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Indigenous peoples and ethnic minority groups often experience poor diet quality and poor health outcomes. Such inequities may be partially due to nutrition interventions not meeting the unique cultural and linguistic needs of these population groups, which could be achieved using co-creation and/or personalised approaches. Cultural adaptation or tailoring of nutrition interventions has shown promise in improving some aspects of dietary intake, but this requires careful consideration to ensure it does not inadvertently exacerbate dietary inequities. The aim of this narrative review was to examine examples of cultural adaptations and/or tailoring of public health nutrition interventions that improved the dietary intake and to consider implications for the optimal design and implementation of personalised and precision nutrition interventions. This review identified six examples of cultural adaptation and/or tailoring of public health nutrition intervention in Indigenous peoples and ethnic minority groups across Australia, Canada and the US. All studies used deep socio-cultural adaptations, such as the use of Indigenous storytelling, and many included surface-level adaptations, such as the use of culturally appropriate imagery in intervention materials. However, it was not possible to attribute any improvements in dietary intake to cultural adaptation and/or tailoring per se , and the minimal reporting on the nature of adaptations limited our ability to determine whether the interventions used true co-creation to design content or were adapted from existing interventions. Findings from this review outline opportunities for personalised nutrition interventions to use co-creation practices to design, deliver and implement interventions in collaboration with Indigenous and ethnic minority groups. [ABSTRACT FROM AUTHOR]

Objective: Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction. Design: Randomised controlled trial. Setting: Web-based intervention for young adults living in Australia. Participants: 18–24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire. Results: Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme. Conclusion: Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify correlates of nutrition label awareness and use, particularly subgroup differences among consumers. Two label types were assessed: (1) nutrition facts tables (NFt) in Australia, Canada, Mexico, UK, and USA and (2) front-of-package (FOP) labels, including mandatory Guideline Daily Amounts (Mexico), voluntary Health Star Ratings (Australia) and voluntary Traffic Lights (UK).Design: Respondents were recruited using Nielsen Consumer Insights Global Panel (n 21 586) and completed online surveys in November-December 2018. Linear regression and generalised linear mixed models examined differences in label use and awareness between countries and label type based on sociodemographic, knowledge-related and dietary characteristics.Setting: Australia, Canada, Mexico, UK and USA.Participants: Adults (≥18 years).Results: Respondents from the USA, Canada and Australia reported significantly higher NFt use and awareness than those in Mexico and the UK. Mexican respondents reported the highest level of FOP label awareness, whereas UK respondents reported the highest FOP label use. NFt use was higher among females, 'minority' ethnic groups, those with higher nutrition knowledge and respondents with 'adequate literacy' compared with those with 'high likelihood of limited literacy'. FOP label use was higher among those with a 'high likelihood of limited literacy' compared with 'adequate literacy' across countries.Conclusions: Lower use of mandatory Guideline Daily Amount labels compared with voluntary FOP labelling systems provides support for Mexico's decision to switch to mandatory 'high-in' warning symbols. The patterns of consumer label use and awareness across sociodemographic and knowledge-related characteristics suggest that simple FOP labels may encourage broader use across countries. [ABSTRACT FROM AUTHOR]

Machine learning methods can help establish evidence-based dietary guidelines One approach to address the difficulties faced when converting complex dietary patterns into quantitative, interpretable summaries is unsupervised learning, which uses machine learning algorithms to identify clusters of individuals that share unique dietary patterns. The Dietary Guidelines for Americans provide dietary advice for health promotion and disease prevention and serve as the cornerstone to all other US Federal nutrition policy and education efforts(1). One machine learning approach to avoid this bias by accounting for heterogeneity is called stacked generalisation(35), which combines several machine learning algorithms into one. [Extracted from the article]

Objective: To assess associations between household food security status and indicators of food skills, health literacy and home meal preparation, among young Canadian adults.Design: Cross-sectional data were analysed using logistic regression and general linear models to assess associations between food security status and food skills, health literacy and the proportion of meals prepared at home, by gender.Setting: Participants recruited from five Canadian cities (Vancouver (BC), Edmonton (AB), Toronto (ON), Montreal (QB) and Halifax (NS)) completed an online survey.Participants: 1389 men and 1340 women aged 16-30 years.Results: Self-reported food skills were not associated with food security status (P > 0·05) among men or women. Compared to those with high health literacy (based on interpretation of a nutrition label), higher odds of food insecurity were observed among men (adjusted OR (AOR): 2·58, 95 % CI 1·74, 3·82 and 1·56, 95 % CI 1·07, 2·28) and women (AOR: 2·34, 95 % CI 1·48, 3·70 and 1·92, 95 % CI 1·34, 2·74) with lower health literacy. Women in food-insecure households reported preparing a lower proportion of breakfasts (β = -0·051, 95 % CI -0·085, -0·017), lunches (β = -0·062, 95 % CI -0·098, -0·026) and total meals at home (β = -0·041, 95 % CI -0·065, -0·016). Men and women identifying as Black or Indigenous, reporting financial difficulty and with lower levels of education had heightened odds of experiencing food insecurity.Conclusions: Findings are consistent with other studies underscoring the financial precarity, rather than lack of food skills, associated with food insecurity. This precarity may reduce opportunities to apply health literacy and undertake meal preparation. [ABSTRACT FROM AUTHOR]

Objective: An absence of food literacy measurement tools makes it challenging for nutrition practitioners to assess the impact of food literacy on healthy diets and to evaluate the outcomes of food literacy interventions. The objective of the present scoping review was to identify the attributes of food literacy.Design: A scoping review of peer-reviewed and grey literature was conducted and attributes of food literacy identified. Subjects included in the search were high-risk groups. Eligible articles were limited to research from Canada, USA, the UK, Australia and New Zealand.Results: The search identified nineteen peer-reviewed and thirty grey literature sources. Fifteen identified food literacy attributes were organized into five categories. Food and Nutrition Knowledge informs decisions about intake and distinguishing between 'healthy' and 'unhealthy' foods. Food Skills focuses on techniques of food purchasing, preparation, handling and storage. Self-Efficacy and Confidence represent one's capacity to perform successfully in specific situations. Ecologic refers to beyond self and the interaction of macro- and microsystems with food decisions and behaviours. Food Decisions reflects the application of knowledge, information and skills to make food choices. These interdependent attributes are depicted in a proposed conceptual model.Conclusions: The lack of evaluated tools inhibits the ability to assess and monitor food literacy; tailor, target and evaluate programmes; identify gaps in programming; engage in advocacy; and allocate resources. The present scoping review provides the foundation for the development of a food literacy measurement tool to address these gaps. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate five popular fast-food chains’ menus in relation to dietary guidance.DesignMenus posted on chains’ websites were coded using the Food and Nutrient Database for Dietary Studies and MyPyramid Equivalents Database to enable Healthy Eating Index-2005 (HEI-2005) scores to be assigned. Dollar or value and kids’ menus and sets of items promoted as healthy or nutritious were also assessed.SettingFive popular fast-food chains in the USA.SubjectsNot applicable.ResultsFull menus scored lower than 50 out of 100 possible points on the HEI-2005. Scores for Total Fruit, Whole Grains and Sodium were particularly dismal. Compared with full menus, scores on dollar or value menus were 3 points higher on average, whereas kids’ menus scored 10 points higher on average. Three chains marketed subsets of items as healthy or nutritious; these scored 17 points higher on average compared with the full menus. No menu or subset of menu items received a score higher than 72 out of 100 points.ConclusionsThe poor quality of fast-food menus is a concern in light of increasing away-from-home eating, aggressive marketing to children and minorities, and the tendency for fast-food restaurants to be located in low-income and minority areas. The addition of fruits, vegetables and legumes; replacement of refined with whole grains; and reformulation of offerings high in sodium, solid fats and added sugars are potential strategies to improve fast-food offerings. The HEI may be a useful metric for ongoing monitoring of fast-food menus. [ABSTRACT FROM AUTHOR]

Objective: Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital. Design: Cross-sectional survey and mapping of discount supermarkets and community food programmes. Setting: Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada. Subjects: Respondents from 484 low-income families who had children and who lived in rental accommodations. Results: Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors. Conclusions: Our findings raise questions about the extent to which neighbourhood- level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity. [ABSTRACT FROM AUTHOR]

Objectives: A number of studies have pointed to the pressure that housing costs can exert on the resources available for food. The objectives of the present study were to characterise the relationship between the proportion of income absorbed by housing and the adequacy of household food expenditures across the Canadian population and within income quintiles; and to elucidate the impact of receipt of a housing subsidy on adequacy of food expenditures among low-income tenant households.Design: The 2001 Survey of Household Spending, conducted by Statistics Canada, was a national cross-sectional survey that collected detailed information on expenditures on goods and services. The adequacy of food spending was assessed in relation to the cost of a basic nutritious diet.Setting: Canada.Subjects: The person with primary responsibility for financial maintenance from 15 535 households from all provinces and territories.Results: As the proportion of income allocated to housing increased, food spending adequacy declined significantly among households in the three lowest income quintiles. After accounting for household income and composition, receipt of a housing subsidy was associated with an improvement in adequacy of food spending among low-income tenant households, but still mean food spending fell below the cost of a basic nutritious diet even among subsidised households.Conclusions: This study indicates that housing costs compromise the food access of some low-income households and speaks to the need to re-examine policies related to housing affordability and income adequacy. [ABSTRACT FROM AUTHOR]