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Background Our objective was to develop a nutrient-based index for evaluating and improving menus in public catering. The nutriRECIPE-Index comprises 24 nutrients and nutrient groups. In developing the index, the following steps were included: setting the goals of the index, nutrient selection, target metrics and scaling, weighting, proof of concept and validation of the index. Furthermore, a unique database was created to integrate bioactive plant compounds in the assessment. An assessment of standard recipes and supposedly healthy recipes should show a significant difference in the results of the nutriRECIPE-Index. Finally, the nutriRECIPE-Index should generate similar or more specific results than existing indices such as the Nutri-Score and the Healthy Meal Index. Methods A whole meal cycle (comprising 6 weeks, 106 recipes and including different menu lines, partially with different side dishes) at a university canteen was analysed with the Federal Food Code (BLS) and the nutriRECIPE-Index. The Healthy Meal Index (comprising 3 nutritionally relevant items) and the Nutri-Score algorithm (comprising 7 items) were used to validate the nutrient composition and the results of the nutriRECIPE-Index. Results The resulting scores of the recipes and menu lines showed substantial differences, wherein the meals of a health-promoting menu line usually received higher scores than the standard recipes. A correlation between the nutriRECIPE-Index and the Healthy Meal Index (0.604) and the Nutri-Score (0.591) was observed. The nutriRECIPE-Index was better at identifying the worst menus and could better separate mediocre menus from good menus. Conclusion The nutriRECIPE-Index is a useful and comprehensive tool for evaluating the nutritional value of recipes and is the first to consider bioactive plant compounds. Further adjustments to different target populations, settings, and cultural backgrounds are possible.

The COVID-19 pandemic has drawn attention to food insecurity in developed countries. Despite adequate levels of agricultural production, consumers experienced demand-induced scarcity. Understanding the effects on nutrition and the environment is limited, yet critical to informing ecologically embedded mitigation strategies. To identify mitigation strategies, we investigated wheat flour and egg retail shortages in the United Kingdom (UK), focusing on consumer behavior during the COVID-19 lockdown. The 6 Steps for Quality Intervention Development (6SQuID) framework informed the methodology. Mixed qualitative and quantitative methods were used to pinpoint the causes of the shortages, and ecological impacts of consumer behavior were related using survey results (n = 243) and environmental and nutritional databases. This research confirmed consumers’ narrowed consideration set, willingness to pay, and significant reliance on processed foods which indicates agronomic biofortification, breeding strategies, selective imports and improved processed food quality are important mitigation strategies. We identified positive and negative synergies in consumer, producer and retailer behavior and related these to mitigation strategies in support of a circular bio-economy for food production. We found that the substitutes or alternative foods consumed during the COVID-19 lockdown were nutritionally inadequate. We identified the most ecological substitute for wheat flour to be corn flour; and for eggs, yogurt. Our findings also indicate that selenium deficiency is a risk for the UK population, especially to the increasing fifth of the population that is vegetarian. Due to the need to implement short-, medium-, and long-term mitigation strategies, a coordinated effort is required by all stakeholders.

Latar belakang: Anemia pada perempuan terjadi jika kadar Hb (Hemoglobin) < 12 gr/dL. kondisi ini sangat dipengaruhi oleh zat gizi antara lain : zat besi, protein dan vitamin C. Daun Kelor (Moringa oleifera) merupakan tumbuhan kaya akan zat gizi, sehingga menarik diteliti. Tujuan: Mengteahui perbedaan kadar Hb berdasarkan kebiasaan konsumsi kelor di Dukuh Ngawenombo, Desa Ngawenombo, Blora, Jawa Tengah. Metode: Penelitian desain cross sectional ini melibatkan 70 subjek perempuan usia ≥ 20 tahun dipilih secara purposive sampling , pada kelompok konsumsi kelor terus menerus dan kelompok tidak konsumsi kelor sama sekali. Data yang dikumpulkan mencakup kadar Hb diukur dengan alat Easy Touch GHb , kebiasaan konsumsi kelor diukur dengan kuisioner dan asupan makanan diukur dengan metode recall 2x24 jam. Uji statistika yang digunakan : uji T-Independent , One Way Anova dan Kruskal Wallis . Uji kenormalan data digunakan uji kolmogorov smirnov . Hasil: Tedapat 30 orang (42,9%) mengkosumsi kelor dan 40 orang (57,1%) tidak konsumsi kelor. Terdapat 17 orang (56,7%) mengkonsumsi kelor sejak 3 tahun terakhir, 9 orang (30,0%) 2 tahun terakhir dan 4 orang (13,3%) 1 tahun terakhir. Frekuensi konsumsi kelor ≥ 3x per-minggu terdapat 26 orang (86,7%) dan < 3x per-minggu terdapat 4 orang (13,3%). Bentuk kelor yang dikonsumsi yaitu sayur kelor, teh kelor, dan kapsul kelor. Rata-rata kadar Hb perempuan konsumsi kelor 13,4gr/dL dan perempuan tidak konsumsi kelor 11gr/dL dan hasil uji perbedaan menunjukkan terdapat perbedaan yang signifikan (p=0,00). Kesimpulan: Terdapat perbedaan signifikan kadar Hb perempuan konsumsi kelor dan tidak konsumsi kelor. Kata Kunci: Kadar Hemoglobin, Daun Kelor, Wanita Usia Subur ABSTRACT Background: Anemia occurs in women if the amount of hemoglobin is

Backgrounds: This study examined salad consumption in relation to daily dietary intake and diet quality among U.S. adults. Methods: Nationally representative sample came from the National Health and Nutrition Examination Survey 2003-2012 waves. Salad consumption was identified through both Food and Nutrient Database for Dietary Studies codes for salad items and combination code for components of and/or additions to salads. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g., eating habits, taste preferences) by using within-individual variations in salad consumption between 2 nonconsecutive 24-hour dietary recalls. Results: Approximately 28.7% of U.S. adults consumed salad on any given day. Among salad consumers, salad consumption occupied 12.5% of daily total energy, 62.8% vegetable, 11.9% fruit, 18.4% fiber, 9.1% sugar, 20.3% total fat, 14.7% saturated fat, 14.9% cholesterol, and 17.7% sodium intake. Compared to no salad consumption on a dietary recall day, salad consumption was associated with increased daily intake of total energy by 461.5 kJ (110.3 kcal), vegetable 85.0 g, fiber 1.0 g, sugar 5.7 g, total fat 10.0 g, saturated fat 1.3 g, cholesterol 18.7 mg, and sodium 216.3 mg. Salad consumption was associated with an increase in the Healthy Eating Index-2010 score by 4.2. Conclusion: Salad consumption is related to better overall diet quality but also higher total energy, sugar, fat, cholesterol, and sodium intake. Interventions that promote salad consumption should provide low-energy-dense, nutrient-rich salad products. Salad consumers should prudently evaluate the caloric and nutrient content of salad in order to make informed and more healthful diet choices.

Background: Some local areas in England stopped gluten free prescriptions for coeliac disease. An explanatory mixed methods study investigated the impact of these changes. Methods: A cross-sectional survey with 1697 participants was followed by 24 qualitative interviews. The survey included questions on use of prescriptions and health care services, and the Coeliac Disease Assessment Questionnaire (CDAQ) to assess quality of life. The survey data were analysed by descriptive statistics, analysis of variance and regression analysis and the interviews by thematic analysis. Findings from the interviews guided the survey analysis. Results: Dietary burden was significantly different between prescribing and non-prescribing areas, with little impact on other aspects of quality of life. Survey participants in non-prescribing areas who felt more impacted by the prescription changes reported lower quality of life. Satisfaction with and use of services was lower in non-prescribing areas. Interviews indicated that after initial frustrations, most people adapted to the changed prescription policy. However, there was a clear preference for gluten free prescriptions to be available, in particular for staple foods. Conclusions: The main quality of life impact was on Dietary burden. It is encouraging that most participants in this study maintained a good quality of life. However, issues of worse experiences of care, lower follow up opportunities, and inequity arose, and these should be taken into consideration in decisions on gluten free food prescriptions. The new guidelines for the National Health Service (NHS) in England have retained prescriptions for bread and flour mixes, which is more limited than the range of staple foods preferred in this study.

Background Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. Methods Cross-sectional analyses of the Living Costs and Food Survey dataset (2010–2017). All households with a child (0–3 years) or pregnant woman were included in the analysis (n = 4869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households). Results Of 876 eligible households, 54% participated in Healthy Start. No statistically significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. Conclusion This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may help to improve programme performance and counteract the harmful effects of poverty on diet.

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers’ experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy, (2) the Policy made it difficult for food retailers to operate successfully, and, (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

Background Interventions to reduce population salt intake are feasible and cost-effective. The Victorian Salt Reduction Partnership implemented a complex, multi-faceted salt reduction intervention between 2014 and 2020 in the Australian state of Victoria. This study aimed to understand stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership. Methods Semi-structured interviews were conducted with Partnership and food industry stakeholders. The Consolidated Framework for Implementation Research was adapted for the Partnership intervention and used to guide the qualitative analysis. Results Fourteen Partnership and seven food industry stakeholders were interviewed. The Partnership was viewed as essential for intervention planning and decision-making and an enabler for intervention delivery. The goals of capacity building and collaborative action were perceived to have been achieved. The implementation team executed intended intervention activities and outputs, with some adaptations to strategy. Barriers and enablers to implementation were identified by interviewees, such as compatibility of individual, organisational and Partnership values and building positive relationships between the Partnership and food industry, respectively. Legal, political, social, environmental, technological and economic factors affecting intervention design, delivery and outcomes were identified. Conclusions Establishing a Partnership with diverse skills and experience facilitated collaborative action, capacity building and execution of the intervention. Monitoring and evaluating implementation informed strategy adaptations, which allowed optimisation of Partnership strategy. The importance of developing strong communication networks between strategic and implementation-levels was a key lesson.

In 2013, the WHO recommended that all member states aim to reduce population salt intake by 30% by 2025. The year 2019 represents the midpoint, making it a critical time to assess countries’ progress towards this target. This review aims to identify all national salt reduction initiatives around the world in 2019, and to quantify countries’ progress in achieving the salt reduction target. Relevant data were identified through searches of peer-reviewed and gray literature, supplemented with responses from prefilled country questionnaires sent to known country leads of salt reduction or salt champions, WHO regional representatives, and international experts to request further information. Core characteristics of each country's strategy, including evaluations of program impact, were extracted and summarized. A total of 96 national salt reduction initiatives were identified, representing a 28% increase in the number reported in 2014. About 90% of the initiatives were multifaceted in approach, and 60% had a regulatory component. Approaches include interventions in settings (n= 74), food reformulation (n = 68), consumer education (n = 50), front-of-pack labeling (n = 48), and salt taxation (n = 5). Since 2014, there has been an increase in the number of countries implementing each of the approaches, except consumer education. Data on program impact were limited. There were 3 countries that reported a substantial decrease (>2 g/day), 9 that reported a moderate decrease (1–2 g/day), and 5 that reported a slight decrease (

Simulation modeling can be useful to estimate the long-term health and economic impacts of population-based dietary policies. We conducted a systematic scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline to map and critically appraise economic evaluations of population-based dietary policies using simulation models. We searched Medline, Embase, and EconLit for studies published in English after 2005. Modeling studies were mapped based on model type, dietary policy, and nutritional target, and modeled risk factor-outcome pathways were analyzed. We included 56 studies comprising 136 model applications evaluating dietary policies in 21 countries. The policies most often assessed were reformulation (34/136), taxation (27/136), and labeling (20/136); the most common targets were salt/sodium (60/136), sugar-sweetened beverages (31/136), and fruit and vegetables (15/136). Model types included Markov-type (35/56), microsimulation (11/56), and comparative risk assessment (7/56) models. Overall, the key diet-related risk factors and health outcomes were modeled, but only 1 study included overall diet quality as a risk factor. Information about validation was only reported in 19 of 56 studies and few studies (14/56) analyzed the equity impacts of policies. Commonly included cost components were health sector (52/56) and public sector implementation costs (35/56), as opposed to private sector (18/56), lost productivity (11/56), and informal care costs (3/56). Most dietary policies (103/136) were evaluated as cost-saving independent of the applied costing perspective. An analysis of the main limitations reported by authors revealed that model validity, uncertainty of dietary effect estimates, and long-term intervention assumptions necessitate a careful interpretation of results. In conclusion, simulation modeling is widely applied in the economic evaluation of population-based dietary policies but rarely takes dietary complexity and the equity dimensions of policies into account. To increase relevance for policymakers and support diet-related disease prevention, economic effects beyond the health sector should be considered, and transparent conduct and reporting of model validation should be improved.

Objective: Unhealthy diets are a key risk factor for chronic disease, with young adults (18–30 years old) in high‐income countries like Australia and the UK particularly at risk. Improved public health nutrition policies can help address unhealthy diets in the population, but many of the more regulatory policies are opposed by food industry groups. This research explores how young adults in Australia and the UK discuss a range of topical public health nutrition policies and analyses whether and how their views may be associated with food industry discourses. Methods: Eight focus groups were held in Sydney, Australia, and Glasgow, UK, with a total of thirty young adults participating. A deliberative‐style method was used in the focus groups to generate discussion about six public health nutrition policies, such as taxation of sugar‐sweetened beverages and restrictions on advertising of less‐healthy foods. Discourse analysis was used to examine participants’ discussions. Results: Twenty discourse codes were developed iteratively from the focus group data. These were thematically linked with nine food industry discourses found in the peer‐reviewed literature, including industry self‐regulation, personal responsibility, corporate social responsibility and challenging nutrition science. Conclusions: These results demonstrate there is an association between common food industry discourses and some young adults’ views about public health nutrition policies. Implications for public health: Identifying, engaging with and responding to common industry discourses is a priority in order to build greater public support and acceptability of policies that will improve diet and prevent chronic disease.

The authors extend their gratitude to all study participants and to the colleagues who have helped with recruitment and outreach., This paper focuses on the effect of the COVID-19 lockdown on the dietary habits of adult Danes. Two aspects were specifically considered: 1) reported changes in intake of specific food categories and 2) effect on healthy eating, operationalized as adherence to the Mediterranean diet (MEDAS score). Respondents (N = 2,462) completed a 44-items self-administered online survey designed for the assessment of their socio-demographic characteristics, general food habits, and consumption frequency of selected foods (mainly related to the MedDiet) during the lockdown. The data indicated that the lockdown has affected dietary habits of adult Danes to a relatively limited degree. The most important findings were that a substantial proportion of respondents (≥28%) reported eating more, snacking more, exercising less, and gaining weight during the lockdown. Results could be linked to the amount of time spent at home (e.g., a higher cooking frequency) a higher degree of emotional eating during the lockdown (e.g., a higher consumption of pastries and alcohol). Women were generally affected to a higher degree than men. Additionally, dietary changes during the lockdown to a certain degree reflected pre-existing (un)healthy eating habits, as positive health outcomes were observed in respondents with a high MEDAS score and negative outcomes (e.g., weight gain and higher intakes of pastries and carbonated beverages) were associated with respondents with a low MEDAS score. These changes, if sustained long-term, are potentially concerning from a public health perspective, especially given that more than half of the respondents were characterized by a low adherence to the MedDiet.

The Kingdom of Saudi Arabia has a large migrant workforce particularly from North Africa, other Gulf states and South Asia. Migration influences food behavior; however, the change is not often health conducive. This study aimed to investigate the dietary acculturation among 880 migrants and their families in a large University in the Kingdoms’ capital city, Riyadh. Methods: A cross sectional study design was used based on 2 questionnaires; Rosenmoller et al’s and the WHO STEPS surveillance tool for chronic disease surveillance. Data on length of residency, dietary patterns, anthropometric and biochemical measurements were collected by trained interviewers. Descriptive statistics were reported as a percentage or mean, as appropriate. Chi-square test, Fisher’s exact test or independent t test, Univariate and Multivariate logistic regression analysis were used to compare the significance between variables. Results: Both male and female participants showed a similar mean age (39.7 and 38.5 years). Approximately 61% of them had Conclusions: Migration into Saudi Arabia from this subgroup showed marked changes in the food practice; acquisition of unhealthy dietary practices also co-existed despite improved awareness and the presence of comorbidities. Findings from this study have relevance to other migrant communities and public health policy.

Objectives The objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. Study design The study design was cross-sectional analyses of questionnaire data collected in April 2020. Methods Six hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. Results Fifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. Conclusions In the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach., Highlights • Half of free school meal eligible children could not access the scheme in April 2020. • Free school meal access differed by income level, school type and country. • Access to a free school meal was associated with the recent use of a food bank.

The objective of this study was to study the association between total sugar intake (TSI) levels of children aged 6-8 years old, nutrient intake and anthropometry. Food and beverage intakes were collected by a prospective three-day recall questionnaire. The 2237 children were distributed into three groups according to TSI percentiles. Mean TSI was 93.77 &plusmn, 25.72 g/day, 22%-25% of total caloric intake, with boys presenting an intake of 96.24 &plusmn, 24.34 g/day and girls 91.38 &plusmn, 26.78 g/day. Greater TSI was associated with higher body fat, parental education, energy intake, nutrients/1000 kcal, and lower weight z-scores, BMI z-scores, waist circumferences, and hip circumferences. Weight, height, and waist circumference had the highest R2 while body fat had the lowest. The percentage of total energy derived (%E) from protein decreased as the %E from TSI increased, while the opposite was true for carbohydrates and saccharides, while for fiber intake, the medium groups presented the highest intake/1000 kcal. For the remaining macronutrients studied, intake/1000 kcal decreased when the %E from TSI increased. Calcium, iodine, magnesium, vitamin B2, folate, and vitamin C intake increased as the %E from TSI increased, while the opposite was true for vitamin B12. Fiber, &omega, 6 PUFA, iodine, folate, vitamin D, and vitamin E intakes were insufficient across most of the sample. TSI levels in children were identified to exceed adult recommendations. It is not clear what the effect of up to an average of 21% of energy coming from total sugars has on childhood obesity and further research is needed in the pediatric population, however, opportunities exist to improve sugar intake patterns.

Iodine deficiency disorders (IDDs) constitute a significant public health problem globally. In India, the entire population is prone to IDDs due to deficiency of iodine in the soil of the sub-continent and thus both animal and plant source food grown on the iodine-deficient soil. IDDs encompass the spectrum of disability and disease and include goitre, cretinism, hypothyroidism, abortion, stillbirth, brain damage, learning disabilities, mental retardation, psychomotor defects, hearing and speech impairment. Iodine deficiency is known to be the single largest cause of preventable brain damage. IDDs with their causal association with brain development, cognition, and learning disabilities impair the human resource development and progress of the country. The children born in iodine-deficient regions on an average have 13.5 intelligence quotient (IQ) points lesser than children born in iodine-sufficient regions. IDD control programme in India is a public health success story, with 92 per cent of the population consuming iodized salt. The partnership between government agencies, academic institutions, salt industry, development agencies and civil society has been key to achieve this success story. The sustainable elimination of iodine deficiency in India is within reach, what is required is accelerated and coordinated effort by all key stakeholder at national and State level.

Background Although it is recommended that childcare centers provide foods consistent with dietary guidelines, the impact of implementing sector-specific guidelines on child outcomes is largely unknown. Objectives This study aims to examine the impact of a web-based program and support to implement dietary guidelines in childcare centers on children's 1) diet; 2) BMI z scores; and 3) child health-related quality of life (HRQoL). Methods This study was a cluster-randomized controlled trial utilizing a Type-3 Hybrid implementation-effectiveness design conducted between October 2016 and March 2018. This study reports on child outcomes. Fifty-four childcare centers in New South Wales, Australia were randomly assigned to the intervention (a web-based menu-planning tool and support) or control group (usual care). The intervention was designed to address barriers and enablers to dietary guideline implementation according to the Theoretical Domains Framework. A quota of 35 consenting childcare centers undertook child-level evaluation of dietary intake where 522 parents consented to completing ≥1 component of data collection for their child. Child consumption of core and discretionary (unhealthy) foods while in care was assessed via dietary observations by blinded research assistants, childcare diet quality was assessed via educator-completed questionnaires, BMI z scores were assessed via measured weight and height, and child HRQoL was assessed via parent report at baseline and 12-mo follow-up. Results There was a significant increase in mean child consumption of fruit (0.39 servings; 95% CI: 0.12, 0.65 servings) and dairy foods (0.38 servings; 95% CI: 0.19, 0.57 servings) and a significant reduction in consumption of discretionary foods (-0.40 servings; 95% CI: -0.64, -0.16 servings) in care in the intervention group, relative to control at 12-mo follow-up. No significant differences were observed in diet quality, BMI z scores, or HRQoL. Conclusions A web-based intervention to support planning of childcare menus consistent with dietary guidelines can improve child consumption of healthier foods in daycare. This trial was registered at www.anzctr.org.au as ACTRN12616000974404.

Unhealthy diets are a leading cause of death and disability globally. The WHO recommends Member States implement front-of-pack (FOP) nutrition labels to guide consumers towards healthier food choices, as part of comprehensive strategies to prevent diet-related non-communicable diseases. Interest in FOP nutrition labelling is increasing, but there is limited guidance for policymakers developing regulations necessary for effective implementation. A rapidly evolving evidence base, limited regulatory capacity and possibility of legal challenge by affected food industry stakeholders can create ‘regulatory chill’, whereby governments are dissuaded from progressive public health policymaking. We use a framework for analysing public health law and available best-practice guidance to evaluate key components of 31 FOP nutrition labelling regulations endorsed by governments up to June 2019. Analysis of regulatory form shows recent rapid uptake of label formats that are easier for consumers to understand and increasing use of mandatory legislation. However, policymakers must decide much more than whether to apply ‘stars’, ‘traffic lights’ or ‘stop signs’. The substance of effective regulation must contain strategic regulatory objectives, clear specifications for displaying the label on pack, a valid scoring mechanism and a justified scope for including foods. While there are limited data on current practice, good governance of FOP nutrition labelling regulation also requires transparency and accountability in processes of label development, implementation, evaluation and enforcement to promote continuous improvement and withstand undue commercial interference. Whether developing new FOP nutrition labels or reforming existing ones, our findings support policymakers to design and implement best-practice, evidence-informed regulation.

Improving population diets is a public health priority, and calls have been made for corporations such as supermarkets to contribute. Supermarkets hold a powerful position within the food system, and one source of power is supermarket own brand foods (SOBFs). Many of the world&rsquo, s largest supermarkets have corporate social responsibility (CSR) policies that can impact public health, but little is known about their quality or practical application. This study examines the nature and quality of Australian supermarkets&rsquo, CSR policies that can impact public health nutrition, and provides evidence of practical applications for SOBFs. A content analysis of CSR policies was conducted. Evidence of supermarkets putting CSR policies into practice was derived from observational audits of 3940 SOBFs in three large exemplar supermarkets (Coles, Woolworths, IGA) in Perth, Western Australia (WA). All supermarkets had some CSR policies that could impact public health nutrition, however, over half related to sustainability, and many lacked specificity. All supermarkets sold some nutritious SOBFs, using marketing techniques that made them visible. Findings suggest Australian supermarket CSR policies are not likely to adequately contribute to improving population diets or sustainability of food systems. Setting robust and meaningful targets, and improving transparency and specificity of CSR policies, would improve the nature and quality of supermarket CSR policies and increase the likelihood of a public health benefit.

Background Although the importance of capacity building for public health nutrition (PHN) has been increasing globally, reports on the current status of training programs for PHN in East-Asia including Japan are limited. The aim of this study was to compare the current status of education and research activities in the field of PHN in Japan with those in South Korea, Taiwan, and mainland China. Methods Necessary information was collected by internet search and telephone inquiry. Collection focused on the number of departments in colleges and universities with PHN as a compulsory subject in the 2016 academic year, and the number of articles and information related to these articles published in the journal Public Health Nutrition between 2007 and 2016. Results The number of departments with PHN as a compulsory subject was the highest in Japan (n = 137), followed by mainland China (n = 32), Taiwan (n = 18) and South Korea (n = 7). Using the classification list of education in each country and region, the majority of these departments were classified as home economics, natural science, health and welfare, and medical science in Japan, South Korea, Taiwan, and mainland China, respectively. Regarding publications, most of the articles were written in colleges and universities not having PHN as a compulsory subject in Japan, South Korea, and Taiwan. The number of articles per department among departments with compulsory PHN education was lowest in Japan (n = 0.3) compared to Taiwan, mainland China, and South Korea (n = 1.2, 2.7, and 3.7, respectively). Conclusions Japan has a much higher number of departments with PHN as a compulsory subject than neighboring East Asian states and relatively low research activities in the field of PHN. This suggests that current university education may not lead to active PHN research in Japan. Further studies are warranted to explore the reasons for this.

Public health nutrition (PHN) seeks to protect and promote the nutrition-related health and wellbeing of populations. PHN science is dynamic and has evolved over time, helping to inform our understanding of the changing nature, scope, causes and solutions to PHN problems. This scientific basis has informed nutrition guidance and policy. Using a narrative synthesis method and guided by Kuhn’s theory on the structure of scientific revolutions, this paper reviews the historical development of PHN, aiming to understand the emergence of major scientific paradigms, paradigm shifts and evidence-informed guidance and policy. We propose that the development of PHN is characterized by the successive layering of paradigms resulting from interactions between science, social change and policy-making. Four eras of PHN are evident: the foundation, nutrient deficiency, dietary excess and imbalances, and environmental sustainability (ES). Dominant paradigms have been communicated through nutrient reference standards, dietary goals and dietary guidelines. Transitions from one era to the next indicated new ways of thinking about PHN, amounting to a paradigm shift. The bidirectional relationship between nutrition and ES is the latest challenge confronting PHN. Investigating PHN paradigm transitions reveals how we have arrived at current guidance and policies, and how PHN might progress into the future.

The Victorian Salt Reduction Partnership (VicSalt Partnership) was launched in 2015, bringing together health and research organisations to develop an action plan for salt reduction interventions at a state level. A comprehensive evaluation was designed to assess the impact of the resulting four-year intervention strategy. As part of the process evaluation, semi-structured interviews were undertaken with stakeholders in March&ndash, May 2017, to understand perceived barriers and enablers to effective strategy implementation. Data were coded in relation to the key topic areas of the interviews with an inductive method used to analyse themes within topics. Seventeen stakeholders were contacted, 14 completed an interview, five from state government or statutory agencies, four from non-government funded organisations, four from research organisations and one from the food industry. Twelve were members of the VicSalt Partnership and two were informal collaborators. Most stakeholders viewed the VicSalt Partnership as a positive example of working collaboratively, and said this was essential for raising awareness of the importance of salt reduction with consumers, the food industry, and the government. Challenges relating to engaging the food industry and federal government through a state-led initiative were identified. New approaches to overcome this, such as forming clear &ldquo, asks&rdquo, to government and committing industry to &ldquo, pledges&rdquo, on reformulation were suggested. Stakeholder interviews and qualitative analysis have provided a range of important insights into barriers and enablers, many of which have already been used to strengthen intervention implementation. The evaluation of the VicSalt Partnership is ongoing and the program is expected to provide a wealth of lessons for state-led interventions to reduce salt intake in Australia and globally.

Food waste and nutrition are intrinsically linked in terms of environmental health and public health. Despite this, it is unknown whether these topics have been previously synthesized into a review. The aim was to identify the interdisciplinary parameters that exist in public health and nutrition literature in terms of food waste and plastic waste associated with food, and to identify how these parameters currently contribute to food sustainability messaging and interventions. A rapid scoping review was conducted. Data were mapped into concepts and synthesized in a narrative review. Four main concepts were identified: (1) food waste and diet quality, nutrient losses, and environmental health, (2) food waste reduction interventions and diet quality, (3) food banks/pantries and diet/nutritional quality, and (4) food and plastic waste messaging in nutrition or dietary guidelines. Food waste is associated with nutrient wastage, and interventions to reduce food waste can successfully address food sustainability and nutrition quality. Food redistribution systems do not currently address access to sustainably sourced foods that are also nutrient-dense for lower-income communities. Opportunities for future research and practice include aligning food waste, plastic waste, and nutrition priorities together and developing better food redistribution systems to limit wastage of high-quality foods.

Background : There is scepticism about health effects of dairy products in the public, which is reflected in an increasing intake of plant-based drinks, for example, from soy, rice, almond, or oat. Objective : This review aimed to assess the scientific evidence mainly from meta-analyses of observational studies and randomised controlled trials, on dairy intake and risk of obesity, type 2 diabetes, cardiovascular disease, osteoporosis, cancer, and all-cause mortality. Results : The most recent evidence suggested that intake of milk and dairy products was associated with reduced risk of childhood obesity. In adults, intake of dairy products was shown to improve body composition and facilitate weight loss during energy restriction. In addition, intake of milk and dairy products was associated with a neutral or reduced risk of type 2 diabetes and a reduced risk of cardiovascular disease, particularly stroke. Furthermore, the evidence suggested a beneficial effect of milk and dairy intake on bone mineral density but no association with risk of bone fracture. Among cancers, milk and dairy intake was inversely associated with colorectal cancer, bladder cancer, gastric cancer, and breast cancer, and not associated with risk of pancreatic cancer, ovarian cancer, or lung cancer, while the evidence for prostate cancer risk was inconsistent. Finally, consumption of milk and dairy products was not associated with all-cause mortality. Calcium-fortified plant-based drinks have been included as an alternative to dairy products in the nutrition recommendations in several countries. However, nutritionally, cow’s milk and plant-based drinks are completely different foods, and an evidence-based conclusion on the health value of the plant-based drinks requires more studies in humans. Conclusion : The totality of available scientific evidence supports that intake of milk and dairy products contribute to meet nutrient recommendations, and may protect against the most prevalent chronic diseases, whereas very few adverse effects have been reported. Keywords: obesity; type 2 diabetes; cardiovascular disease; osteoporosis; cancer; mortality (Published: 22 November 2016) Citation: Food & Nutrition Research 2016, 60: 32527 - http://dx.doi.org/10.3402/fnr.v60.32527

Background : Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone. Objective : This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents. Design : A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall. Results: Valid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes ( p= 0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls ( p< 0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls ( p< 0.01), and 6.1% of boys and 1.7% of girls met the WHO recommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%). Conclusions : Adolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake. Keywords: urinary sodium; urinary potassium; intake; adolescents; salt (Published: 1 April 2016) Citation: Food & Nutrition Research 2016, 60: 29442 - http://dx.doi.org/10.3402/fnr.v60.29442

Diet includes many risk factors for the most common non-communicable diseases (NCDs), but diets consumed in Europe and in other parts of the developed world are not being modified sufficiently to take account of health priorities concerning, in particular, the prevention of NCDs, while much excess mortality and morbidity could be prevented by government actions to regulate appropriately both the agricultural and food industries, and to apply appropriate taxes and subsidies to promote healthier nutrition. In Europe, the Common Agricultural Policy (CAP) continues to promote production of saturated fat rich foods and sugar, with scarce attempts to promote increased production of fruit and vegetables. Meanwhile, the food industry continues to market secondary food products rich in sugar, salt and saturated fats. Powerful lobbies seek to block reform; however, necessary reforms are indicated in the interests of improved nutritional health.

Background : Parent-reported 24-h diet recalls are an accepted method of estimating intake in young children. However, many children eat while at childcare making accurate proxy reports by parents difficult. Objective : The goal of this study was to demonstrate a method to impute missing weekday lunch and daytime snack nutrient data for daycare children and to explore the concurrent predictive and criterion validity of the method. Design : Data were from children aged 2-5 years in the My Parenting SOS project ( n =308; 870 24-h diet recalls). Mixed models were used to simultaneously predict breakfast, dinner, and evening snacks (B+D+ES); lunch; and daytime snacks for all children after adjusting for age, sex, and body mass index (BMI). From these models, we imputed the missing weekday daycare lunches by interpolation using the mean lunch to B+D+ES [L/(B+D+ES)] ratio among non-daycare children on weekdays and the L/(B+D+ES) ratio for all children on weekends. Daytime snack data were used to impute snacks. Results : The reported mean (± standard deviation) weekday intake was lower for daycare children [725 (±324) kcal] compared to non-daycare children [1,048 (±463) kcal]. Weekend intake for all children was 1,173 (±427) kcal. After imputation, weekday caloric intake for daycare children was 1,230 (±409) kcal. Daily intakes that included imputed data were associated with age and sex but not with BMI. Conclusion : This work indicates that imputation is a promising method for improving the precision of daily nutrient data from young children. Keywords: nutrition; daycare; children; missing data; methods (Published: 17 December 2015) Citation: Food & Nutrition Research 2015, 59: 28626 - http://dx.doi.org/10.3402/fnr.v59.28626

Objective 842 million people worldwide are undernourished, while simultaneously the number of overweight and obese individuals increased to 2.1 billion in 2013. There is growing opinion that addressing the global burden of diet-related disease requires a much more comprehensive and multidisciplinary approach than stand-alone public health nutrition interventions such as nutrition education or food labelling. Instead, we need to develop whole of systems interventions to address the core problem and consider the way we grow, process, distribute and commercialize our food. However, there is little evidence or guidance on how to best achieve this goal. This research aims to develop a whole of food systems approach for public health nutrition research by building on systems methods from other fields of science. Specific objectives are to: 1) identify systems methods that are applicable to public health nutrition research; 2) identify how these systems methods and public health research can best be integrated. Methods/results We explored a range of systems methods which could potentially be applied to public health nutrition research. Based on these, we developed a framework for using and combining different systems methods in public health nutrition research. The framework consists of three main phases: A) availability and affordability of (un)healthy food; B) determinants of (un)healthy food availability and affordability; and C) food system intervention development. Phase A forms the platform of this research combining a series of smaller projects examining food availability, affordability and healthiness. Phase B uses global value chain analysis (GVCA) to identify different attributes of value, including both health and monetary values. Phase C aims to identify sustainable food system public health interventions using Group Model Building (GMB) and logistic modelling approaches. Conclusion This paper presents why and how systems methods can be used in public health nutrition research. The food system is highly complex and this complexity needs to be acknowledged to find solutions for the current nutrition challenges (obesity, under nutrition), which cannot be solved in isolation. We envision that the methods presented in this paper can form the basis for future research in this area where it can be applied to other public health nutrition research (for example other food products, in relation to specific diseases, different countries) as well as other domains of a sustainable food system not specifically focused on here e.g. economic, social and specific environmental outcomes.

Background Women’s health during their reproductive years and whilst pregnant has implications for their children’s health, both in utero and during childhood. Associations of women’s pre-pregnancy dietary patterns (DP) with maternal socio-demographic characteristics and nutrient intake were investigated in ProcriAr cohort study in São Paulo/Brazil, 2012. Methods The DPs of 454 women were investigated by principal component factor analysis, using dietary information from a validated 110-item food frequency questionnaire. Multiple linear regression models identified independent associations between DPs and maternal socio-demographic characteristics and Spearman’s correlation determined associations between DPs and nutrients intake. Results Participants’ mean age was 26.1 years (standard deviation = 6.3), 10.3% had more than 8 years of formal education, 30% were migrants from outside of the Southeast of Brazil, 48% were employed, 13% were smokers, and 51% were overweight/obese. Four DPs were derived: ‘Lentils, whole grains and soups,’ ‘Snacks, sandwiches, sweets and soft drinks,’ ‘Seasoned vegetables and lean meats,’ and ‘Sweetened juices, bread and butter, rice and beans’. The ‘Lentils, whole grains and soups’ score was positively related to maternal age, being non-smoker and born in the South, North or Midwest of Brazil. The ‘Snacks, sandwiches, sweets and soft drinks’ score was positively related to higher maternal education, and negatively related to age, lack of formal work and being born in the Northeast region. The ‘Seasoned vegetables and lean meats’ score was positively related to higher maternal education. The ‘Sweetened juices, bread and butter, rice and beans’ score was positively related to unemployment and to no family history of hypertension, and negatively related to maternal overweight and obesity. Dietary intake of fruits and vegetables, foods that require preparation, nutrients from one-carbon metabolism, protein, iron, calcium and vitamin D were correlated with the ‘Seasoned vegetables and lean meats’. Dietary intake of sugar-sweetened and alcoholic beverages, industrialized and takeaway foods, and foods rich in sugar, energy, fat, and synthetic folate were correlated with the ‘Snacks, sandwiches, sweets and soft drinks’. Conclusions Findings from this study add perspectives to be considered in the implementation of health interventions, which could improve women’s nutritional status and provide an adequate environment for the developing fetus. Electronic supplementary material The online version of this article (10.1186/s12889-018-5184-4) contains supplementary material, which is available to authorized users.

Background : Health-related illnesses such as obesity and diabetes continue to increase, particularly in groups of low socioeconomic status. The increasing cost of nutritious food has been suggested as an explanation. Objective : To construct a price index describing the cost of a diet adhering to nutritional recommendations for a rational and knowledgeable consumer and, furthermore, to investigate which nutrients have become more expensive to obtain over time. Methods : Linear programming and goal programming were used to calculate two optimal and nutritious diets for each year in the interval under different assumptions. The first model describes the rational choice of a cost-minimizing consumer; the second, the choice of a consumer trying to deviate as little as possible from average consumption. Shadow price analysis was used to investigate how nutrients contribute to the diet cost. Results : The cost of a diet adhering to nutritional recommendations has not increased more than general food prices in Sweden between 1980 and 2012. However, following nutrient recommendations increases the diet cost even for a rational consumer, particularly for vitamin D, iron, and selenium. The cost of adhering to the vitamin D recommendation has increased faster than the general food prices. Conclusions : Not adhering to recommendations (especially those for vitamin D) offers an opportunity for consumers to lower the diet cost. However, the cost of nutritious diets has not increased more than the cost of food in general between 1980 and 2012 in Sweden. Keywords : diet cost; nutritional recommendations; nutritional intake; linear programming; goal programming; socioeconomic status; vitamin D; fruit and vegetables (Published: 8 April 2015) Citation: Food & Nutrition Research 2015, 59 : 26932 - http://dx.doi.org/10.3402/fnr.v59.26932

Availability of less-healthy packaged food and beverage products has been implicated as an important driver of obesity and diet-related disease. An increasing number of packaged foods and beverages are sold in India. Our objective was to evaluate the healthiness of packaged foods sold by India’s largest manufacturers. Healthiness was assessed using the Australian Health Star Rating (HSR) system and the World Health Organization’s European Regional Office (WHO Euro) Nutrient Profile Model. Sales-value-weighted mean healthiness and the proportions of “healthy” products (using a validated HSR cut-off of ≥3.5, and products meeting WHO Euro criteria as healthy enough to market to children) were calculated overall, by company and by food category. Nutrient information for 943 products sold by the 11 largest Indian manufacturers was obtained from nutrient labels, company websites or directly from the manufacturer. Healthiness was low overall (mean HSR 1.8 out of 5.0 stars) with a low proportion defined as “healthy” by both HSR (17%) and also by WHO Euro criteria (8%). There were marked differences in the healthiness of similar products within food categories. Substantial variation between companies (minimum sales-value-weighted mean HSR 0.5 for Company G, versus maximum HSR 3.0 for Company F) was a result of differences in the types of products sold and the nutritional composition of individual products. There are clear opportunities for India’s largest food companies to improve both the nutritional quality of individual products and to improve their product mix to include a greater proportion of healthy products.

The implementation of a standardized front-of-pack-labelling (FoPL) scheme would likely be a useful tool for many consumers trying to improve the healthfulness of their diets. Our objective was to examine what the traffic light labelling scheme would look like if implemented in the US. Data were extracted from Label Insight’s Open Access branded food database in 2017. Nutrient levels and the proportion of products classified as “Red” (High), “Amber” (Medium) or “Green” (Low) in total fat, saturated fat, total sugar and sodium for food and beverage items were examined. The proportion of products in each category that had each possible combination of traffic light colors, and met the aggregate score for “healthy” was examined. Out of 175,198 products, >50% of all US packaged foods received a “Red” rating for total sugar and sodium. “Confectionery” had the highest mean total sugar (51.9 g/100 g) and “Meat and meat alternatives” the highest mean sodium (781 mg/100 g). The most common traffic light label combination was “Red” for total fat, saturated fat and sodium and “Green” for sugar. Only 30.1% of products were considered “healthy”. A wide variety (n = 80) of traffic light color combinations were observed. A color coded traffic light scheme appears to be an option for implementation across the US packaged food supply to support consumers in making healthier food choices.

Introduction School canteens represent an opportune setting in which to deliver public health nutrition strategies given their wide reach, and frequent use by children. Online school canteen ordering systems, where students order and pay for their lunch online, provide an avenue to improve healthy canteen purchases through the application of consumer behaviour strategies that impact on purchasing decisions. The aim of this study is to assess the efficacy of a consumer behaviour intervention implemented in an online school canteen ordering system in reducing the kilojoule, saturated fat, sugar and sodium content of primary student lunch orders. Methods and analysis The study will employ a cluster randomised controlled trial design. Approximately 1040 students (aged 5–12 years) from 10 primary schools in New South Wales, Australia, currently using an online canteen ordering system will be invited to participate. Schools will be randomised in a 1:1 ratio to receive either the intervention (enhanced system) or control (standard online ordering only). The intervention will include evidence-based strategies shown to influence healthy food purchasing (strategies targeting availability, menu labelling, placement and prompting). The primary outcomes of the trial will be the mean content per student online lunch order of (1) energy (kJ), (2) saturated fat (g), (3) sugar (g) and (4) sodium (mg). The impact of the intervention will be determined by between-group assessment of the nutritional content of lunch purchases over a 2-month period postintervention initiation. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee, University of Newcastle Human Research Ethics Committee and New South Wales Department of Education and School Communities. Study findings will be disseminated widely through peer-reviewed publications and relevant presentations in international conferences and to stakeholders. Trial registration number ACTRN12616000499482.

Malnutrition and poor diet are the largest risk factors responsible for the global burden of disease. Therefore, ending all forms of malnutrition by 2030 is a global priority. To achieve this goal, a key element is to design and implement nutrition policies based on the best available scientific evidence. The demand for evidence-based nutrition policies may originate directly from policymakers or through social actors. In both cases, the role of research institutions is to generate relevant evidence for public policy. The two key objects of analysis for the design of an effective policy are the nutrition conditions of the population and the policies and programs available, including the identification of delivery platforms and competencies required by personnel in charge of the provision of services (social response). In addition, systematic literature reviews about risk factors of malnutrition, as well as the efficacy and effectiveness of policy actions, lead to evidence-based policy recommendations. Given the multifactorial nature of malnutrition, the drivers and risk factors operate in several sectors (food and agriculture, health, education, and social development) and may be immediate, underlying or basic causes. This multilevel complexity should be considered when developing nutrition policy. In this article, we show two models for the evidence-based design of nutrition policies and programs that may be useful to academia and decision makers demonstrated by two examples of policy design, implementation and evaluation in Mexico.

Background : Young men are difficult to reach with conventional nutrition information and they have a low intake of vegetables and whole grain cereals. Few intervention studies have focused on improving young men’s consumption of vegetables and whole grains. Objective : A 5-month intervention focusing on a combination of increased availability of healthy foods and nutritional information was developed to stimulate the intake of vegetables and semi-whole grain bread among a group of young men in the Norwegian military. Subjects : A total of 376 recruits in the intervention group and 105 recruits in the control group participated in the entire study. Results: The average daily increase in consumption of vegetables was 82 g ( p

Background Enhancing the use of evidence in policymaking is critical to addressing the global burden of nutrition-related disease. Whilst the public health nutrition community has embraced evidence-informed policymaking, their approach of defining relevant evidence and evaluating policy has not brought about major shifts in policymaking. This article uses a public health nutrition case study to refine a novel theory-informed framework for enhancing the use of evidence in government public health nutrition policymaking. Our aim is to contribute insights from evidence-informed policy to the emerging paradigm in public health nutrition policymaking. Methods An enquiry framework informed by three groups of theories underpinning evidence-informed policy was used to explore the role of socially mediated processes on the use of evidence. A public health nutrition case study on food marketing to New Zealand children was conducted to refine the framework. Interview data collected from 54 individuals representing four key policy stakeholder groups, policymakers, academics, and food industry and non-government organisations were analysed using deductive and inductive thematic analysis. To enhance theoretical robustness, an alternative hypothesis of political explanations for evidence use was explored alongside the enquiry framework. Results We found the prevailing political climate influenced the impact of advocacy for evidence inclusive processes at the meta-policy and policymaking process levels and in policy community relationships. Low levels of awareness of the impact of these processes on evidence use and uncoordinated advocacy resulted in the perpetuation of ad hoc policymaking. These findings informed refinements to the enquiry framework. Conclusion Our study highlights the role advocates can play in shifting government public health nutrition policymaking systems towards enhanced use of evidence. Our Advocacy for Evidence Use framework argues for a three-channel approach to advocacy for using evidence in the public interest. The framework provides a means for building a constituency for evidence use in public health nutrition and adds understanding about advocacy to the field of evidence-informed policy. Future research should examine the impact of coordinated advocacy on public health nutrition policymaking systems. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0154-8) contains supplementary material, which is available to authorized users.

Background : Our hypothesis was that a modified diet would improve blood glucose control with beneficial impact on weight management and overall health in established diabetes. Objective : This prospective interventional study investigated the clinical effect of an Okinawan-based Nordic diet on anthropometry, metabolic control, and health-related quality of life (HRQoL) in Scandinavian type 2 diabetes patients. Design : Food was prepared and delivered to 30 type 2 diabetes patients. Clinical information along with data on HRQoL, blood samples, and urine samples were collected during 12 weeks of diet interventions, with follow-up 16 weeks after diet completion. Results : After 12 weeks of dietary intervention, a reduction in body weight (7%) ( p< 0.001), body mass index ( p< 0.001), and waist circumference (7.0 cm) ( p< 0.001) was seen. Improved levels of proinsulin ( p= 0.005), insulin ( p =0.011), and fasting plasma glucose ( p< 0.001) were found already after 2 weeks; these improved levels remained after 12 weeks when lowered levels of C-peptide ( p= 0.015), triglycerides ( p= 0.009), total cholesterol ( p= 0.001), and low-density lipoprotein-cholesterol ( p= 0.041) were also observed. Insulin resistance homeostasis model assessment for insulin resistance was lowered throughout the study, with a 20% reduction in hemoglobin A1c levels ( p< 0.001) at week 12, despite reduced anti-diabetes treatment. Lowered systolic blood pressure (9.6 mmHg) ( p< 0.001), diastolic blood pressure (2.7 mmHg) ( p< 0.001), and heart and respiratory rates ( p< 0.001) were accompanied by decreased cortisol levels ( p =0.015) and improvement in HRQoL. At follow-up, increased levels of high-density lipoprotein-cholesterol were found ( p =0.003). Conclusion : This interventional study demonstrates a considerable improvement of anthropometric and metabolic parameters and HRQoL in Scandinavian type 2 diabetes patients when introducing a modified Okinawan-based Nordic diet, independently of exercise or other interventions. Through these dietary changes, anti-diabetes treatment could be decreased or cancelled. Keywords: anthropometry; metabolic control; interventional study; type 2 diabetes; Okinawan diet; Nordic diet; quality of life (Published: 22 September 2016) Citation: Food & Nutrition Research 2016, 60: 32594 - http://dx.doi.org/10.3402/fnr.v60.32594

Background : Ethanolic extract of licorice root has been shown to reduce low-density lipoprotein (LDL) oxidation in atherosclerotic mice and in both hypercholesterolemic and normal lipidemic humans. Objective : This study examined the effect of licorice-root extract on carotid intima-media thickness (CIMT) in individuals with hypercholesterolemia. Design : Individuals with hypercholesterolemia (total cholesterol ≥6.18 mmol/L [240 mg/dL]) and without significant stenosis were randomly allocated to two groups: an experimental group that consumed 0.2 g/day of ethanolic extract of licorice root for 12 months, and a control group that received a placebo. Results : Of 110 eligible participants, 94 (41–80 years old) completed the study. A significant CIMT decrease from 0.92±0.25 mm to 0.84±0.21 mm was observed in the experimental group compared with an increase from 0.85±0.17 mm to 0.88±0.19 mm in the control group. Mean plasma total cholesterol levels and LDL cholesterol decreased, at the range baseline to 1 year, from 284±32 mg/dl to 262±25 mg/dl and from 183±8.5 mg/dl to 174±9.1 mg/dl, respectively, for the experimental group ( p

Background : Food consumption patterns of young children in China are not well known. Objective : Characterised food groups consumed by infants and young children in urban China using data from the Maternal Infant Nutrition Growth (MING) study. Design : One 24-h dietary recall was completed for 1,350 infants and young children (436 infants aged 6–11 months and 914 young children aged 12–35 months), who were recruited from maternal and child care centres in eight cities via face-to-face interviews with the primary caregiver. All foods, beverages and supplements reported were assigned to one of 64 food groups categorised into the following: milk and milk products, grains, vegetables, fruits, protein foods and desserts/sweets. The percentage of infants and young children consuming foods from specific food groups was calculated, regardless of the amount consumed. Results : Less than half of infants consumed breast milk (47%), whereas 59% of infants consumed infant formula and 53–75% of young children consumed growing-up (fortified) milk. Rice was the number one grain food consumed after 6 months (up to 88%) and the consumption of infant cereal was low. About 50% of infants did not consume any fruits or vegetables, and 38% of young children did not consume any fruits on the day of the recall. Only 40% of all children consumed dark green leafy vegetables and even fewer consumed deep yellow vegetables. Eggs and pork were the most commonly consumed protein foods. Conclusions : The data provide important insight for developing detailed food consumption guidelines for this population group. Mothers of infants should be encouraged to continue breastfeeding after the first 6 months. Parents should be advised to offer a wide variety of vegetables and fruits daily, particularly dark green leafy and deep yellow vegetables and colourful fruits. The consumption of fortified infant cereal should be advocated to improve the iron intake of Chinese infants. Keywords: MING; dietary patterns; infants; young children; China Citation: Food & Nutrition Research 2016, 60: 30289 - http://dx.doi.org/10.3402/fnr.v60.30289

Background: High blood pressure (BP) is the leading risk factor for global disease burden, contributing to 7% of global disability adjusted life years. Angiotensin converting enzyme (ACE)-inhibiting bioactive peptides have the potential to reduce BP in humans. These peptides have been identified in many dairy products and have been associated with significant reductions in BP.Objective: The objective of this trial was to examine whether a cheese rich in ACE-inhibiting peptides (Gamalost®), or a standard Gouda-type cheese could lower BP.Design: A total of 153 healthy participants were randomised to one of three parallel arms: Gamalost® (n=53, 50 g/day for 8 weeks), Gouda-type cheese (n=50, 80 g/day for 8 weeks), and control (n=50). BP and anthropometric measurements were taken at the baseline and at the end, with an additional BP measurement midway. Based on BP at baseline, participants were categorised as having optimal BP (140/>90 mmHg). Questionnaires about lifestyle, health, and dietary habits were completed at baseline, midway and end.Results: In total, 148 participants (mean age 43, 52% female) completed the intervention. There were no differences among the three groups in relevant baseline characteristics. BP was reduced in the entire study population, but the cheese groups did not differ from control. However, in a subgroup of participants with slightly elevated BP, BP at 4 weeks of intervention seemed to be borderline significantly more reduced in the Gamalost® group compared with the control group (Dunnett test: diastolic BP −3.5 mmHg, 95% confidence interval (CI) −7.3, 0.4, systolic BP: −4.3 mmHg, 95% CI −9.8, 1.1).Conclusion: An intention-to-treat analysis of the data showed no cheese effect upon BP compared to control, but Gamalost® seemed to have a small, non-significant lowering effect on diastolic BP after 4 weeks in people with a normal-high BP.Keywords: bioactive peptides; intervention; dairy; Gamalost; Gouda; cardiovascular diseases(Published: 4 August 2016)Citation: Food & Nutrition Research 2016, 60: 32017 - http://dx.doi.org/10.3402/fnr.v60.32017

Background : School meals, if both nutritious and attractive, provide a unique opportunity to improve health equality and public health. Objective : To describe the study rationale, data collection, and background of participants in the study ‘Prospects for promoting health and performance by school meals in Nordic countries’ (ProMeal). The general aim was to determine whether overall healthiness of the diet and learning conditions in children can be improved by school lunches, and to capture the main concerns regarding school lunches among children in a Nordic context. Design : A cross-sectional, multidisciplinary study was performed in Finland, Iceland, Norway, and Sweden on pupils ( n =837) born in 2003. Results : In total 3,928 pictures of school lunches were taken to capture pupils’ school lunch intake. A mean of 85% of all parents responded to a questionnaire about socioeconomic background, dietary intake, and habitual physical activity at home. Cognitive function was measured on one occasion on 93% of the pupils during optimal conditions with a Stroop and a Child Operation Span test. A mean of 169 pupils also did an Integrated Visual and Auditory Continuous Performance Test after lunch over 3 days. In total, 37,413 10-sec observations of classroom learning behavior were performed. In addition, 753 empathy-based stories were written and 78 focus groups were conducted. The pupils had high socioeconomic status. Conclusions : This study will give new insights into which future interventions are needed to improve pupils’ school lunch intake and learning. The study will provide valuable information for policy making, not least in countries where the history of school meals is shorter than in some of the Nordic countries. Keywords: school meals; Nordic countries; education; cognitive function; dietary intake (Published: 10 August 2016) Citation: Food & Nutrition Research 2016, 60: 30468 - http://dx.doi.org/10.3402/fnr.v60.30468

Discute-se a construção da intersetorialidade entre o campo da saúde e da segurança alimentar e nutricional (SAN) no Brasil, entre 2003 e 2010, período que inaugura a priorização deste tema na agenda governamental. Para tanto, desenvolveu-se uma pesquisa qualitativa segundo a epistemologia construcionista, mediante entrevistas com informantes-chave do órgão de controle social do campo da SAN de abrangência nacional. Os avanços e desafios do processo são abordados enquanto categorias de análise. A Política Nacional de Alimentação e Nutrição (PNAN) foi mencionada como articuladora entre os dois campos, sendo descentralizada por uma rede com atuação nos estados e municípios. No entanto, registraram-se dificuldades políticas, institucionais e operacionais para que a PNAN possa ser efetiva no Sistema Único de Saúde e assim contribuir para o avanço da SAN no país. O predomínio do modelo biomédico, curativo e de alta complexidade foi referido como o principal impeditivo, conferindo ainda às políticas de promoção da saúde, como a PNAN, uma posição secundária em termos da sua priorização. This article discusses the establishment of inter-sector action between health and food and nutritional security in Brazil from 2003 to 2010, when this issue was launched as a priority on the government's agenda. A qualitative study was developed according to constructivist epistemology, using key-informant interviews in the field's nationwide social oversight body. Advances and challenges in this process are addressed as analytical categories. The National Food and Nutrition Policy (PNAN) was mentioned as the link between the two fields, decentralized through a network with activity in the states and municipalities. However, the study found political, institutional, and operational obstacles to the effective implementation of the PNAN in the Brazilian Unified National Health System and consequently to a contribution to the advancement of Health and Food and Nutritional Security in the country. The predominance of the biomedical, curative, and high-complexity model was cited as the principal impediment, while health promotion policies like the PNAN were assigned secondary priority. Se discute la construcción de la intersectorialidad entre el campo de la salud y el de la seguridad alimentaria y nutricional en Brasil, entre 2003 y 2010, período que inaugura la priorización de este tema en la agenda gubernamental. Para tal efecto, se desarrolló una investigación cualitativa, según la epistemología construccionista, mediante entrevistas con informantes-clave del órgano de control social en el campo de la seguridad alimentaria y nutricional dentro de una dimensión nacional. Los avances y desafíos del proceso se abordan por categorías de análisis. La Política Nacional de Alimentación y Nutrición (PNAN) se mencionó como articuladora entre los dos campos, siendo descentralizada por una red con actuación en los estados y municipios. Sin embargo, se registraron dificultades políticas, institucionales y operacionales para que la PNAN pudiera ser efectiva en el Sistema Único de Salud, y así contribuir al avance de la seguridad alimentaria y nutricional en el país. El predominio del modelo biomédico, curativo y de alta complejidad fue mencionado como el principal impeditivo, otorgando incluso a las políticas de promoción de la salud, como la PNAN, una posición secundaria en términos de su priorización.

Background: Adolescence is a period of gender-specific physical changes, during which eating habits develop. To better understand what factors determine unhealthy eating habits such as dieting to lose weight, skipping meals and consumption of unhealthy foods, we studied how physical measurements and body perception relate to eating habits in boys and girls, before and during adolescence. Methods: For this cross-sectional study, we obtained data from both written questionnaires and physical measurements of height, weight and waist circumference (WC). Results: Dieting to lose weight and skipping breakfast were more common among adolescents than among younger boys and girls (pOn the day of the defence date the status of this article was Manuscript.Funding agencies: Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of south-east Sweden [FORSS-233111]

Objectives: Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries. Design: A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data. Setting: The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK. Subjects: Sixty key informants participated in the study. Results: There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents. Conclusions: There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes., funded by DG Education and Culture - JOBNUT project

Background/objectives : Significant changes have been reported in dietary habits and food availability in Iceland that would be expected to compromise selenium intake and status, especially among young people. These include substantial decreases in the consumption of fish and milk, as well as the selenium content of imported wheat. The aim of this study was to assess selenium in the diet and whole blood of adolescent girls, as well as define the most important foods contributing to intake and blood concentrations of selenium. Design : The subjects were 96 randomly selected girls, aged 16-20, who answered a validated food frequency questionnaire (FFQ) for dietary assessment. Selenium intake from each food group was calculated in mg/day. Blood samples were collected for measurement of whole blood selenium. Results : Mean dietary selenium was 51 ± 25 mg/day. Milk/dairy products, including cheese, contributed 36 ± 14% of total dietary selenium; fish 18 ± 12%; and bread/cereal products 13 ± 6%. Mean whole blood selenium was 117 ± 12 µg/l (range 90-208); nearly 90% of subjects were above the optimal level of 100 µg/l. Fish and bread/cereal products were the only foods significantly correlated with selenium in blood (r = 0.32; P =0.002 and r = 0.22; P = 0.04, respectively) while no correlation was found with milk and dairy products in spite of their greater contribution to total selenium intake. Conclusion : In this population of Icelandic adolescent girls, selenium intake and status seem acceptable. Judging from associations between intake and blood levels, fish and cereals may be the most important contributors to blood selenium. Keywords : selenium; diet; micronutrient status; adolescent girls; fish consumption; milk consumption (Published: 31 August 2012) Citation: Food & Nutrition Research 2012. 56 : 18476 - http://dx.doi.org/10.3402/fnr.v56i0.18476

Background and objective: Nutrient values are influenced by the analytical method used. Food folate measured by high performance liquid chromatography (HPLC) or by microbiological assay (MA) yield different results, with in general higher results from MA than from HPLC. This leads to the question of how to deal with different analytical methods in compiling standardised and internationally comparable food composition databases? A recent inventory on folate in European food composition databases indicated that currently MA is more widely used than HPCL. Since older Dutch values are produced by HPLC and newer values by MA, analytical methods and procedures for compiling folate data in the Dutch Food Composition Database (NEVO) were reconsidered and folate values were updated. This article describes the impact of this revision of folate values in the NEVO database as well as the expected impact on the folate intake assessment in the Dutch National Food Consumption Survey (DNFCS). Design: The folate values were revised by replacing HPLC with MA values from recent Dutch analyses. Previously MA folate values taken from foreign food composition tables had been recalculated to the HPLC level, assuming a 27% lower value from HPLC analyses. These recalculated values were replaced by the original MAvalues. Dutch HPLC and MAvalues were compared to each other. Folate intake was assessed for a subgroup within the DNFCS to estimate the impact of the update. Results: In the updated NEVO database nearly all folate values were produced by MA or derived from MA values which resulted in an average increase of 24%. The median habitual folate intake in young children was increased by 11-15% using the updated folate values. Conclusion: The current approach for folate in NEVO resulted in more transparency in data production and documentation and higher comparability among European databases. Results of food consumption surveys are expected to show higher folate intakes when using the updated values. Keywords: analytical method; food composition; NEVO; HPLC; microbiological assay; food intake; food consumption survey; children (Published: 2 April 2012) Citation: Food & Nutrition Research 2012. 56 : 5449 - DOI: 10.3402/fnr.v56i0.5449

Background: The methodology used in the first Belgian food consumption survey followed to a large extent the instructions of the European Food Consumption (EFCOSUM) reports, where repeated 24-hour recalls (24HR) using EPIC-SOFT were recommended. Objectives: To evaluate the relative validity of two non-consecutive 24HR using the European prospective investigation on nutrition and cancer-(SOFT) (EPIC-SOFT) by comparison with 5-day estimated dietary records (EDR). To assess misreporting in energy for both methods by comparing energy intake with energy expenditure from accelerometery in a subsample. Design: A total of 175 subjects (aged 15 and over) were recruited to participate in the study. Repeated 24HR were performed with an interval of 2-8 weeks. After completion of the second interview, subjects were instructed to keep an EDR. Dietary intakes were adjusted for within-person variability to reflect usual intakes. A Student’s t-test was calculated to assess differences between both methods. Spearman and Kappa correlation coefficients were used to investigate agreement. Results: In total, 127 subjects completed the required repeated 24HR as well as the five record days. From 76 participants, accelerometer data were available. In both methods, about 35% of participants had ratios of Energy Intake/Total Energy Expenditure (EI/TEE) above or below 95% confidence intervals for EI/TEE, suggesting misreporting of energy. Significant differences between the two dietary intake methods were found for total energy, total fat, fatty acids, cholesterol, alcohol, vitamin C, thiamine, riboflavin and iron. In general, intakes from 24HR were higher compared to EDR. Correlation coefficients for all nutrients ranged from 0.16 for thiamine to 0.70 for water. Conclusions: The results from this study show that in the context of nutritional surveillance, duplicate 24HR can be used to asses intakes of protein, carbohydrates, starch, sugar, water, potassium and calcium. Keywords: estimated dietary record; dietary assessment; accelerometry; relative validity(Published: 11 November 2011)Citation: Food & Nutrition Research 2011, 55: 7307 - DOI: 10.3402/fnr.v55i0.7307

Background: Changes in dietary habits and lifestyle are considered the main factors associated with several diet-related diseases in the Arab Gulf countries. The aim of this study was, therefore, to describe the dietary and lifestyle habits amongst adolescents in Bahrain. Design: A cross-sectional study was carried out amongst male and female secondary school students selected using the multi-stage stratified random sampling technique. A sample size of 735 subjects (339 males and 396 females), aged 15-18 years, was selected from government schools from all the governorates of Bahrain. Results: Skipping breakfast was significantly greater in females (62.8%) compared to males (37.2%), ( P