Action Plan 2015–2020 and the WHO Global Action Plan on the Prevention and Control of Noncommunicable Diseases, has a role in curbing the consumption of unhealthful foods and drink. We ask how countries are performing in the adoption of these policies and how the comprehensiveness of their food environment policies explains variations in consumption of unhealthful products across Europe. Methods In order to assess the state of policy adoption, we developed a composite indicator—the Food Regulatory Environment Index (FREI) for which we calculated unweighted and weighted formulations according to the strength of the evidence base. We used linear regression models to explain variations in the consumption of unhealthful products as well as variations in a composite indicator of obesogenic diets. Results Overall, wealthier countries in the Region perform better. The weighting of the constituent policies does not affect the rankings. We find negative associations between unweighted and weighted formulations of the Index and household consumption of sugary and carbonate drinks as well as with the composite indicator for obesogenic diets. Conclusions The main strength of this study is the comprehensiveness and comparability of the policy data across the relatively large number of countries covered. There is a negative association that is statistically significant, between all formulations of the FREI and the household consumption of sugary and carbonated drinks. There is also a negative association between some FREI formulations and obesogenic diets. [ABSTRACT FROM AUTHOR]

Summary: Categories such as "low" and "high" have been used for several decades to describe the prevalence of stunting and wasting in populations of children aged under 5 years. They provide support for public health risk assessment and policy‐making, including alerting health departments and aid agencies to national trends and local needs. In the light of the need for monitoring progress to meet globally agreed targets for overweight and obesity, the classification of their prevalence will be a valuable to aid in policy development, to target resources, and to promote public health interventions. This paper reviews the current use of categories to describe obesity prevalence in policy, advocacy, and research literature. Where prevalence categories have been formally proposed, this paper compares their application on large‐scale datasets. The paper then develops a set of recommended threshold values to classify prevalence levels for overweight and obesity among children under age 5 years, children aged 5–19 years, and adults. [ABSTRACT FROM AUTHOR]

Background Overweight (OW) and obesity affect millions of adolescents worldwide. Evidence from high-income countries indicates widespread weight stigma that adversely affects young people's mental and physical health. However, evidence relating to low- and middle-income countries (LMICs) is sparse. We aimed to generate insight into weight stigma prevalence and experience among adolescents in three LMICs. Methods We identified adolescents aged 15-19 from Brazil, South Africa, and Indonesia from families within market research databases. We adopted a mixed-methods design. The sample included equal numbers by country, sex, and age, and included urban and rural dwellers. Self-reported weight was recorded but was not a selection criterion. Consent (age >18) and assent/parental consent (

Summary: Unhealthy marketing has been unequivocally linked to children's food preferences, requests, purchases and eating behaviors and hence to childhood obesity. Regulating children's exposure to such marketing has been identified as a key challenge to which States must rise. Regulation mandates the need for monitoring and hence for credible data that are comparable between countries, regions and across time. However, there are major challenges presented by the complexity of the digital marketing ecosystem including the personalized targeting with persuasive, exploitative advertising to which children are subject. This narrative review identifies challenges faced by researchers in the digital ecosystem; reviews recent papers attempting to address these and specifies benefits and limitations; and introduces a set of WHO protocols with templates and guidance for studies of food marketing to children. [ABSTRACT FROM AUTHOR]

The aim was to determine whether commercial baby foods marketed within Europe (up to 36 months of age) have inappropriate formulation and high sugar content and to provide suggestions to update European regulations and recommendations as part of a nutrient profile model developed for this age group. The latter was produced following recommended World Health Organization (WHO) steps, including undertaking a rapid literature review. Packaging information from countries across the WHO European region was used to determine mean energy from total sugar by food category. The percentage of products containing added sugar and the percentage of savoury meal‐type products containing pureed fruit were also calculated. A total of 2,634 baby foods from 10 countries were summarised: 768 sold in the United Kingdom, over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 99–200 from Hungary, Norway, Portugal, Estonia and Slovenia. On average, approximately a third of energy in baby foods in these European countries came from total sugar, and for most food categories, energy from sugar was higher than 10%. Use of added sugars was widespread across product categories, with concentrated fruit juice most commonly used. Savoury meal‐type purees did not contain added sugars except in United Kingdom and Malta; however, fruit as an ingredient was found in 7% of savoury meals, most frequently seen in UK products. Clear proposals for reducing the high sugar content seen in commercial baby foods were produced. These suggestions, relating to both content and labelling, should be used to update regulations and promote product reformulation. [ABSTRACT FROM AUTHOR]

The WHO encourages countries to conduct national dietary surveys (NDS) to inform preventative policies targeting malnutrition and noncommunicable diseases. Previous reviews have found inadequate nutrient intakes and survey provision across Europe. This research is the first to provide an updated review of NDS provision within the whole WHO European Region, across the lifecourse, with reference to disadvantaged groups, obesity and nutrients of concern. Over a third of WHO European countries, mainly Central and Eastern European countries (CEEC), had no identifiable NDS. Where countries reported nutrient intakes, poor WHO recommended nutrient intake attainment was Europe-wide across the lifecourse, particularly in CEEC. Lower educated individuals had poorer diet quality. However, heterogeneity in age group sampled, dietary assessment method, nutrient composition database and under-reporting hindered inter-country comparisons. Average population trans fatty acid intakes below WHO recommended limits may hide inequalities in disadvantaged groups; legislative bans may help alleviate this. There were few associations between NDS-derived consumed food portion size (FPS) and BMI. However, consumed FPS was greater than on-pack serving-size in the majority of foods studied. This review illustrates how NDS can generate information on diet, nutrient intakes and the food environment. However, to enable valid inter-country comparisons, countries should be encouraged to conduct and report harmonised NDS, particularly in the age groups sampled, dietary assessment methodology, nutrient range, underpinning food composition database and treatment of under-reporters. This will aid effective, coordinated policy development that can have a real impact on dietary improvement, on a population and subgroup level, throughout Europe. [ABSTRACT FROM AUTHOR]

This paper investigates how consumers use and understand nutrition information on food labels in their daily lives. Primary data were collected from a survey (1127 Portuguese consumers) and four focus groups exploring dissimilarities among consumer segments: a) nutrition-concerned adults; b) adults non-concerned with nutritional issues; c) young consumers, aged 15–18; d) less educated and older consumers. A mixed-methods approach was crucial to further understand consumers' preferences for labels and to identify obstacles to their use. Data evidence that consumers prefer symbolic, coloured, and simple, FOP schemes and that 'traffic light' schemes are better understood and result in faster decision-making at points of sale. By collecting data on how different consumer segments search, understand, like, and use food labels, this paper provides rich guidelines to agri-food practitioners' future actions, particularly retailers. It also reveals serious interpretation obstacles faced by consumers, which needs to be revisited by policy-makers on nutritional labelling and inform decisions on a national scheme. Lastly, it further strengthens existing models by setting that some influencing dimensions are related to the idiosyncratic nature of the subject (consumer) and others are related to the object itself (label format), neither of which has been explored in the literature. [ABSTRACT FROM AUTHOR]

Street food is part of the culture in central Asia. Although nourishing food can be found, unhealthier options are becoming increasingly popular – a marker of nutrition transition. The nutritional composition of street food in urban settings is, however, unknown. The objective of the present study was, thus, to characterise the street food availability in Dushanbe, Tajikistan. A total of 800 street food vending sites in public markets were selected through random and systematic procedures. Trained interviewers collected data on vending sites' characteristics, location and food available. Samples of the most commonly available food were collected (ninety-nine homemade and thirty-five industrial). Macronutrients were quantified through proximate analysis. Fruit, drinks and food other than fruits were available, respectively, in 4·5, 40·5 and 87·4 %, of the vending sites. Among the latter, 63·6 % sold only homemade (e.g. bread, traditional dishes, snacks, pastries, sandwiches and cakes), 19·3 % only industrial (e.g. bread, snacks, pastries and cookies) and 17·1 % both types of food. Homemade food presented higher energy per serving compared with industrial food (median 452 v. 276 kcal/serving (1891 v. 1155 kJ/serving); P < 0·001). A high content of SFA (soup: 10·9 g/serving) and trans -fatty acids (cakes: 1·8 g/serving) was also found in homemade food. However, industrial wafers showed the highest content of these fatty acids (12·9 g/serving and 2·5 g/serving, respectively). Soft drinks were available in 68·5 % of the vending sites selling beverages. Homemade and industrial street food, with heterogeneous nutritional value, were widely available in Dushanbe. Hence, policies promoting the availability of healthy food should be encouraged. [ABSTRACT FROM AUTHOR]

The WHO encourages national diet survey (NDS) implementation to obtain relevant data to inform policies addressing all forms of malnutrition, which remains a pressing issue throughout Europe. This paper provides an up-to-date review on energy, macro- and selected micronutrient intakes in children across WHO Europe using the latest available NDS intakes. It assesses these against WHO recommended nutrient intakes (RNI) to highlight vulnerable groups and areas of concern. Dietary survey information was gathered by Internet searches, contacting survey authors and nutrition experts. Survey characteristics, energy and nutrient intakes were extracted and weighted means calculated and presented by region. Child energy and nutrient intakes were extracted from twenty-one NDS across a third (n 18) of the fifty-three WHO Europe countries. Of these, 38 % (n 6) reported intakes by socio-economic group, but by various indicators. Energy and macronutrients, where boys and older children had higher intakes, were more widely reported than micronutrients. Most countries met under half of the WHO RNI for nutrients reported in their NDS. Micronutrient attainment was higher than macronutrients, but worst in girls and older children. Only a third, mainly Western, WHO European member states provided published data on child nutrient intakes. Gaps in provision mean that dietary inadequacies may go unidentified, preventing evidence-based policy formation. WHO RNI attainment was poor, particularly in girls and older children. Inconsistent age groups, dietary methodologies, nutrient composition databases and under-reporting hinder inter-country comparisons. Future efforts should encourage countries to conduct NDS in a standardised format by age and sociodemographic variables. [ABSTRACT FROM AUTHOR]

Objective: The present commentary introduces a Health Evidence Network (HEN) report that synthesises evidence of front-of-pack food labelling (FOPL) policy development and implementation across the European Region.Design: Countries were identified as having policies on interpretive FOPL from the WHO databases of Member State policies and online repositories of global food policies. For each identified country, evidence published from 1 January 1980 to 31 March 2018 was retrieved from peer-reviewed and grey literature. Extracted data were cross-checked with in-country representatives to ensure completeness and accuracy.Setting: WHO European Region, spanning fifty-three countries.Results: Fifteen countries had a government-endorsed policy on interpretive FOPL. Thirteen of these countries had introduced endorsement logos, while only three labelling systems provided an indicator for unhealthfulness. Common steps were identified in FOPL policy development, including: establishing FOPL as a nutrition policy priority; engaging stakeholders and the public; and collecting formative evidence on which to base the labelling system. Few countries had outlined formal provisions for evaluation of FOPL systems. The HEN report describes seven considerations for the adoption/review of FOPL policies to ensure these achieve the population nutrition aims of FOPL. These considerations relate to supporting consumer use and understanding of the labelling, policy feasibility and credibility, and ensuring policy implementation and accountability.Conclusions: The HEN report encourages countries to consider FOPL policy that is applied widely across all products and provides negative evaluative judgements, possibly combined with positive indicators. Implementation provisions should drive widespread uptake of the system and allow for formal evaluation of impact. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recommends a reduced intake of free sugars throughout the life course (strong recommendation) with a reduction of free sugars intake to less than 10% of the total energy intake (strong recommendation) and preferably below 5% of the total energy intake (conditional recommendation) in both adults and children. Available data clearly show that people already consume significantly more sugar than they should, increasing the risk for dental caries, overweight and obesity. The WHO recommendations are intended for use by the policy makers as a benchmark for assessing intake of sugars by populations and as a driving force for policy change. To create a favorable environment, enabling the overall amount of free sugar intake to be as low as possible and to reduce the frequency of consumption of sugar-rich foods, a range of public health interventions is advised. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence and geographic distribution of overweight and obesity in Russian adults aged 25–64 years as well as the association between chronic risk factors and obesity. Methods: Data were obtained from the survey "Epidemiology of Cardiovascular Diseases and Its Risk Factors in Some Regions of the Russian Federation" (ESSE-RF). This is a large cross-sectional multicenter population-based study that included interviews and medical examination (anthropometry, blood pressure [BP] measurement, and laboratory analysis) applied in 2012–2014. Results: The sample included 20,190 adults (response rate 79.4%) aged 25–64 years. Approximately one third of participants (30.3%) had obesity and another third (34.3%) were classified as overweight. BMI increased with age in both sexes. The prevalence of obesity between regions ranged from 24.4 to 35.5%. Overweight and obesity levels decreased with higher education (men only). Overall obesity rates were higher in rural than urban populations, but rates of overweight were similar in rural and urban populations. Participants with obesity were more likely to have BP > 160/100 mm Hg (odds ratio > 2.0) and also > 140/90 mm Hg, raised blood glucose, and high triglycerides. Conclusion: The prevalence of overweight and obesity in Russian adults aged 25–64 years is not evenly distributed geographically, but it is comparable to that of other European countries. Individuals with obesity were also more likely to have indicators of poor cardiovascular and metabolic health. [ABSTRACT FROM AUTHOR]

Objective: To project the prevalence of obesity across the WHO European region and examine whether the WHO target of halting obesity at 2010 levels by 2025 is achievable. Methods: BMI data were collected from online databases and the literature. Past and present BMI trends were extrapolated to 2025 using a non-linear categorical regression model fitted to nationally representative survey data. Where only 1 year of data was available, a flat trend was assumed. Where no data were available, proxy country data was used adjusted for demographics. Results: By 2025, obesity is projected to increase in 44 countries. If present trends continue, 33 of the 53 countries are projected to have an obesity prevalence of 20% or more. The highest prevalence is projected for Ireland (43%, 95% confidence interval (CI): 28-58%). Lithuania, Finland, and the Netherlands were each estimated to have an absolute increase of 2 percentage points in the prevalence of obesity between 2015 and 2025. Discussion: The quality of BMI data across Europe is highly variable, with fewer than 50% of the 53 countries having measured nationally representative data and often not enough data to interpret projections meaningfully. Nevertheless, the prevalence of obesity in the European Region appears to be increasing in most countries and, with it, the health and economic burden of its associated diseases. This paints a concerning picture of the future burden of obesity-related noncommunicable diseases across the region. Greater and continued effort for the implementation of effective preventive policies and interventions is required from governments. [ABSTRACT FROM AUTHOR]

Background Unhealthy diet, especially consumption of trans fatty acids (TFAs), is a known risk factor for cardiovascular disease (CVD), a leading cause of death in Austria. In 2009, Austria introduced a law regulating the content of TFAs in foods. The aim of this study was to assess the impact of the TFA regulation on CVD-related outcomes. Methods The study evaluated the TFA regulation as an intervention in a natural experiment. Two study periods were assessed: pre-intervention (1995–2009) and post-intervention (2010–14). The study compared the age-standardized death rates per 100 000 population for CVD outcomes with those of a 'synthetic' international comparator population, created from data of OECD countries where TFA regulation has not been implemented, but where the population is otherwise comparable. Results There was a continuous decrease in CVD-related mortality throughout the study period in both the synthetic international comparator population, as well as in the adult Austrian population, with no significant change in this trend observed as an effect of TFA regulation. Conclusions Whilst the results are counterintuitive, given the established link between TFA consumption and an increased risk of CVD, there are many possible explanations: high prevalence of tobacco smoking, changes in TFA content in foods due to international guidance as opposed to formal regulation and a beneficial impact of TFA regulation on sub-groups of the population that might not be detected with nationally aggregated data. However, reduction in TFAs should still be considered an important part of risk factor reduction for CVD and other non-communicable diseases. [ABSTRACT FROM AUTHOR]

Objective: The WHO encourages the virtual elimination of artificial trans-fatty acids (TFA), which increase CHD risk. Our UK analysis explores whether voluntary reformulation results in differential TFA intakes among socio-economic groups by determining characteristics of high TFA consumers before and after product reformulation.Design: Food intake was collected by 7d weighed records pre-reformulation and 4d diaries post-reformulation. Sociodemographic characteristics of TFA consumers above the WHO limit, and of the top 10 % of TFA consumers as a percentage food energy, were compared with those of lower TFA consumers. Multivariate logistic regression determined independent socio-economic predictors of being a top 10 % consumer.Subjects: UK National Diet and Nutrition Surveys (NDNS) for adults aged 19-64 years pre-reformulation (2000/01; N 1724) and post-reformulation (2010/11-2011/12; N 848).Results: Post-reformulation 2·5 % of adults exceeded the WHO limit, v. 57 % pre-reformulation. In unadjusted analyses, high TFA consumption was associated with lower income, lower education and long-term illness/disability pre- but not post-reformulation. In adjusted pre-reformulation analyses, degree holders were half as likely as those without qualifications to be top 10 % consumers (OR=0·51; 95 % CI 0·28, 0·92). In adjusted post-reformulation analyses, those with higher income were 2·5-3·3 times more likely to be top 10 % consumers than lowest income households. Pre-reformulation, high consumers consumed more foods containing artificial TFA, whereas ruminant TFA were more prominent post-reformulation.Conclusions: High TFA consumption was associated with socio-economic disadvantage pre-reformulation, but evidence of this is less clear post-reformulation. Voluntary reformulation appeared effective in reducing TFA content in many UK products with mixed effects on dietary inequalities relating to income and education. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were (1) to determine the coverage of national nutrition surveys in the 53 countries monitored by the World Health Organization (WHO) Regional Office for Europe and identify gaps in provision, (2) to describe relevant survey attributes and (3) to check whether energy and nutrients are reported with a view to providing information for evidence-based nutrition policy planning. Design: Dietary survey information was gathered using three methods: (1) direct email to survey authors and other relevant contacts, (2) systematic review of literature databases and (3) general web-based searches. Survey characteristics relating to time frame, sampling and dietary methodology and nutrients reported were tabled from all relevant surveys found since 1990. Setting: Fifty-three countries of the WHO Regional Office for Europe, which have need for an overview of dietary surveys across the life course. Subjects: European individuals (adults and children) in national diet surveys. Results: A total of 109 nationally representative dietary surveys undertaken post-1990 were found across 34 countries. Of these, 78 surveys from 33 countries were found post-2000, and of these, 48 surveys from 27 countries included children and 60 surveys from 30 countries included adults. No nationally representative surveys were found for 19 of 53 countries, mainly from Central and Eastern Europe. Multiple 24hr recall and food diaries were the most common dietary assessment methods. Only 22 countries reported energy and nutrient intakes from post-2000 surveys; macronutrients were more widely reported than micronutrients. Conclusions: Less than two-thirds of WHO Europe countries have nationally representative diet surveys, mainly collected post-2000. The main availability gaps lie in Central and Eastern European countries, where nutrition policies may therefore lack an appropriate evidence base. Dietary methodological differences may limit the scope for inter-country comparisons. [ABSTRACT FROM AUTHOR]

This cross-sectional study is aimed at assessing sodium (Na) and potassium (K) content and the molar Na:K ratios of the most commonly available ready-to-eat street foods in Tajikistan and Kyrgyzstan. Four different samples of each of these foods were collected and 62 food categories were evaluated through bromatological analysis. Flame photometry was used to quantify sodium and potassium concentrations. The results show that home-made foods can be important sources of sodium. In particular, main dishes and sandwiches, respectively, contain more than 1400 and nearly 1000 mg Na in an average serving and provide approximately 70% and 50% of the maximum daily recommended values. Wide ranges of sodium content were found between individual samples of the same home-made food collected from different vending sites from both countries. In industrial foods, sodium contents ranged from 1 to 1511 mg/serving in Tajikistan, and from 19 to 658 mg/serving in Kyrgyzstan. Most Na:K ratios exceeded the recommended level of 1.0 and the highest ratios were found in home-made snacks (21.2) from Tajikistan and industrial beverages (16.4) from Kyrgyzstan. These findings not only improve data on the nutritional composition of foods in these countries, but may also serve as baseline information for future policies and interventions. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) encourages countries to undertake national dietary survey (NDS) but implementation and reporting is inconsistent. This paper provides an up-to-date review of adult macro and micronutrient intakes in European populations as reported by NDS. It uses WHO Recommended Nutrient Intakes (RNIs) to assess intake adequacy and highlight areas of concern. NDS information was gathered primarily by internet searches and contacting survey authors and nutrition experts. Survey characteristics and adult intakes by gender/age group were extracted for selected nutrients and weighted means calculated by region. Of the 53 WHO Europe countries, over a third (n = 19), mainly Central & Eastern European countries (CEEC), had no identifiable NDS. Energy and nutrient intakes were extracted for 21 (40%) countries but differences in age group, methodology, under-reporting and nutrient composition databases hindered inter-country comparisons. No country met more than 39% WHO RNIs in all age/gender groups; macronutrient RNI achievement was poorer than micronutrient. Overall RNI attainment was slightly worse in CEEC and lower in women and female elderly. Only 40% countries provided adult energy and nutrient intakes. The main gaps lie in CEEC, where unknown nutrient deficiencies may occur. WHO RNI attainment was universally poor for macronutrients, especially for women, the female elderly and CEEC. All countries could be encouraged to report a uniform nutrient set and sub-analyses of nationally representative nutrient intakes. [ABSTRACT FROM AUTHOR]

WHO guidelines on sugars strongly recommend reducing free sugar intake to below 10% of total energy, also their guidance on 'Ending the inappropriate promotion of foods for infants and young children (IYC)' recommends avoiding free sugars. Information on the sugar content of commercially available complementary foods (CACFs) for infants is limited, and the levels of added, free, and total sugar in baby foods is not fully addressed in existing guidelines. Up-to-date data is needed to inform recommendations for revising European regulations and guidelines. Front and back of pack information for baby foods from countries across the WHO European Region was collected. Mean sugar content per 100 g product and percentage energy from total sugar by food category were determined. The percentage of products containing added sugars by food category was calculated; as was the percentage of savoury meals containing pureed fruit, which is often used to sweeten products. The creation of the product categories was part of WHO work to develop a Nutrient Profile Model for CACFs marketed as suitable for IYC aged 6–36 months. A literature review of current issues also informed the process. 2642 CACFs from 10 countries were summarised; 768 products sold in the UK; over 200 each from Denmark (319), Spain (241), Italy (430) and Malta (243) and between 100–200 from Hungry, Norway, Portugal and Slovenia. About a third of energy in CACFs in these European countries came from total sugar and the mean contribution of total sugar for most food categories in the countries was higher than 10%. The amount of added and free sugar content was not labelled. However, added sugars listed as ingredients were widespread across product categories, and the type varied across countries and products, though concentrated fruit juice was most common. Savoury meal purees did not contain added sugars except in UK and Malta; however fruit puree as an ingredient was found in 7% of those examined across Europe and were most likely in UK savoury meals: in 15% on average and 41% of pureed meals with meat as the first named food. In conclusion, the sugar content of baby foods across Europe is high and updated regulations and reformulation are needed. Sugars can be restricted in a variety of ways, but first consultation with WHO Europe Member States is required to support the establishment of effective legal and policy measures to avoid inappropriate manufacture and selling of infant foods. [ABSTRACT FROM AUTHOR]

Obesity is a major health problem facing the European population; over two thirds (67%) of UK adult men and 58% women are overweight or obese 1. The positive association between on-pack serving-size and food intake is known as the 'portion size effect'. However, although direct links with obesity remain unproven, evidence suggests that limiting consumed portion size contributes to reduced energy intake and therefore reduced weight gain 2. UK portion size guidance is outdated and evidence suggests that on-pack serving-sizes have increased in some energy-dense foods 3. This study explores consumed portion sizes and on-pack serving-sizes in popular energy, fat and sugar-dense foods. The UK National Diet & Nutrition Survey 2008–2014 (n = 2377) dataset was used to identify commonly consumed energy, fat and sugar-dense foods. Data was analysed for adults aged 19–64y (excluding under-reporters) for consumed portion sizes, and a commercial product database of major UK retailer and manufacturer data provided serving-sizes. Commonly consumed energy, fat and sugar-dense food groups were split into 45 product-based subgroups. Means of consumed portion size and on-pack serving-size were calculated and compared and nutrition per 100 g and per serve was explored. Just 57% products had serving-size details, whereas 97% had pack-size information; Chocolate had the least products with serving-size information (35%). Lack of on-pack serving-size guidance is therefore a widespread issue, particularly in some energy-dense snack foods. Serving-size ranges were wide and varied across food groups. Consumed portion sizes were significantly higher than on-pack serving-size in all main food groups and most subgroups. The greatest difference between consumed portion size and on-pack serving-size was Crisps (44%), and within this, 'popcorn' (151%). There is a real need for policies aimed at setting product pack and serving-sizes that help individuals consume smaller portions. However, further consideration is needed on how consumers understand on-pack serving-size messaging, front-of-pack labelling and pack size. Serving-size was unavailable for many products. However, where available, consumed portion sizes were higher than on-pack serving-size in all main food groups and most subgroups. These results could inform updated portion size guidance of energy-dense foods. Further work is needed to clarify whether smaller serving and pack sizes would lead to lower total consumption and energy/nutrient intake. [ABSTRACT FROM AUTHOR]

In the Republic of Moldova, more than half of all deaths due to noncommunicable diseases (NCDs) are caused by cardiovascular disease (CVD). Excess salt (sodium) and inadequate potassium intakes are associated with high CVD. Moreover, salt iodisation is the preferred policy to prevent iodine deficiency and associated disorders. However, there is no survey that has directly measured sodium, potassium and iodine consumption in adults in the Republic of Moldova. A national random sample of adults attended a screening including demographic, anthropometric and physical measurements. Sodium, potassium and iodine intakes were assessed by 24 h urinary sodium (UNa), potassium (UK) and iodine (UI) excretions. Knowledge, attidues and behaviours were collected by questionnaire. Eight-hundred and fifty-eight participants (326 men and 532 women, 18–69 years) were included in the analysis (response rate 66%). Mean age was 48.5 years (SD 13.8). Mean UNa was 172.7 (79.3) mmoL/day, equivalent to 10.8 g of salt/day and potassium excretion 72.7 (31.5) mmoL/day, equivalent to 3.26 g/day. Only 11.3% met the World Health Organization (WHO) recommended salt targets of 5 g/day and 39% met potassium targets (>90 mmoL/day). Whilst 81.7% declared limiting their consumption of processed food and over 70% not adding salt at the table, only 8.8% looked at sodium content of food, 31% still added salt when cooking and less than 1% took other measures to control salt consumption. Measures of awareness were significantly more common in urban compared to rural areas. Mean urinary iodine was 225 (SD: 152; median 196) mcg/24 h, with no difference between sexes. According to WHO criteria, 41.0% had adequate iodine intake. Iodine content of salt table was 21.0 (SD: 18.6) mg/kg, lower in rural than urban areas (16.7, SD = 18.6 vs. 28.1, SD = 16.5 mg/kg, p < 0.001). In most cases participants were not using iodised salt as their main source of salt, more so in rural areas. In the Republic of Moldova, salt consumption is unequivocally high, potassium consumption is lower than recommended, both in men and in women, whilst iodine intake is still inadequate in one in three people, although severe iodine deficiency is rare. Salt consumed is often not iodised. [ABSTRACT FROM AUTHOR]

Excess salt and inadequate potassium intakes are associated with high cardiovascular disease (CVD). In Montenegro, CVD is the leading cause of death and disability. There is no survey that has directly measured salt and potassium consumption in Montenegro. The aim is to estimate population salt and potassium intakes and explore knowledge, attitudes and behaviour (KAB), amongst the adult population of Podgorica. Random samples of adults were obtained from primary care centres. Participants attended a screening including demographic, anthropometric and physical measurements. Dietary salt and potassium intakes were assessed by 24 h urinary sodium (UNa) and potassium (UK) excretions. Creatinine was measured. KAB was collected by questionnaire. Six hundred and thirty-nine (285 men, 25–65 years) were included in the analysis (response rate 63%). Mean UNa was 186.5 (SD 90.3) mmoL/day, equivalent to 11.6 g of salt/day and potassium excretion 62.5 (26.2) mmoL/day, equivalent to 3.2 g/day. Only 7% of them had a salt intake below the World Health Organization (WHO) recommended target of 5 g/day and 13% ate enough potassium (>90 mmoL/day). The majority (86%) knew that high salt causes ill-health. However, only 44% thought it would be useful to reduce consumption. Salt consumption is high and potassium consumption is low, in men and women living in Podgorica. [ABSTRACT FROM AUTHOR]

Evidence links consumed food portion size (FPS) and excess weight via increased energy intake. Policies to regulate on-pack serving sizes may be needed; determining consumed FPS of popular energy-dense foods for normal weight and overweight or obese (OWOB) adults, as reported here, may provide evidence to assist this. Data were analysed from national cross-sectional surveys, the French Étude Individuelle Nationale des Consommations Alimentaires2 2005–2007 (n = 2117), and UK National Diet and Nutrition Survey 2008–2014 (n = 3413). The impact of body mass index (BMI) on FPS is also investigated, adjusting for age, sex and under-reporting. Effects of under-reporting on relationships between FPS and BMI; and BMI on consumption frequency (UK only) were explored. OWOB reported larger FPS than normal-weight individuals in many, but not all food subgroups; however, there were only two significant FPS differences. In adjusted analyses, French individuals consumed 1.0 g (99% CI 0.01–2.1 p = 0.01) greater FPS in cakes for 1 point difference in BMI. 'Other cakes' and 'dark chocolate' were also significantly positively associated with BMI. High-fat bar snacks, but no UK main food groups, were positively associated with BMI. There was limited evidence of links between FPS and BMI in UK and French national cross-sectional data, possibly due to data limitations such as under-reporting. Future work should explore this and relationships between consumed FPS and on-pack suggested serving sizes to provide evidence to assist obesity-prevention policies. [ABSTRACT FROM AUTHOR]

In the European Union (EU) three coloured graded Front-of-Pack labels (FoPLs), two endorsed by governments (Nutri-Score and Multiple Traffic Lights (MTL)) and one designed by industry (Evolved Nutrition Label (ENL)) are currently being discussed. This study aimed to investigate the impact of these FoPLs on portion size selection, specifically for less healthy products. In 2018, participants from the French NutriNet-Santé cohort study (N = 25,772) were exposed through a web-based self-administered questionnaire to products from three food categories (sweet biscuits, cheeses, and sweet spreads), with or without FoPLs, and were invited to select the portion they would consume (in size and number). Kruskall-Wallis tests, and mixed ordinal logistic regression models, were used to investigate the effects of FoPLs on portion size selection. Compared to no label, Nutri-Score consistently lowered portion sizes (OR = 0.76 (0.74–0.76)), followed by MTL (OR = 0.83 (0.82–0.84)). For ENL, the effects differed depending on the food group: It lowered portion size selection for cheeses (OR = 0.84 (0.83–0.87)), and increased it for spreads (OR = 1.19 (1.15–1.22)). Nutri-Score followed by MTL appear efficient tools to encourage consumers to decrease their portion size for less healthy products, while ENL appears to have inconsistent effects depending on the food category. [ABSTRACT FROM AUTHOR]

Background: Evidence based health policy, such as that put forward in the European Food and Nutrition Action Plan 2015-2020 and the WHO Global Action Plan on the Prevention and Control of Noncommunicable Diseases, has a role in curbing the consumption of unhealthful foods and drink. We ask how countries are performing in the adoption of these policies and how the comprehensiveness of their food environment policies explains variations in consumption of unhealthful products across Europe., Methods: In order to assess the state of policy adoption, we developed a composite indicator-the Food Regulatory Environment Index (FREI) for which we calculated unweighted and weighted formulations according to the strength of the evidence base. We used linear regression models to explain variations in the consumption of unhealthful products as well as variations in a composite indicator of obesogenic diets., Results: Overall, wealthier countries in the Region perform better. The weighting of the constituent policies does not affect the rankings. We find negative associations between unweighted and weighted formulations of the Index and household consumption of sugary and carbonate drinks as well as with the composite indicator for obesogenic diets., Conclusions: The main strength of this study is the comprehensiveness and comparability of the policy data across the relatively large number of countries covered. There is a negative association that is statistically significant, between all formulations of the FREI and the household consumption of sugary and carbonated drinks. There is also a negative association between some FREI formulations and obesogenic diets., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.)

Competing Interests: We declare no competing interests.

Evidence links consumed food portion size (FPS) and excess weight via increased energy intake. Policies to regulate on-pack serving sizes may be needed; determining consumed FPS of popular energy-dense foods for normal weight and overweight or obese (OWOB) adults, as reported here, may provide evidence to assist this. Data were analysed from national cross-sectional surveys, the French Étude Individuelle Nationale des Consommations Alimentaires2 2005⁻2007 ( n = 2117), and UK National Diet and Nutrition Survey 2008⁻2014 ( n = 3413). The impact of body mass index (BMI) on FPS is also investigated, adjusting for age, sex and under-reporting. Effects of under-reporting on relationships between FPS and BMI; and BMI on consumption frequency (UK only) were explored. OWOB reported larger FPS than normal-weight individuals in many, but not all food subgroups; however, there were only two significant FPS differences. In adjusted analyses, French individuals consumed 1.0 g (99% CI 0.01⁻2.1 p = 0.01) greater FPS in cakes for 1 point difference in BMI. 'Other cakes' and 'dark chocolate' were also significantly positively associated with BMI. High-fat bar snacks, but no UK main food groups, were positively associated with BMI. There was limited evidence of links between FPS and BMI in UK and French national cross-sectional data, possibly due to data limitations such as under-reporting. Future work should explore this and relationships between consumed FPS and on-pack suggested serving sizes to provide evidence to assist obesity-prevention policies.

Background: Many children who have overweight or obesity before puberty can develop obesity in early adulthood, which is associated with increased morbidity and mortality. The preschool years (ages 0-5) represents a point of opportunity for children to be active, develop healthy eating habits, and maintain healthy growth. Surveillance of childhood overweight and obesity in this age group can help inform future policies and interventions., Objective: To review and report available prevalence data in WHO European Region Member States and determine how many countries can accurately report on rates of overweight and obesity in children under 5 years., Methods: We conducted a rapid review of studies reporting on overweight and obesity prevalence in children ages 0-5 in the WHO European region member states from 1998 to 2015., Results: Currently, 35 of the 53 member states have data providing prevalence rates for overweight and obesity for children under 5 years. There was little consistency in study methods, impacting comparability across countries. The prevalence of overweight and obesity in children under 5 years ranges from 1 to 28.6% across member states., Conclusion: Although measuring overweight and obesity in this age group may be challenging, there is an opportunity to leverage existing surveillance resources in the WHO European Region.

With the worldwide consumption of energy drinks increasing in recent years, concerns have been raised both in the scientific community and among the general public about the health effects of these products. Recent studies provide data on consumption patterns in Europe; however, more research is needed to determine the potential for adverse health effects related to the increasing consumption of energy drinks, particularly among young people. A review of the literature was conducted to identify published articles that examined the health risks, consequences, and policies related to energy drink consumption. The health risks associated with energy drink consumption are primarily related to their caffeine content, but more research is needed that evaluates the long-term effects of consuming common energy drink ingredients. The evidence indicating adverse health effects due to the consumption of energy drinks with alcohol is growing. The risks of heavy consumption of energy drinks among young people have largely gone unaddressed and are poised to become a significant public health problem in the future.