Search

Purpose. This study identified restaurant manager/owner factors that may contribute to adoption of a restaurant-based healthy eating program, Eat Fit. Findings may be used to engage restaurants in efforts to increase access to and availability of healthy foods, promote healthy food choices, and work toward improving diet and lowering obesity and chronic disease risk in the community. Methods. Cross-sectional survey data were collected from restaurant managers/owners interested in partnering with Eat Fit. Variables included restaurant manager/owner beliefs, perceived staff knowledge/skills, support, self-efficacy, outcome expectancies, and barriers and facilitators to implementation. Results. Forty-nine managers/owners participated. Most managers/owners held positive beliefs about offering healthy food items in restaurants (83.7%). Most agreed that restaurants could influence eating behaviors (83.7%) and that restaurants have a responsibility to offer healthy options (77.6%). Most managers/owners perceived high levels of support (83.7%) and were confident in their ability (95.9%) to implement the Eat Fit program. The most cited barriers were customer preference, ingredient availability, staff knowledge, and operational challenges. The most common reasons for involvement in the program were a desire to increase access to healthy food, to entice customers looking for healthier food, a belief that restaurants should offer healthy food, and opportunities to market through Eat Fit. Conclusions. This research contributes to knowledge about beliefs and perceptions of restaurant manager/owners. Efforts to engage restaurants should focus on benefits of offering healthy food and the role restaurants can play in promoting health. Furthermore, programs may benefit from enhanced restaurant staff training, customer-targeted marketing, and educational efforts. [ABSTRACT FROM AUTHOR]

Research into the link between food environments and health is scarce. Research in this field has progressed, and new comprehensive methods (i.e., incorporating all food retail outlets) for classifying food retail environments have been developed and are yet to be examined alongside measures of obesity. In this study, we examine the association and temporal trends between the food environment and BMI of a repeated cross-sectional sample of the adult population between 2008 and 2016. Methods: Food retail data for 264 postal areas of Greater Melbourne was collected for the years 2008, 2012, 2014, and 2016, and a container-based approach was used to estimate accessibility to supermarkets, healthy and unhealthy outlets. Data on BMI for postal areas was obtained from the Victorian Population Health Survey (n = 47,245). We estimated the association between the food environment and BMI using linear mixed models. Results indicated that BMI increased as accessibility to healthy outlets decreased by up to −0.69 kg/m2 (95%CI: −0.95, −0.44). BMI was lower with high and moderate access to supermarkets compared to low access by −0.33 kg/m2 (−0.63, −0.04) and −0.32 kg/m2 (−0.56, −0.07), and with high access to unhealthy outlets compared to low access (−0.38 kg/m2: −0.64, −0.12) and moderate access (−0.54 kg/m2: −0.78, −0.30). Conclusion: Our results show that increasing access and availability to a diverse range of food outlets, particularly healthy food outlets, should be an important consideration for efforts to support good health. This research provides evidence that Australia needs to follow suit with other countries that have adopted policies giving local governments the power to encourage healthier food environments.

IntroductionThere is increasing recognition of the value of linking food sales databases to national food composition tables for population nutrition research.ObjectivesExpanding upon automated and manual database mapping approaches in the literature, our aim was to match 1,179 food products in the Canadian data subset of Euromonitor International’s Passport Nutrition to their closest respective equivalents in Health Canada’s Canadian Nutrient File (CNF).MethodsMatching took place in two major steps. First, an algorithm based on thresholds of maximal nutrient difference (between Euromonitor and CNF foods) and fuzzy matching was executed to offer match options. If a nutritionally appropriate match was available among the algorithm suggestions, it was selected. When the suggested set contained no nutritionally sound matches, the Euromonitor product was instead manually matched to a CNF food or deemed unmatchable, with the unique addition of expert validation to maximize meticulousness in matching. Both steps were independently performed by at least two team members with dietetics expertise.ResultsOf 1,111 Euromonitor products run through the algorithm, an accurate CNF match was offered for 65% of them; missing or zero-calorie data precluded 68 products from being run in the algorithm. Products with 2 or more algorithm-suggested CNF matches had higher match accuracy than those with one (71 vs. 50%, respectively). Overall, inter-rater agreement (reliability) rates were robust for matches chosen among algorithm options (51%) and even higher regarding whether manual selection would be required (71%); among manually selected CNF matches, reliability was 33%. Ultimately, 1,152 (98%) Euromonitor products were matched to a CNF equivalent.ConclusionOur reported matching process successfully bridged a food sales database’s products to their respective CNF matches for use in future nutritional epidemiological studies of branded foods sold in Canada. Our team’s novel utilization of dietetics expertise aided in match validation at both steps, ensuring rigor and quality of resulting match selections.

BackgroundThe global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry – a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF). MethodsThis study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present). ResultsDespite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of ‘failure’ of food policy intervention and an entrenched narrowly economic conception of food security. ConclusionThis study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition.

Objective: This study explored variations in food insecurity across sociodemographic groups and changes specific to the COVID-19 pandemic, including income loss, stimulus check receipt, and changes in household size. Design: A cross-sectional online survey was conducted using a 2-item food insecurity screener. COVID-19 related factors and sociodemographic data were collected. Setting: Data were collected in Arkansas, United States, during July and August 2020. Participants: A sample of 1205 adults was recruited using ARresearch, a volunteer research registry. Participants were over the age of 18 and living, working, or receiving health care in Arkansas. Results: The prevalence of food insecurity was 24.9% during the COVID-19 pandemic. Food insecurity was elevated even after the majority of respondents received a stimulus check. Chi-square and t-tests revealed that food insecurity was more prevalent among those who are younger, Black, Hispanic/Latinx, lower-income, less educated, and living in households with children. Multivariate logistic regression revealed that odds of food insecurity were greater for individuals who reported income loss due to the pandemic (OR = 3.29; p

Home cooking is an important obesity prevention strategy and associated with benefits for diet and health. Although cooking may be a joyful act of mindfulness, it also requires planning, preparation and time. Historically, women have been more likely to fulfill the role of food shopping and cooking. More recent studies suggested a transition in traditional household role assignments towards a larger involvement of males. This study examined the current sex distribution of cooking and food shopping responsibilities in the United States of America based on a nationally representative sample of 9078 citizens from the National Health and Nutrition Examination Surveys (2017–2020). More than 80% of women aged 25 years or older indicated that they were the person who did most of the planning/preparing of meals in their families, whereas the percentage of males responding affirmatively was substantially lower, ranging from 38.73% to 43.20% depending on age. Analyses on food shopping duties revealed a comparable distribution. In multivariate regression, female sex was associated with significantly higher odds of being the main food shopper/meal preparer in the family (OR: 4.82 (4.14–5.60) and 5.54 (4.60–6.67), respectively). Our data suggest that the majority of food shopping and cooking duties are still performed by women, which has important implications for public health nutrition initiatives. [ABSTRACT FROM AUTHOR]

Objective: In this paper, we examined whether there are inequalities in access to food retail (by type and healthiness) across local government areas (LGA) in Greater Melbourne and by LGA grouped based on their distance from the central business district and Growth Area designation. We also examined whether these inequalities persisted over time., Design: This is a secondary analysis of a repeated cross-sectional census of food outlets collected at four time points (2008, 2012, 2014 and 2016) across 31 LGA. Using Geographical Information Systems, we present a spatial analysis of food retail environments in Melbourne, Australia, at these four times over eight years., Setting: Greater Melbourne, Australia., Participants: 31 LGA in Greater Melbourne., Results: Findings show significant inequalities in access to healthy food retail persisting over time at the LGA level. Residents in lower density urban growth areas had the least access to healthy food retail. Unhealthy food retail was comparatively more accessible, with a temporal trend indicating increased accessibility over time in urban growth areas only., Conclusion: Accessibility to food outlets, particularly healthy food outlets and supermarkets, in Greater Melbourne is not equal. To identify and address health inequalities associated with rapid urban growth, further understanding of how people interact with the food environment needs to be explored.

Objective: Several studies suggest that during the early pandemic, amidst socioeconomic instability, children from underserved families were more likely to resort to consuming cheaper, lower-quality foods with longer shelf lives. This study investigated the change in unhealthy food consumption across different phases (pre, early, mid) of the COVID-19 pandemic, and whether the strength of association between unhealthy food consumption and household socioeconomic disadvantage (HSED) varied across phases of the pandemic., Methods: This study utilized serial cross-sectional data collected from low-income families enrolled in a school-based food co-op, Brighter Bites. Secondary data analysis included 5,384 surveys from families who had complete data: 3422 pre-pandemic, 944 from the early pandemic, and 1,018 mid-pandemic. Outcome measures included sugary food intake and convenience/fast food intake, each of which was operationalized as a scale using pre-validated items from the surveys. HSED was operationalized as a composite of parent employment, parent education, food insecurity, and participation in government programs; responses were categorized into low, medium, and high HSED groups for analysis. We examined the interaction between HSED and time period to explore how HSED and its association with dietary measures changed over the course of the pandemic., Results: A significant linear negative trend, i.e., a decrease in consumption from pre-to-mid-pandemic period was seen in sugary food intake ( p  < 0.001), but not in convenience food intake. In data pooled across time-periods, both sugary food and convenience/fast food consumption were inversely associated with HSED, and low unhealthy food consumption was observed among high-disadvantage groups. No significant interaction between time period and HSED was observed on either scale. However, the post-regression estimates from the adjusted interaction model showed a significant association between convenience/fast food consumption and HSED in pre- and mid-pandemic periods., Conclusion: The study highlights the nuances of socioeconomic dynamics on the diet behaviors of children from low-income families during a natural disaster., Competing Interests: Shreela Sharma serves on the board of directors of Brighter Bites 501c3 nonprofit organization. This is an unpaid board position. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Parthasarathy, Ranjit, Chuang, Markham, Pomeroy, Noyola, Ernest and Sharma.)

Objectives: The aim of this study was to analyze the modeling methodologies of fiscal policies on food with health or environmental outcomes., Background: Evidence suggests that fiscal policies on food can contribute to addressing the growing burden of noncommunicable diseases and climate change. These policies should be modeled in advance to see the implications for the environment and health., Methods: A systematic review was conducted of studies that modeled fiscal policies on the food groups targeted by the EAT-Lancet Commission and examined their health or environmental outcomes. The Scopus and PubMed databases were searched on November 30, 2021. The records were double-screened and data on modeling methods were extracted from the included studies., Results: A total of 55 studies were included in the review. The most frequently modeled interventions were fruit and vegetable subsidies (n = 19) and carbon taxes on food (n = 17). One study also included a consumer education campaign to enhance the effect of fiscal policy. The outcomes are highly sensitive to consumption change and price elasticities. None of the studies modeled the health effects of environmental outcomes., Conclusions: A model that covered all the relevant aspects of the issue was not found. Some parts were missing from all the included models. It is advisable to model the stability of the amount of diet consumed, either by keeping the amount of food in the diet stable or by taking a more conservative approach and keeping the consumed calories stable. It is preferable to keep the included diseases and environmental boundaries broad to have more valid outcome estimates on this complex issue. A more comprehensive understanding of fiscal policies would allow us to better anticipate the impact of our actions and inactions and thus could lead to more sophisticated measures taken by policymakers., Systematic Review Registration: PROSPERO registration no. 2022 CRD42022291945/., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Abstract 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.

In 2016, Thailand introduced voluntary front-of-pack nutrition labeling, the ‘Thailand Healthier Choice’ logo (THCL), in order to help consumers make informed, healthier food choices in each food category. This study aimed to assess the uptake of the THCL scheme in Thailand after five years of implementation by analyzing a newly launched product database. Data on the nutritional composition and labeling were obtained from the Mintel Global New Products Database between 2017 and 2021. The product’s healthfulness was determined using the Health Star Rating (HSR) algorithm. The numbers and proportions of total, eligible, and labeled products bearing the THCL logo were analyzed and classified by food category, by HSR value, and by manufacturer. After 5 years of implementation, THCL uptake as a proportion of total products and eligible products continues to increase by 3.0% and 10.2% per annum, respectively. The logo has correspondingly appeared on 10.7% and 39.5% of total and eligible products. As a voluntary implementation, 76.1% of products displaying the THCL logo belonged to the ‘non-core’ group, i.e., non-alcoholic beverages and instant foods. This food category (HSR < 3.0) was more likely to register to bear THCL rather than those ‘core’ food scoring an HSR ≥ 3.5, which might reflect economic considerations and benefits. The present analysis also found that only 10% of manufacturers in Thailand launched ‘healthier’ products that display the THCL logo with varied product numbers. To summarize, the initial five-year implementation of the THCL program shows promise, but its adoption remains limited and inconsistent, thereby restricting its influence on public health. Our discoveries highlight the limitations of commercial goodwill in applying THCL voluntarily in Thailand and offer potential suggestions to enhance its adoption in the coming years.

Lifelong education for dietitians in Japan is based mainly on competencies according to years of experience. Because learning content differs depending on the desired position and specialty, training programs that reflect the individual learning needs of public health dietitians are needed. This study aimed to assess the individual learning needs of public health dietitians via years of experience in health promotion. In 2021, an online survey of public health dietitians involved in health promotion in prefectures, designated cities, and other municipalities throughout Japan was conducted. Years of experience in health promotion were categorized as early (

Objective: A core function of the public health nutrition workforce is advocacy. Little is known of the nutritionists' role in policymaking from a policy process theory perspective. The current study analyses the nutritionists' role in advocating for a six-year governmental plan on obesity prevention in Quebec, Canada. Design: We conducted qualitative research using Quebec's obesity policy as a case study to understand the role of nutritionists in advocating for obesity prevention policies. A conceptual framework combining the Advocacy Coalition Framework with a political analysis model based on the Theory of the Strategic Actor was developed to analyse the beliefs, interests and strategies of policy actors including nutritionists. Data sources comprised semi-structured open-ended interviews with key policy actors (n 25), including eight nutritionists (32 %) and policy-related documents (n 267). Data analysis involved thematic coding and analysis using NVivo 11 Pro. Setting: Quebec, Canada. Participants: Key policy actors including nutritionists. Results: Nutritionists formed the core of the dominant public health coalition. They advocated for an inter-sectoral governmental plan to prevent obesity through enabling environments. Their advocacy, developed through an iterative process, comprised creating a think tank and reinforcing partnerships with key policy actors, conducting research and developing evidence, communicating policy positions and advocacy materials, participating in deliberative forums and negotiating an agreement with other coalitions in the policy subsystem. Conclusions: Nutritionists' advocacy influenced agenda setting and policy formulation. This research may contribute to empowering the public health nutrition workforce and strengthening its advocacy practices. It informs practitioners and researchers concerned with obesity policy and workforce development. [ABSTRACT FROM AUTHOR]

Public health nutrition concerns fall within the general topic of the Social Hygiene Movement of the late 19th andearly 20th centuries. The public health nutrition discourse focuses on several priority topics: an almost all plant-based diet, lack of culinary know-how, the consumption of rotten corn as the cause of pellagra. Beyond various issues potentially resolvable by means of a better education, public nutrition hygiene poses the question of the actual economic capacity of the peasant household. When dealing with the subject of public health nutrition, the Romanian hygiene doctors will always take into consideration its ideological connotations, calling to mind the need to both boost population growth and ensure public good health, which is inextricably linked to the country’s economic and military resources. The differences which exist between the advocates of the Social Hygiene Movement are determined by their acceptance (or not) of the state’s responsibility for the peasantry as the largest part of its citizens, and all the more so as their access to staple foods may eventually facilitate access to land ownership.

Abstract 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.

Abstract 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.

ABSTRAK 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, Perempuan ABSTRACT Background: Anemia occurs in women if the amount of hemoglobin is

Context Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings. Objectives The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process. Data sources Six electronic databases were searched and field experts contacted. Study selection An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial ("prescale") in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition. Data extraction Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model. Results Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from –32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions. Conclusion The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy. Systematic Review Registration PROSPERO registration no.CRD42020149267. [ABSTRACT FROM AUTHOR]

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet‐related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective of natural resources and biodiversity, (iii) be culturally acceptable and (iv) be accessible, economically fair and affordable. Dietitians Australia acknowledges that it is critical to prioritise Indigenous knowledges in consultation, policy‐making and implementation processes to achieve these recommendations. In facilitating the uptake of healthy and sustainable diets, dietitians are contributing to the transformation of our current food system that is urgently required to nourish present and future generations within planetary boundaries. In developing this position statement, opportunities for future research have been identified including those to advance the professions' capacity to improve environmental sustainability outcomes across all areas of practice. To achieve a population‐level shift towards this diet, Dietitians Australia recommends: (i) the development of a National Food and Nutrition Strategy which honours Indigenous knowledges on food systems, (ii) the integration of sustainability principles in Australia's dietary guidelines, (iii) the reorientation of our food environment to prioritise access to healthy and sustainable foods, and (iv) investment in capacity building activities to equip the current and future nutrition and dietetics workforce. [ABSTRACT FROM AUTHOR]

Aquatic foods are rich in micronutrients essential to human health, and fisheries and aquaculture are increasingly recognized for their capacity to contribute to reducing global micronutrient deficiencies and diet‐based health risks. Whether fisheries and aquaculture sector and public health nutrition policies align to meet this goal, however, is unclear. Do fisheries and aquaculture policies have explicit nutrition and public health objectives? Do public health nutrition policies recognize the contribution of aquatic foods? Using content analysis, we assessed the alignment of objectives in national fisheries and public health nutrition policies. We further determined conditions associated with varying levels of cohesion among policies in these sectors or domains. We found that 77 of 158 national fisheries policies identified nutrition as a key objective in the sector, and 68 of 165 public health nutrition policies identified the importance of fish and shellfish consumption as key objectives. More recent policies were associated with improved coherence among sectors. International organization presence in policy development was also associated with greater coherence. Countries with higher overweight prevalence had fisheries and public health nutrition policies that were not aligned. There has been a promising recent trend for improved alignment of objectives between fisheries and public health nutrition policies, but more targeted and systematic policy approaches are needed to realize the potential contribution of nutrient‐rich fish and shellfish to healthier food systems. [ABSTRACT FROM AUTHOR]

Background: The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry -- a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF). Methods: This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present). Results: Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of 'failure' of food policy intervention and an entrenched narrowly economic conception of food security. Conclusion: This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: High food consumption due to spending excess money and low physical activity could increased the risk of overweight.Objectives: This study aimed to analyzed the differences amount of pocket money and physical activity between students with overweight and normal at SMA Negeri 5 Surabaya.Methods: The design of the study was case control involving 52 samples with 26 case sampels for overweight students and 26 control sampels for normal students. Body weight measurements using a digital body scale and height using microtoise, this measurements was done before the research began. The quetioners were to identified data identity, amount of pocket money and physical activity. Data were analyzed using Mann Whitney with p>0.005. Results: Some characteristic of the sampels were based on age groups, parent’s occupation and body mass index. The average age of case sampels was 15 years old and control sampels was 16 years old. The occupation of sampels father from two groups were as employees (53.8% and 57.7%) and entrepreneurs (15.4% and 19.2%). Furthermore the occupation of sampel’s mother from two groups were as house wife (96.2% and 92.3%) and entrepreneurs (3.8%). The test result showed the p value about difference of amount of pocket money was p=0.380 and p

Dietitians are deeply embedded within food systems, so food systems concepts are becoming an essential component of dietetic education in Canada. Yet how can we, as educators, better prepare future dietitians to embrace the complexity of food systems and be forces of change towards equity? In an effort to explore this question in a practical way, we integrated food systems concepts into a mandatory course of a public health graduate dietetics program. This field report shares our experiences teaching food systems over five years based on our notes kept, student feedback, and course evaluations. Our learnings have been in three key areas: intentions, facilitation, and tensions. We recognized that teaching about food systems is value-laden. Hence we have been explicit with the students about our positionality and our intentions in designing the course, partly to meet the management of food systems competency requirements, but also to stimulate thinking about alternative options for purpose, structures, and processes in food systems. Our facilitation approaches aimed to foster a critical consciousness towards social justice and systems change. Using teaching and evaluation methods such as experiential learning, community projects, and reflection assignments, students have encountered the complexity of food systems and the challenges-opportunities they pose. As educators, we have grappled with the tensions of challenging dominant positivist discourses in public health nutrition. Politicized topics such as migrant farm-worker regimes, industrial food production, regulation of food marketing, and mitigation of the impact of colonization have generated debates in the classroom about the role and scope of dietetic practice. Most students have situated themselves more explicitly within a food system, and some began to question hidden structures of power. While it remains challenging to address this breadth within the constraints of one course, we believe it worthwhile to model and stimulate critical reflexivity with the next generation of dietitians as critical food learners-teachers themselves. Even though the course is no longer offered using this food systems approach, course components can be integrated throughout the dietetic curriculum.

BackgroundUnhealthy eating behaviors are risk factors for non-communicable diseases. Parents largely influence the development of eating behaviors during childhood through their feeding practices. Parental feeding practices in line with recommendations are more likely to turn into healthier outcomes in children. From a public health perspective, it should be first ascertained whether providing parents with recommendations about child feeding is a useful approach for increase parental knowledge. Recently, the French health authorities developed a brochure covering updated child feeding recommendations. The present study aims to evaluate the short-term effects of reading this brochure on parental knowledge about child feeding, distinguishing knowledge accuracy and certainty.MethodsA brochure containing updated child feeding recommendations for 0–3 years old was developed by the French public health agency. A representative sample of French parents (n = 400) was targeted to complete an online questionnaire (T0) comprising 30 statements regarding child feeding. For each statement, parents indicated whether it was true/false and how certain they were of their answer (4-point scale). After receiving and reading the brochure, the same parents completed the same questionnaire 3 weeks later (T1). Accuracy (number of correct answers) and certainty (number of mastered answers: correct answers given with the maximal degree of certainty) were compared at T1 vs. T0 using paired t-tests. Knowledge evolution based on parental age, parity and education level was tested with linear models.ResultsA total of 452 parents responded at T0 and T1 and were considered for analysis. Between T0 and T1, the number of correct answers [median 22–25, t(451) = 17.2, p ≤ 0.001] and mastered answers [median 11–17, t(451) = 18.8, p ≤ 0.001] significantly increased. The median of the difference between T1 and T0 was larger for mastered than for correct answers. The observed evolution in knowledge was independent of parental age, parity or education level.ConclusionsA brochure containing child feeding recommendations has the potential to increase the accuracy and, to an even greater degree, the certainty of parental knowledge. This increase was observed even for younger or less educated parents.

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. [ABSTRACT FROM AUTHOR]

Background: School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online.Objective: This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students' lunch orders 18 months after baseline.Methods: This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up.Results: In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (-74.1 kJ; 95% CI [-124.7, -23.4]; P=.006) and saturated fat (-0.4 g; 95% CI [-0.7, -0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a -2.6% change). There was no between-group difference over time in canteen revenue.Conclusions: This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. [ABSTRACT FROM AUTHOR]

Home cooking is an important obesity prevention strategy and associated with benefits for diet and health. Although cooking may be a joyful act of mindfulness, it also requires planning, preparation and time. Historically, women have been more likely to fulfill the role of food shopping and cooking. More recent studies suggested a transition in traditional household role assignments towards a larger involvement of males. This study examined the current sex distribution of cooking and food shopping responsibilities in the United States of America based on a nationally representative sample of 9078 citizens from the National Health and Nutrition Examination Surveys (2017–2020). More than 80% of women aged 25 years or older indicated that they were the person who did most of the planning/preparing of meals in their families, whereas the percentage of males responding affirmatively was substantially lower, ranging from 38.73% to 43.20% depending on age. Analyses on food shopping duties revealed a comparable distribution. In multivariate regression, female sex was associated with significantly higher odds of being the main food shopper/meal preparer in the family (OR: 4.82 (4.14–5.60) and 5.54 (4.60–6.67), respectively). Our data suggest that the majority of food shopping and cooking duties are still performed by women, which has important implications for public health nutrition initiatives.

Methodology: An exploratory methodology was adopted to examine experiences relating to capability and capacity among formal and informal helpers within the PHN domain. An online survey, mainly open-ended questions, was used to capture experiences over the period 2010 - 2020. A mixed sampling strategy, including snowball and convenience sampling, via social media and social network contact-sharing approaches, was adopted. Data was analysed using an inductive thematic approach. Results: A total of 89 participants representing the PHN system in England were recruited over two months. Three main themes and eight sub-themes were identified. The first reflected unequivocal accounts of the impact of austerity and the inability of PHN services to meet demand for food security. The second articulated capacity and capability issues within the system, with geographical variations in service delivery, and a lack of connectivity between central, local government, and third sector providers. These were attributed to widening nutrition and health inequalities. Participants felt that the government needed to invest more technical and financial resources to support public health nutrition. They also felt that schools could play a larger role at local level, but there was a need for a clear national recovery plan, setting out a comprehensive and fully supported national strategy to eradicate food insecurity in England Conclusions: Further in-depth research is needed to continue to track the impact of recovery strategies on food insecure people and the capacity of the PHN system. Urgent investment in the capacity and coordination of PHN services is needed to support food insecure people in England. The UK could include the ratification of the right to food in national laws, in line with global commitments already agreed to by the UK State Party.

Background: In 2019, Canada's Food Guide underwent its first transformation in over a decade. The change received considerable attention given the increased focus on plant‐based proteins and the decision to eliminate the milk and alternatives food group. Yet little is known about health professionals' views of these updates. In response, the present study examined Canadian dietitians' attitudes and behaviours towards the guide's expanded plant‐based recommendations. Methods: A pan‐Canadian cross‐sectional online survey was administered from January to March 2020 to currently practicing registered dietitians. The study was pre‐registered, piloted and received ethical approval. Descriptive and inferential statistics were performed and open‐text responses underwent thematic analysis. Results: In total, 411 dietitians from 10 provinces and various work settings participated. Most dietitians (82.8%) consider the food guide's recommendation to choose protein foods that come from plants more often is evidence‐based. Compared to its predecessor, dietitians encourage their patients/clients to choose protein foods that come from plants (p < 0.001) and non‐dairy sources of calcium (p < 0.001) significantly more frequently under the new guide. A slight majority of dietitians (57.7%) agree with the decision to omit the standalone milk and alternatives group in favour of bringing dairy into the protein category. Conclusions: Canadian dietitians generally look favourably upon the new plant‐based recommendations and have adjusted their nutrition counselling in response. The findings are considered to be the first to characterise how dietitians view changes to the plant‐based content of one of the most recognisable diet‐related educational tools in Canada. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Attitudes and knowledge regarding the food environment and purchasing behaviour are drivers or hindrances toward a healthier lifestyle. A questionnaire-based study on consumers' knowledge about food and health and main drivers for food purchasing was applied to a group of Romanians and results were compared with those from a similar study carried about 10 years ago. Respondents seem to be more aware of some environmental and ecological problems (deforestation, global warming, etc), about the importance of bioproducts consumption, and regarding the link between food products and health. Still, the nutritional part of the food label is underused. The main reasons for selecting food are the same as in 2011, but with the greater interest paid to food related health aspects and taste. The perceived trust in food safety remains low. The consumers' amount of knowledge regarding food increased, food being perceived more as a useful adjuvant for health maintenance and an energy booster. Ten years after, some positive changes have been noticed in a group of Romanian citizens. Efforts have to continue in order to put a greater accent on the link between health, food, and purchasing behaviour. Education policies at local and European level have to guide consumers' choices so that the impact of food consumption becomes a sanogenic and sustainable one, both on people, and the environment. [ABSTRACT FROM AUTHOR]

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

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.

Purpose: There is conflicting advice about the inclusion of dairy foods in a lower greenhouse gas (GHG) emission dietary pattern. Our purpose was to assess the prevalence of dairy food intake among higher diet quality and lower GHG emission diets in Australia and within these diets assess the association between level of dairy food intake and adequate intake of a broad range of nutrients. Methods: Dietary intake data collected using a 24-h recall process were sourced from the most recent Australian Health Survey. Diet quality was assessed by level of compliance with the food group-based Australian Dietary Guidelines. A subgroup of 1732 adult (19 years and above) daily diets was identified having higher diet quality score and lower GHG emissions (HQLE). Intake of core dairy foods (milk, cheese, yoghurt) was assessed and nutrient profiling was undertaken for 42 macro- and micronutrients. Results: The HQLE subgroup had 37% higher diet quality score and 43% lower GHG emissions than the average Australian adult diet (P < 0.05). Intake of dairy foods was very common (90% of HQLE diets) and greatly exceeded the intake of non-dairy alternatives (1.53 serves compared to 0.04 serves). HQLE daily diets in the highest tertile of dairy food intake were more likely to achieve the recommended intake of a wide range of nutrients, including calcium, protein, riboflavin, vitamin B12, folate, phosphorous, magnesium, iodine and potassium compared to other HQLE daily diets. Conclusion: Core dairy foods have an important role for achieving adequate nutrient intakes in a healthy and lower GHG emission dietary pattern in Australia. [ABSTRACT FROM AUTHOR]

Background: Protein-rich foods are major parts of the human diet and are highly heterogeneous in nutrient composition and health effects. Designing healthy diets for disease prevention requires careful consideration of substituting unhealthier protein foods with healthier protein foods.Methods: This was a pooled analysis of six prospective cohort studies of 29 682 US participants. Data were collected in 1985-2016. Adjusted hazard ratios (HRs) and 30-year absolute risk differences (ARDs) were calculated for the associations between simultaneous substitution of one or more animal protein foods with other animal or plant protein foods at various amounts, and incident cardiovascular disease (CVD) and all-cause mortality.Results: Substituting eggs, processed meat, unprocessed red meat or poultry with nuts, whole grains, legumes or fish was associated with lower risks of incident CVD and all-cause mortality. According to different substitution amounts (varying from one serving per week to one serving per day) and different numbers of protein foods being simultaneously substituted (varying from one to four), estimates ranged between 1%: HR, 0.99 [95% confidence interval (CI), 0.98-1.00], and 54%: HR, 0.46 (0.35-0.60), lower risks on the relative scale and between 0.3%: ARD, -0.29% (-0.48% to -0.05%), and 14.0%: ARD, -13.96% (-17.29% to -9.96%) lower risks on the absolute scale.Conclusions: Nuts, whole grains, legumes and fish appeared to be healthier protein sources than eggs, processed meat, unprocessed red meat and poultry for preventing incident CVD and premature death. The magnitude of lower risk for incident CVD and all-cause mortality was driven by amount and number of animal protein foods substituted. [ABSTRACT FROM AUTHOR]

Introduction: The factors that determine the behavior and feeding practices are multiple and complex. Within the National School Feeding Program (PNAE), the approach to this topic should be carried out in a multidisciplinary and intersectoral manner, with food and nutrition education (EAN) as the strategy. The nutritionist is inserted in this context as the technical responsible, or technical framework of the program, thus being an important component among the actors responsible for the development of EAN actions in the school environment. Objective: To know the perception of the nutritionist acting in the PNAE regarding the activities of food and nutrition education, the impact of training in practices and identify the facilities and barriers existing in this context. Methods: We conducted qualitative research with interviews and recording of the speeches for later analysis of content. We analyzed the confrontation of ideas by convergences, divergences and complementarities. Results and Conclusion: It was noted that, despite the recent strengthening of the EAN, there is still a gap between what is proposed by legislation and the practice undertaken by professionals. The main deficiencies described by them were the absence of a consistent theoretical-methodological basis guiding the practices of EAN, insufficient technical framework and difficulty in integrating the different areas, which generates discontinuity in the learning process and inefficiency of actions. Strategies such as periodic courses, training to better plan and involve teams, as well as improvement of working conditions and quantitative of professionals in all dimensions of the PNAE, are indispensable for the full implementation of the program. [ABSTRACT FROM AUTHOR]

Nutrition policymakers frequently treat their knowledge of nutrition as acultural and universal. We analyze food guidelines in Mexico and Guatemala to draw attention to embedded, but often unrecognized, cultural values of standardization and individual responsibility. We suggest that nutrition policy would be improved by attending to the cultural values within nutrition science, and that nutrition guidelines should attend not only to other people's cultures but to what we are calling "cultures of nutrition." We conclude by offering an example of an adaptive approach to policy-making that may be useful for handling situations where many different cultures of nutrition collide. [ABSTRACT FROM AUTHOR]

Introduction: Sleep and diet are crucial determinants of overall health and wellbeing, with the potential to mutually influence each other. This study examined the association between sleep duration and fruits and vegetables (FV) consumption among Finnish adults., Methods: The study analyzed data from the National FinHealth 2017 Study involving 5,043 adults aged 18 years and above. Participants reported their habitual sleep duration, and dietary consumption through a validated self-administered questionnaire. Confounders such as demographic, socio-economic factors, and chronotype were considered. A sensitivity analysis, which excluded energy under-reporters, was conducted to validate the findings., Results: Mean dietary consumption was compared across three sleep duration categories (short, normal, long), revealing that short sleepers consumed 37 g/d fewer FV, and long sleepers consumed 73 g/d fewer FV than normal sleepers. Binary logistic regression analyses consistently demonstrated significant negative association between FV consumption and both short and long sleep duration across all models, even when adjusted for a range of covariates. Linear regression analyses revealed a positive but non-significant association between sleep duration and FV consumption that became significant when excluding energy under-reporters, particularly in model 1., Discussion: This study suggests a consistent pattern where deviation from normal sleep duration was associated with decreased FV consumption, suggesting the need for considering sleep patterns in dietary intervention. The substantial role of accurate energy reporting in explaining these associations is highlighted. Further research, including longitudinal studies, is needed to better understand the mechanisms underlying these associations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Thapa, Lahti, Maukonen and Partonen.)

Introduction: An important impediment to the large-scale adoption of evidence-based school nutrition interventions is the lack of evidence on effective strategies to implement them. This paper describes the protocol for a "Collaborative Network Trial" to support the simultaneous testing of different strategies undertaken by New South Wales Local Health Districts to facilitate the adoption of an effective school-based healthy lunchbox program ('SWAP IT'). The primary objective of this study is to assess the effectiveness of different implementation strategies to increase school adoption of the SWAP across New South Wales Local Health Districts., Methods: Within a Master Protocol framework, a collaborative network trial will be undertaken. Independent randomized controlled trials to test implementation strategies to increase school adoption of SWAP IT within primary schools in 10 different New South Wales Local Health Districts will occur. Schools will be randomly allocated to either the intervention or control condition. Schools allocated to the intervention group will receive a combination of implementation strategies. Across the 10 participating Local Health Districts, six broad strategies were developed and combinations of these strategies will be executed over a 6 month period. In six districts an active comparison group (containing one or more implementation strategies) was selected. The primary outcome of the trial will be adoption of SWAP IT, assessed via electronic registration records captured automatically following online school registration to the program. The primary outcome will be assessed using logistic regression analyses for each trial. Individual participant data component network meta-analysis, under a Bayesian framework, will be used to explore strategy-covariate interactions; to model additive main effects (separate effects for each component of an implementation strategy); two way interactions (synergistic/antagonistic effects of components), and full interactions., Discussion: The study will provide rigorous evidence of the effects of a variety of implementation strategies, employed in different contexts, on the adoption of a school-based healthy lunchbox program at scale. Importantly, it will also provide evidence as to whether health service-centered, collaborative research models can rapidly generate new knowledge and yield health service improvements., Clinical Trial Registration: This trial is registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12623000558628)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Barnes, Jones, Wolfenden, Robertson, Seidler, Norman, Budgen, Mattingly, Piliskic, Moorhouse, Mozina, Plaskett, McDermott, Darney, Vuong, Douglass, McDonnell and Sutherland.)