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The COVID-19 lockdowns saw many individuals lose income, experience distress and increase intake of foods that would typically be considered less 'healthy' (more processed and less fresh produce). Establishing whether there are direct and indirect links between these variables would be of benefit in preparing for similar future events but also has implications for the current global financial climate, where many are experiencing relative decreases in income. Adults in two locations (UK and Australia) (N = 917) completed online questionnaires to explore the impact of the first COVID-19 lockdown on their change in income, emotional wellbeing (depression, anxiety, stress, loneliness), resilience and diet quality. A structural equation model revealed that income loss was indirectly associated with diet quality via distress. As such, the greater the loss of income experienced, the more distress reported; distress was then directly associated with a less nutritious diet. This pattern of results existed when data from both countries were combined but also when they were modelled individually. Our findings indicate that where individuals experience a sudden reduction of income there are likely to be negative consequences for both mental and physical health. It is plausible that these findings would extend to other circumstances in which sudden loss of income may be experienced such as reductions in state social care, rising inflation and interest rates and sudden increases to the general cost of living., Competing Interests: Declaration of competing interest AS has received research funding, honoraria, conference support and consultancy from the nutrition industry. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The objective of this study was to evaluate the economic and financial viability of finishing of two sexes of Brazilian Somalis sheep in feedlot receiving diets with 0 and 15% reduction in the total digestible nutrients and crude protein contents. A completely randomized design was adopted, in a 2 × 2 factorial arrangement, with treatments consisting of two sexes (non-castrated males (21.13 ± 5.00 kg) and females (17.99 ± 3.79 kg) and two diets (0 and 15% reduction in the levels of total digestible nutrients and crude protein). Four simulations of productive scenarios were carried out: non-castrated males receiving the diet with 0% reduction; non-castrated males receiving the diet with 15% reduction; females receiving the diet with 0% reduction and females receiving the diet with 0% reduction, for a period of 70 days in feedlot. The highest costs of the system were with feeding and other costs, mainly the acquisition of animals. For both sexes, the 0% reduction diet showed the highest total cost, total revenue, break-even point. Non-castrated males fed a non-reduced diet and females fed a 15% reduction diet had higher net income, rate of return, total productivity, net present value, internal rate of return, profitability index and profitability rate. Less favorable situations were not profitable for any scenario. However, the increase in sales price favorability makes the activity viable. The reduction of total digestible nutrients and crude protein affects the economic and financial viability of Brazilian Somalis sheep. For non-castrated males it is recommended the diet without reduction and for females the diet with 15% reduction of nutrients., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The 2023 Mexican Healthy and Sustainable Dietary Guidelines (HSDG 2023) were developed to include all dimensions of sustainability. Here we compare the environmental impact and cost of diets based on the HSDG 2023, current diets and the Mexican-adapted EAT healthy reference diet. Diets following HSDG 2023 are 21% less expensive, require 30% less land to be produced and have 34% less carbon emissions than current diets-particularly in Mexico City and other urban areas with higher prevalence of Westernized diets. This is driven by reduced animal-source food, especially red meat, and ultra-processed foods. In south-rural areas, the water footprint and cost of diets following HSDG 2023 were higher than those of current diets owing to increased intake of nuts, fruits and vegetables not offset by lower meat consumption (which is already close to recommendations). Diet environmental impact and cost could be further reduced with the Mexican-adapted EAT healthy reference diet compared with the HSDG 2023., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: This study aimed to estimate the health, economic, and environmental impacts of moderate simulated interventions on dietary intake in Brazil., Methods: Data on food price and consumption were obtained from three nationwide surveys. Baseline dietary intake was estimated for 33,859 individuals aged 25 years and older. Counterfactual intakes were based on six hypothetical intervention scenarios, by changing the weekly frequency and serving size in low or high consumers of fruit and vegetables (FV), milk, whole grains, red and processed meats, and sugar-sweetened beverages. For each scenario, we estimated the attributable number of deaths and disability-adjusted life years (DALY), monetary cost, environmental impacts (14 midpoint indicators), and environmentally-mediated health impacts., Results: Compared with the baseline intake and cost, the most expensive intervention (+ 8.3%) was to increase FV intake (+ 125 g), resulting in a 1.2% reduction in all-cause mortality (16,307 deaths/year). The cheapest (- 9.9%) was to reduce red and processed meat intake (- 40 g), resulting in a 1.1% reduction in all-cause mortality (14,272 deaths/year). The combined intervention was, on average, 3.7% cheaper than the baseline cost, resulting in an increase in diet cost for 30% of the population (45-22% in the lower- and higher-income groups); all-cause mortality would be reduced by 3.8% (49,488 deaths/year). Interventions targeting red and processed meats would reduce emissions and resource use by 35-55%, in addition to reducing 2300 DALYs/year., Conclusion: A meaningful number of deaths can be avoided and environmental impacts reduced through moderate and potentially affordable diet modifications., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.

Background: While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets., Methods: Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios., Results: We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect., Conclusions: The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns., (© 2024. The Author(s).)

Globalization, income growth and changing cultural trends are believed to prompt consumers in low-income countries to adopt the more affluent diet of high-income countries. This study investigates the convergence of food expenditure patterns worldwide, focusing on total food expenditure, raw food categories and ultra-processed foods and beverages across more than 90 countries over the past decades. Contrary to prior belief, we find that food expenditure patterns of lower-income countries do not universally align with those of higher-income nations. This trend is evident across most raw food categories and ultra-processed foods and beverages, as the income level of a country continues to play a crucial role in determining its food expenditure patterns. Importantly, expenditure patterns offer estimates rather than a precise idea of dietary intake, reflecting consumer choices shaped by economic constraints rather than exact dietary consumption., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: The objective of this study was to assess purchasing, intake, and weight after discounting fruits and vegetables (F&V) and noncaloric beverages in New York City supermarkets., Methods: A 16-week randomized controlled trial was conducted with a 4-week baseline, an 8-week intervention with 50% discounts on F&V and noncaloric beverages, and a 4-week follow-up. Purchasing was tracked via loyalty cards, and intake was tracked via 24-h dietary recalls. Weights were measured at five in-person visits., Results: Data from 67 participants were analyzed (38 in the experimental group; 29 in the control group). F&V and noncaloric beverage weekly purchasing was greater in the experimental than the control group (mean difference [SD], $4.64 [$1.44], p < 0.0001; $0.53 [$0.39], p = 0.008) during intervention, with F&V purchasing remaining greater in the experimental versus control group during follow-up (p = 0.005). F&V intake was greater for the experimental than the control group during intervention (142 [105] g/day; p = 0.009) and follow-up (p = 0.001). Although no difference in noncaloric beverage consumption was observed between groups, there was lower alcohol intake in the experimental than the control group during follow-up (-85.8 [60.2] g/day; p = 0.004). The experimental group lost weight compared with the control group (-1.33 [0.92] kg; p = 0.006 intervention and p = 0.106 follow-up). No differences in nutrient composition or high energy-dense product consumption were found., Conclusions: A 50% discount on F&V and noncaloric beverages promoted increased purchasing and intake of F&V and induced weight loss., (© 2024 The Obesity Society.)

Despite sustained nutrition education, consumption of animal source foods (ASFs) has been hindered by their low availability, accessibility and affordability. Drying eggs into powder can reduce transport/storage costs, increase shelf-life and allow easier dosage for use of smaller portions. This study aimed to evaluate the contribution of integrating egg powder to the nutrient adequacy and affordability of diets. Using the 'cost of the diet' analysis, we simulated the incorporation of egg powder into households' and children's diet and evaluated its contribution to the nutrient adequacy and affordability of diets. Analysis of the household consumption and expenditure survey (HCES 2016) revealed that only 0.2% of the total consumption expenditure was allocated for eggs, far below the 2.2% and 4.3% required to allow the consumption of one egg a day by the average and the poorest households, respectively. However, the minimum-cost nutritious diet required only 2.5 g of egg powder/person/day to reduce the cost of the optimized diet by 14% (0-24%), allowing an additional 1.2 million households (~4-6 million individuals) afford the optimized diet. The optimized diet for a child 6-23 months of age could be afforded by all households, except by those in the poorest wealth quintile. But, free distribution of egg powder to households in the poorest wealth quintile, if supplemented by effective nutrition education, can allow them to afford the minimum-cost nutritious diet for their 6- to 23-month child. The simple dehydration of egg into egg powder can have a substantial contribution towards increased egg consumption by increasing the affordability of the minimum-cost nutritious diet., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Introduction: The lack of access to a diverse and nutritious diet has significant health consequences worldwide. Governments have employed various policy mechanisms to ensure access, but their success varies., Method: In this study, the impact of changes in food assistance policy on food prices and nutrient security in different provinces of Iran, a sanctioned country, was investigated using statistical and econometric models., Results: Both the old and new policies were broad in scope, providing subsidized food or cash payments to the entire population. However, the implementation of these policies led to an increase in the market price of food items, resulting in a decline in the intake of essential nutrients. Particularly, the policy that shifted food assistance from commodity subsidies to direct cash payments reduced the price sensitivity of consumers. Consequently, the intake of key nutrients such as Vitamin C and Vitamin A, which are often constrained by their high prices, decreased. To improve the diets of marginalized populations, it is more effective to target subsidies towards specific nutrient groups and disadvantaged populations, with a particular focus on food groups that provide essential nutrients like Vitamin A and Vitamin C in rural areas of Iran., Discussion: More targeted food assistance policies, tailored to the specific context of each province and income level, are more likely to yield positive nutritional outcomes with minimal impact on food prices., Competing Interests: The author declares 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 Pakravan-Charvadeh.)

Objective: Improved food availability and a growing economy in Tanzania may insufficiently decrease pre-existing nutritional deficiencies and simultaneously increase overweight within the same individual, household or population, causing a double burden of malnutrition (DBM). We investigated economic inequalities in DBM at the household level, expressed as a stunted child with a mother with overweight/obesity, and the moderating role of dietary diversity in these inequalities., Design: We used cross-sectional data from the 2015-2016 Tanzania Demographic and Health Survey., Setting: A nationally representative survey., Participants: Totally, 2867 children (aged 6-23 months) and their mothers (aged 15-49 years). The mother-child pairs were categorised into two groups based on dietary diversity score: achieving and not achieving minimum dietary diversity., Results: The prevalence of DBM was 5·6 % (sd = 0·6) and significantly varied by region (ranging from 0·6 % to 12·2 %). Significant interaction was observed between dietary diversity and household wealth index ( P for interaction < 0·001). The prevalence of DBM monotonically increased with greater household wealth among mother-child pairs who did not achieve minimum dietary diversity ( P for trend < 0·001; however, this association was attenuated in those who achieved minimum dietary diversity ( P for trend = 0·16), particularly for the richest households ( P = 0·44). Analysing household wealth index score as a continuous variable yielded similar results (OR (95 % CI): 2·10 (1·36, 3·25) for non-achievers of minimum dietary diversity, 1·38 (0·76, 2·54) for achievers)., Conclusions: Greater household wealth was associated with higher odds of DBM in Tanzania; however, the negative impact of household economic status on DBM was mitigated by minimum dietary diversity.

Objective: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality., Design: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach., Setting: Mexico, 2018., Participants: A nationally representative sample of 74 647 Mexican households., Results: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water . In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers , sugar and honey , oil and fat and less on food away from home., Conclusions: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Background: This study investigates the impact of low food diversity on the health status of children using the Dietary Diversity Score (DDS) and Dietary Serving Score (DSS) in a sub-district with the highest percentage of poor households. The economic burden of low food diversity was observed by analysing the cost of illness in the children with low food diversity., Methods: Data from 329 children were collected. We determined the impact of DDS and DSS and other factors on the health status of children aged 2-14 years, using a probit model. The cost of illness (e.g., typhus, stomach ulcers, coughs, flu, and fever) due to low food diversity was calculated from medical registration fees, medical action costs, transportation costs, and other costs., Results: The results shows that a 1% point increase in DDS or DSS potentially decreases children's health complaints by 10% and 8%, respectively. Given the current 26% prevalence of health complaints among children with low DDS, the annual economic burden reaches US$75.72 per child per household. In addition, the current 41% prevalence of children with low DDS resulted in an annual cost to the government of US$153.45 per child., Conclusions: The effect of inadequate dietary diversity on children's health is potentially high and contributes to the economic burden on households and the government., (© 2024. The Author(s).)

Objectives: Telehealth is a promising tool for delivering lifestyle interventions for the management of health conditions. However, limited evidence exists regarding the cost-effectiveness of these interventions. This systematic review aimed to evaluate the current literature reporting on the cost-effectiveness of telehealth-delivered diet and/or exercise interventions., Methods: Four electronic databases (PubMed, CENTRAL, CINAHL and Embase) were searched for published literature from database inception to November 2020. This review adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the ISPOR Criteria for Cost-Effectiveness Review Outcomes Checklist. The quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to telehealth modality, organised into tables and reported narratively., Results: Twenty-four studies of controlled trials (11 combined diet and exercise, 9 exercise-only and 4 diet-only telehealth-delivered interventions) were included for data extraction and quality assessment. Interventions were reported as cost-effective in 12 studies (50%), five studies (21%) reported inconclusive results, and seven studies (29%) reported that the interventions were not cost-effective. Telephone interventions were applied in eight studies (33%), seven studies (29%) used internet interventions, six studies (25%) used a combination of internet and telephone interventions, and three studies (13%) evaluated mHealth interventions. Quality of study reporting varied with between 54% and 92% of Consolidated Health Economic Evaluation Reporting Standards items reported., Conclusions: This review suggests that telehealth-delivered lifestyle interventions can be cost-effective compared to traditional care. There is a need for further investigations that employ rigorous methodology and economic reporting, including appropriate decision analytical models and longer timeframes., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objective: To determine whether the Chinese heart-healthy diet (Sichuan cuisine version) (CHH diet-SC) was more expensive than the conventional Sichuan diet and explore the food groups and nutrients that mainly affected the cost of CHH diet-SC., Design: Cost analysis of 4-week intervention diets in the Sichuan center representing southwestern China in the CHH diet study., Setting: A multicentre, parallel-group, single-blind, randomised feeding trial evaluating the efficacy of lowering blood pressure with the cuisine-based CHH diet., Participants: Totally, fifty-three participants with hypertension aged 25-75 years in the Sichuan center were randomised into the control group ( n 26) or the CHH diet-SC group ( n 27)., Results: The CHH diet-SC was more expensive than the control diet (¥27·87 ± 2·41 v . ¥25·18 ± 2·79 equals $3·90 ± 0·34 v . $3·52 ± 0·39, P < 0·001), and the incremental cost-effectiveness ratio for a 1-mm Hg systolic blood pressure reduction was ¥9·12 ($1·28). Intakes and the cost of seafood, dairy products, fruits, soybeans and nuts, whole grains and mixed beans were higher for the CHH diet-SC than for the control diet ( P < 0·001). Intakes of vitamin B 1 , vitamin B 6 , vitamin C, Mg and phosphorus were positively correlated with the cost ( P < 0·05)., Conclusions: The CHH diet-SC costs more than the conventional Sichuan diet, partly due to the high cost of specific food groups. Positive correlations between the intakes of vitamin B 1 , vitamin B 6 , vitamin C, Mg, phosphorus and the dietary cost could be a direction to adjust the composition within the food groups to reduce the cost of the CHH diet-SC.

Objective: This study aims at comparing two Italian case studies in relation to schoolchildren's plate waste and its implications, in terms of nutritional loss, economic cost and carbon footprint., Design: Plate waste was collected through an aggregate selective weighting method for 39 d., Setting: Children from the first to the fifth grade from four primary schools, two in each case study (Parma and Lucca), were involved., Results: With respect to the served food, in Parma, the plate waste percentage was lower than in Lucca ( P < 0·001). Fruit and side dishes were highly wasted, mostly in Lucca (>50 %). The energy loss of the lunch meals accounted for 26 % (Parma) and 36 % (Lucca). Among nutrients, dietary fibre, folate and vitamin C, Ca and K were lost at most (26-45 %). Overall, after adjusting for plate waste data, most of the lunch menus fell below the national recommendations for energy (50 %, Parma; 79 %, Lucca) and nutrients, particularly for fat (85 %, Parma; 89 %, Lucca). Plate waste was responsible for 19 % (Parma) and 28 % (Lucca) of the carbon footprint associated with the food supplied by the catering service, with starchy food being the most important contributor (52 %, Parma; 47 %, Lucca). Overall, the average cost of plate waste was 1·8 €/kg (Parma) and 2·7 €/kg (Lucca), accounting respectively for 4 % and 10 % of the meal full price., Conclusion: A re-planning of the school meals service organisation and priorities is needed to decrease the inefficiency of the current system and reduce food waste and its negative consequences.

Objective: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya., Design: Cross-sectional., Participants: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi., Variables Measured: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer., Analysis: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression., Results: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05)., Conclusions and Implications: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Classical homocystinuria (HCU) is an inborn defect of methionine metabolism caused by a deficiency of the enzyme cystathionine β-synthase (CBS). The main symptoms of classical homocystinuria are lens subluxation, bone lesions, vascular disease and developmental delay/intellectual disability. The treatment method for HCU is a methionine-poor diet supplemented with amino acid preparations. The aim of the study was to examine the relationship of dietary factors, metabolic compensation and selected skeletal parameters in patients with HCU., Methods: Bone mineral density measurements (DXA) were performed in pediatric patients with HCU, and blood levels of selected amino acids, minerals and vitamins, as well as dietary nutritional value, were analyzed., Results: A total of 11 patients with HCU whose median age was 9.3 years were enrolled in the study. The median DXA total body less head of HCU patients was -0.4 z-score, and the lumbar spine was -1.4 z-score. Despite supplementation, calcium intake was below the age norm. Average vitamin D3 intake was in line with recommendations, but 36% of patients had reduced blood levels. Bone mineral density depended on blood levels of 25-hydroxyvitamin D, homocysteine and methionine, as well as on BMI, age and intake of natural protein (R 2 = 98.5%, p = 0.015; R 2 = 86.7%, p = 0.0049) and protein from an amino acid preparation (r = 0.69, p = 0.026)., Conclusion: The results of the study indicate the need for regular densitometry in patients with HCU and also the use of additional calcium and vitamin D3 supplementation. It is also necessary to perform a comprehensive analysis of the diet and metabolic controls.

This study aimed to identify dietary trends in Aotearoa New Zealand (NZ) and whether inequities in dietary patterns are changing. We extracted data from the Household Economic Survey (HES), which was designed to provide information on impacts of policy-making in NZ, and performed descriptive analyses on food expenditures. Overall, total household food expenditure per capita increased by 0.38% annually over this period. Low-income households spent around three quarters of what high-income households spent on food per capita. High-income households experienced a greater increase in expenditure on nuts and seeds and a greater reduction in expenditure on processed meat. There was increased expenditure over time on fruit and vegetables nuts and seeds, and healthy foods in Māori (Indigenous) households with little variations in non-Māori households. But there was little change in processed meat expenditure for Māori households and expenditure on less healthy foods also increased over time. Routinely collected HES data were useful and cost-effective for understanding trends in food expenditure patterns to inform public health interventions, in the absence of nutrition survey data. Potentially positive expenditure trends for Māori were identified, however, food expenditure inequities in processed meat and less healthy foods by ethnicity and income continue to be substantial., (© 2022. The Author(s).)

The primary aim of this study was to evaluate factors associated with changes in food-preparation practices during the Coronavirus Disease 2019 (COVID-19) pandemic in Japan and its associations to food-group intake. To examine this, a cross-sectional online survey was conducted in July 2020. Participants were 2285 adults aged 20-69 years who resided in any of 13 prefectures in Japan where specific COVID-19 regulations had been implemented. Self-reported changes in food-preparation practices when compared to the pre-COVID-19 pandemic period were measured as "increased" (24.6%), "decreased" (7.3%), and "no change" (68.1%), respectively. Stepwise logistic regression analyses indicated that participants who increased the time and effort for food preparation were younger in age, partially working remotely, experiencing reduced household income due to COVID-19, but highly concerned the importance of diet. On the other hand, participants whose household income decreased, and household economic status worsened, as well as those whose importance of diet deteriorated due to COVID-19 were more likely to decrease time and effort for cooking. Although the increased group were more likely to prepare meals with raw ingredients, the decreased group showed higher frequency of using takeout. These results indicated major determinants of changes in time spending on food preparation in consequence of COVID-19, and highlighted essential targets for future nutrition education.

Objectives: During the Middle Ages, Portugal witnessed unprecedented socioeconomic and religious changes under transitioning religious political rule. The implications of changing ruling powers for urban food systems and individual diets in medieval Portugal is poorly understood. This study aimed to elucidate the dietary impact of the Islamic and Christian conquests., Materials and Methods: Radiocarbon dating, peptide mass fingerprinting (ZooMS) and stable isotope analysis (δ 13 C, δ 15 N) of animal (n = 59) and human skeletal remains (n = 205) from Muslim and Christian burials were used to characterize the diet of a large historical sample from Portugal. A Bayesian stable isotope mixing model (BSIMM) was used to estimate the contribution of marine protein to human diet., Results: Early medieval (8-12th century), preconquest urban Muslim populations had mean (±1SD) values of -18.8 ± 0.4 ‰ for δ 13 C 10.4 ± 1 ‰ for δ 15 N, indicating a predominantly terrestrial diet, while late medieval (12-14th century) postconquest Muslim and Christian populations showed a greater reliance on marine resources with mean (±1SD) values of -17.9 ± 1.3‰ for δ 13 C and 11.1 ± 1.1‰ for δ 15 N. BSIMM estimation supported a significant increase in the contribution of marine resources to human diet., Discussion: The results provide the first biomolecular evidence for a dietary revolution that is not evidenced in contemporaneous historical accounts. We find that society transitioned from a largely agro-pastoral economy under Islamic rule to one characterized by a new focus on marine resources under later Christian rule. This economic change led to the naissance of the marine economy that went on to characterize the early-modern period in Portugal and its global expansion., (© 2021 The Authors. American Journal of Physical Anthropology published by Wiley Periodicals LLC.)

Background: Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias., Methods and Findings: This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data)., Conclusions: Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings., Trial Registration: ISRCTN registry ISRCTN87225572., Competing Interests: The authors have declared that no competing interests exist.

Higher consumption of 'ultra-processed' (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016-2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

Objectives　This study aims to develop a dietary consciousness scale and examine its reliability and validity, as well as investigate the changes in psychological aspects that influence diet among Japanese adults during the COVID-19 pandemic and clarify its related factors.Methods　An online survey was conducted from July 1, 2020 to July 3, 2020. Participants were adults aged between 20 and 69 years selected from 13 prefectures where the government declared the state of emergency from April to May 2020. All selected participants were shopping or cooking foods for more than 2 days a week at the time of the survey. A total of 2,299 participants were included in the analysis. Dietary consciousness was measured using 12 items, and the construct was examined using factor analysis. Cronbach's alpha was examined as an indicator of internal validity, and the criterion-referenced validity was confirmed using the Kruskal-Wallis test. To determine changes in dietary consciousness, we calculated total scores based on changes in each item of the Dietary Consciousness Scale as follows: no change (0 points), improved (+1 point), and worsening (-1 point). The associations between the changes in dietary consciousness and characteristics or socioeconomic factors of the participants were examined using the chi-squared test and residual analysis.Results　Exploratory and confirmatory factor analyses demonstrated that a model consisting of two factors fitted the data (GFI = 0.958, AGFI = 0.938, CFI = 0.931, RMSEA = 0.066). Cronbach's alpha of the first factor (importance of diet) was 0.838 and 0.734 for the second factor (precedence of diet), and the reliability was confirmed at 0.828 for the entire scale. In the examination of criterion-related validity, the higher the stage of change, the higher the total score of the scale, and a significant difference was observed (P<0.001). The percentage of participants whose precedence worsened was higher than the importance. Significant differences were observed regarding gender, age group, marital status, employment status, household annual income, and income change during the COVID-19 pandemic considering changes in both the importance and precedence of diet. Those who were in the "worsening tendency" group in both the importance and precedence were men, 20-29 years old, unmarried, full-time employees, with a household income of 4-6 million yen during the past year.Conclusion　During the COVID-19 pandemic, the precedence of diet worsened, compared to its importance, and men, young, or unmarried persons show a worsening of dietary consciousness.

The French food-based dietary guidelines recommend eating pulses at least twice a week and to reduce meat consumption. This study assessed the impact on the sustainability characteristics (nutrition, cost, environment) of individual diets of meeting the pulse guideline. Dietary data of 2028 adults from the Esteban survey were completed with the nutritional content (considering bioavailability on iron, zinc and protein), price and environmental impacts of foods. When the pulse guideline (i.e., 57 g/day) was not met, two substitution scenarios raised the quantity of pulses to the recommended level, in replacement of an equivalent portion of (i) starches or (ii) meat. Only 9.6% of the participants reached the pulse guideline. Diet sustainability characteristics improved with the meat scenario (nutritional indicators improved; diet cost, greenhouse gas emissions and acidification decreased), while several indicators deteriorated with the starches scenario. Zinc available for absorption slightly decreased in both scenarios while iron available for absorption decreased in the meat scenario only. Increasing pulse consumption to two portions/week could modestly improve the sustainability of diets when pulses replace meat but not starches. Cultural acceptability of that substitution still needs to be proven, and iron and zinc status of individuals at risk of deficiency should be monitored.

Background: This study was conducted to estimate the impacts of using varied feeding regimens with or without protease supplementation on the growth performance, apparent amino acid ileal digestibility (AID%), economic efficiency, intestinal histology, and blood biochemical parameters of broiler chickens. Three hundred one-day-old chicks (Ross 308 broiler) were randomly allotted to a 3 × 2 factorial design. The experimental design consisted of three feeding regimens; FR1: a recommended protein SBM diet, FR2: a low-protein SBM diet, and FR3: a low-protein diet with the inclusion of 5% DDGS and 5% SFM, with or without protease supplementation (250 mg/kg)., Results: Increased feed intake and feed conversion ratio were observed in the FR3 treatment during the starter stage and decreased body weight and body weight gain during the grower stage. However, there was no significant effect of the different feeding regimens, protease supplementation, or interaction on the overall performance. The economic value of diets also remained unaffected by the different feeding regimens, protease supplementation, or interaction. Protease supplementation resulted in lowering the AID% of tryptophan and leucine. Reduced AID% of methionine was evident in the FR2 + VE and FR3 - VE treatments. Histological findings substantiated the FR3 treatment mediated a decrease in the duodenal and jejunal villous height (VH), jejunal villous width (VW), and ileal VW, whereas, increase in the ileal crypt depth (CD). The FR2 + VE treatment reduced the VH:CD ratio in the duodenum. The duodenal CD and the jejunal goblet cell count were reduced as a consequence of protease supplementation. The FR3 + VE treatment documented a rise in duodenal CD, while an increase in the jejunal goblet cell count was observed in the FR3 - VE treatment. The FR3 treatment enhanced the IgM serum levels compared to the FR1 and FR2 treatments. IgM serum levels were also elevated following protease supplementation. FR3 + VE treatment increased IgM serum levels. The highest serum ALP was found in the FR3 treatment, whereas the lowest level was obtained in the FR2 treatment., Conclusion: Low-protein SBM-based diets could be used without affecting the birds' growth. Altered morphometric measures of the intestine and increased IgM and ALP levels indicated the low-protein SBM/DDGS-SFM diet-induced damage of the intestinal histoarchitecture and immune system of birds. These different diets and protease supplementation failed to affect economic efficiency positively., (© 2021. The Author(s).)

Snacking contributes a significant portion of adolescents' daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12-19 years) from the National Health and Nutrition Examination Survey 2005-2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories "Milk and Dairy" (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and "Fruits" (aOR: 0.62, 95% CI: 0.50-0.78; p = 0.001) as snacks and higher odds of consuming "Beverages" (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3-3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

Background and Aims: This study aims to identify the barriers and facilitators faced by obese patients with NAFLD from north India, while undergoing lifestyle-modification., Methods: 30 obese patients with NAFLD were interviewed regarding the barriers and facilitators to lifestyle change and responses were noted. Inductive thematic analysis was used., Results: Eight themes under barriers (lack of family support, difficult intervention, work-related, financial, psychological, social, physical and infrastructure related) and four themes under facilitators (family support, intensive nature of intervention, psychological and physiological) were identified from the reponses., Conclusions: Personalized and socio-culturally appropriate counseling strategies may promote successful treatment outcomes among these patients., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: Poor diet is the leading preventable risk factor contributing to the burden of disease globally and in Australia, and is inequitably distributed. As the price of healthy foods is a perceived barrier to improved diets, evidence on the cost and affordability of current (unhealthy) and recommended (healthy, more equitable and sustainable) diets is required to support policy action., Methods: This study applied the Healthy Diets ASAP (Australian Standardised Affordability and Pricing) methods protocol to measure the cost, cost differential and affordability of current and recommended diets for a reference household in Queensland, Australia. Food prices were collected in 18 randomly selected locations stratified by area of socioeconomic disadvantage and remoteness. Diet affordability was calculated for three income categories., Results: Surprisingly, recommended diets would cost 20% less than the current diet in Queensland as a whole. Households spent around 60% of their food budget on discretionary choices (that is, those not required for health that are high in saturated fat, added sugar, salt and/or alcohol). Queensland families would need to spend around 23% of their income on recommended diets. However, recommended diets would not be affordable in low socioeconomic or very remote areas, costing 30 and 35% of median household income respectively. The government supplements due to the SARS-CoV-2 pandemic would improve affordability of recommended diets by 29%., Conclusions: Study findings highlight that while price is one factor affecting consumer food choice, other drivers such as taste, convenience, advertising and availability are important. Nevertheless, the study found that recommended diets would be unaffordable in very remote areas, and that low-income families are likely experiencing food stress, irrespective of where they live in Queensland. Policy actions, such as increasing to 20% the current 10% tax differential between basic healthy, and unhealthy foods in Australia, and supplementing incomes of vulnerable households, especially in remote areas, are recommended to help improve diet equity and sustainability, and health and wellbeing for all.

Coronavirus disease 2019 (COVID-19) can have far-reaching consequences for developing countries through the combined effects of infection and mortality, and the mitigation measures that can impact food systems and diets. Using a mobile platform, this cross-sectional study evaluated the effect of COVID-19 on food prices and dietary quality for 1797 households in Nouna and Ouagadougou in Burkina Faso, Addis Ababa and Kersa in Ethiopia, and Lagos and Ibadan in Nigeria. We assessed the consumption of 20 food groups during the previous 7 days. The dietary diversity scores (DDS) and Prime Diet Quality Scores (PDQS) were used to assess dietary diversity and quality. We used generalized estimating equation (GEE) linear models to evaluate associations between price changes for staples, pulses, vegetables, fruits, and animal source foods (ASFs) with the DDS and PDQS PDQS. Most participants reported increasing prices of staples, pulses, fruits, vegetables and ASF, and ≥ 40% reported the decreased consumption of staples, legumes, and other vegetables and fruits. The DDS (except in Kersa and Ouagadougou) and PDQS were lower during the COVID-19 pandemic. Higher pulse prices were associated with lower DDS (estimate, -0.35; 95% confidence interval [CI], -0.74 to 0.03; P = 0.07) in the combined analysis and in Burkina Faso (estimate, -0.47; 95% CI, -0.82 to -0.11). Higher vegetable prices were positively associated with the DDS (estimate, 0.22; 95% CI, 0.08 to 0.37). Lower crop production (estimate, -0.54; 95% CI, -0.80 to -0.27) was associated with lower DDS. The price increases and worsening dietary diversity and quality call for social protection and other strategies to increase the availability and affordability of nutrient-rich foods during the COVID-19 pandemic and public health emergencies.

Grain-free pet food options abound in the pet food market today, representing more than 40% of available dry dog foods in the United States. There is currently a dearth of information about the factors that contribute to a dog owner's choice of a grain-free dry dog food and if those factors are similar among countries. Therefore, the primary objective of the current survey was to identify the variables that are predictive of a dog owner's choice of a grain-free dry food across North America (Canada and the United States) and Europe (France, the United Kingdom and Germany). The survey consisted of 69 questions, took less than 15 minutes to complete and was distributed virtually via Qualtrics (Qualtrics XM, Utah, USA). A total of 3,298 responses were collected, equally distributed between countries. Multinomial logistic regression was performed in SPSS Statistics (Version 26, IBM Corp, North Castle, New York, USA). Male respondents, people from France, people who ranked the importance of ingredients in a pet food in the lower quartiles and people who do not rotate their dog's diet to provide variety were less likely to select 'no grain' when choosing a pet food. In contrast, people who believe that their dog has a food allergy, follow more than 5 specific dietary routines in their own diet, do not try to include grains in their own diet, get their information about pet food from online resources or pet store staff and look for specific claims on pet food (such as 'no fillers'), were all more likely to select 'no grain' when choosing a pet food. This survey provides insight into the similarities and differences in decision making among dog owners in North America and Europe and should be considered when exploring the effects of grain-free dog foods on canine health and well-being., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Sydney Banton was funded by Rolf C. Hagen, Inc. to complete the research. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Spineless cactus (Nopalea cochenillifera) is widely used in animal feed in semi-arid regions, due to the adaptive characteristics to such conditions and for having high levels of soluble carbohydrates. This research article describes the effect of replacing grain maize with spineless cactus in the diet of dairy goats on dry matter intake, water intake, milk yield, milk physicochemical characteristics and diet production costs. Eight multiparous Anglo Nubian goats were fed diets in which grain maize was replaced with spineless cactus at four levels (0, 33, 66, and 100%) in a double 4 × 4 Latin square design. Milk yield was measured and samples collected in the last three days of each period for physicochemical analysis and for determining nutrient intake. Diet production costs were also determined. Replacing maize with spineless cactus did not influence dry matter intake. Water intake via the drinker decreased linearly in response to the increasing levels of spineless cactus in the diet. The replacement of maize with spineless cactus did not change milk yield or physicochemical parameters. Total feed cost and the percentage of revenue losses from feed decreased with the replacement. Therefore, spineless cactus can fully replace grain maize in the diet of dairy goats, as it does not change dry matter intake or milk yield, but rather reduces feed costs and the drinking-water intake of goats.

Background: The relationship between diet quality and health care costs is unclear., Objective: The aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs., Design: Data from a longitudinal cohort study were analyzed., Participants/setting: Data for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health were analyzed., Main Outcome Measures: Diet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia's universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change ("diet quality worsened" [ARFS change ≤ -4 points], "remained stable" [-3 ≤ change in ARFS ≤3 points], or "improved" [ARFS change ≥4 points])., Statistical Analyses: Linear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status., Results: Consuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259])., Conclusions: Greater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent's perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with 'deli' counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents' perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.

Obesity and other diet-related health conditions have received much attention in the public health literature over the past two decades. This study investigates the relationship between household food budget shares at different food outlets with diet quality and weight-related health outcomes in the United States. Our analysis used event-level food purchase data from the national household food acquisition and purchases survey (FoodAPS). We find that, after controlling for observables, food purchase location is significantly associated with diet quality and body mass index (BMI). Our findings indicate that larger food budget shares at convenience stores and restaurants are linked with poor diet quality based on the healthy eating index-2015 (HEI-2015) scores and higher BMI. We further explored potential heterogeneity on outcomes of interest across income groups. Results suggest heterogeneous effects may exist across income groups: low-income households, who spent a larger share of their food budget at convenience stores and fast-food restaurants are related to poor diet quality and more likely to be obese. Our findings will help improve understanding of the causes of diet-related health problems and may illuminate potential avenues of intervention to address obesity.

Background: Offering financial incentives promotes increases in fruit and vegetable purchases in farmers' markets and supermarkets. Yet, little is understood about whether food-insecure adults purchase more fruits and vegetables as a result of receiving financial incentives in mobile produce market settings., Methods: In 2018-2019, Food on the Move provided a 50% discount to customers using Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fruit and vegetables from 16 market locations in Rhode Island (n = 412 market occasions). We used mixed multivariable linear regression to estimate the difference in total dollar sales per transaction per month between SNAP transactions and non-SNAP transactions. We also estimated the difference in out-of-pocket dollar sales per transaction per month between SNAP and non-SNAP transactions, less the 50% discount. This reflects the actual amount spent on fresh fruits and vegetables purchased per visit. In both models, we controlled for the number of market sites per month, with fixed effects for quarter and year. We estimated random intercept variance for date of transaction and market site to adjust for clustering., Results: In 2018-2019, the majority of market transactions (total n = 13,165) were SNAP transactions [n = 7.988 (63.0%)]. On average, customers spent $17.38 (SD = 16.69) on fruits and vegetables per transaction per month. However, customers using SNAP benefits spent significantly more on FVs per transaction per month [$22.01 (SD = 17.97)] compared to those who did not use SNAP benefits [9.81 (SD = 10.68)] (β = $10.88; 95% CI: 10.18, 11.58). Similarly, out-of-pocket dollar sales per SNAP transaction per month (i.e., less the 50% discount) were significantly higher [$11.42 (SD = 9.44)] relative to non-SNAP transactions [$9.40 (SD = 9.33)] (β = $1.85; 95% CI: 1.44, 2.27)., Conclusions: Financial incentives contributed to higher fruit and vegetable purchases among low-income customers who shop at mobile produce markets by making produce more affordable. Higher spending on fruits and vegetables may promote healthy diet behaviors and reduce chronic disease risk among food-insecure adults.

This study aimed to evaluate the performance of broiler chickens fed on 3 black soldier fly larvae (BSFL) (Hermetia illucens) and Greenleaf desmodium (Desmodium intortum)-based meals. We evaluated growth performance, carcass quality, and profitability under various commercial pathways (doorstep, retail, whole, and assorted). Desmodium and BSFL powders were formulated into 3 ratios: T1 25:75, T2 50:50, and T3 75:25. A commercial feed was used as a control. One hundred and twenty mixed-sex 1-day-old broiler chicks (Cobb) were reared in pens for 42 d in a completely randomized design. The chickens were weighed weekly to monitor their growth rate. After the 42-day rearing period, they were slaughtered for carcass quality evaluation and recording of the weights of internal organs. During the initial growth phase (7-21 d), significant effects of fish meal replacement were found on the chickens' average weight (P < 0.001), average daily body weight gain (P < 0.001), average daily feed intake (P < 0.001), and feed conversion ratio (P < 0.001). However, during the second phase (21-42 d), no significant effect of the replacement was detected except on average daily feed intake (P = 0.003). No significant differences were found in terms of the relative weights of internal organs. It was found that Desmodium-BSFL-based feeds were more profitable than the control feed, and the assorted and retail modes of sale generated more revenue compared to when the chickens were sold at doorstep and on whole-chicken basis. The return on investment was higher for a push-pull adopter compared to a non-adopter. The study found that a BSFL-Desmodium mixture can be a valuable replacement for the protein component in conventional feed and would provide a new impetus for the adoption of push-pull., (Copyright © 2020. Published by Elsevier Inc.)

Americans waste about a pound of food per day. Some of this is represented by inedible food waste at the household level. Our objective was to estimate inedible food waste in relation to diet quality and participant socio-economic status (SES). Seattle Obesity Study III participants ( n = 747) completed the Fred Hutch Food Frequency Questionnaire (FFQ) and socio-demographic and food expenditure surveys. Education and geo-coded tax-parcel residential property values were measures of SES. Inedible food waste was calculated from diet records. Retail prices of FFQ component foods ( n = 378) were used to estimate individual-level diet costs. The NOVA classification was used to identify ultra-processed foods. Multivariable linear regressions tested associations between inedible food waste, SES, food spending, Nutrient Rich Food (NRF 9.3 ) and Healthy Eating Index (HEI-2015) scores. Inedible food waste was estimated at 78.7 g/d, mostly from unprocessed vegetables (32.8 g), fruit (30.5 g) and meat, poultry, and fish (15.4 g). Greater inedible food waste was associated with higher HEI-2015 and NRF 9.3 scores, higher food expenditures and lower percent energy from ultra-processed foods. In multivariable models, more inedible food waste was associated with higher food expenditures, education and residential property values. Higher consumption of unprocessed foods were associated with more inedible food waste and higher diet costs. Geo-located estimates of inedible food waste can provide a proxy index of neighborhood diet quality.

Background: Population intake goals intended to prevent diet-related non-communicable diseases (NCDs) have been defined for multiple nutrients. Yet, little is known whether the existing food supply in Africa is in conformity with these goals or not. We evaluated the African food balances against the recommendations for macronutrients, free sugars, types of fatty acids, cholesterol and fruits and vegetables over 1990 to 2017, and provided regional, sub-regional and country-level estimates., Methods: The per capita supply of 95 food commodities for 45 African countries (1990-2017) was accessed from the FAOSTAT database and converted into calories, carbohydrate, fat, protein, free sugars, cholesterol, saturated (SFA), monounsaturated (MUFA), and polyunsaturated (PUFA) fatty acids contents using the Food Data Central database. The supply of fruits and vegetables was also computed., Results: In Africa the energy supply increased by 16.6% from 2,685 in 1990 to 3,132 kcal/person/day in 2017. However, the energy contribution of carbohydrate, fat and protein remained constant and almost within acceptable range around 73, 10 and 9%, respectively. In 2017, calories from fats surpassed the 20% limit in upper-middle- or high-income and Southern Africa countries. Energy from SFA remained within range (<10%) but that of PUFA was below the minimum desirable level of 6% in 28 countries. Over the period, energy from free sugars remained constant around 7% but the figure exceeded the limit of 10% in upper-middle- or high-income countries (14.7%) and in Southern (14.8%) and Northern (10.5%) sub-regions. Between 1990 and 2017 the availability of dietary cholesterol per person surged by 14% but was below the upper limit of 300 mg/day. The supply of fruits and vegetables increased by 27.5% from 279 to 356 g/capita/day; yet, with the exception of Northern Africa, the figure remained below the target of 400 g/capita/day in all sub-regions., Conclusion: According to this population level data, in Africa most population intake goals are within acceptable range. Yet, the supply of fruits and vegetables and PUFAs are suboptimal and the increasing energy contributions of free sugars and fats are emerging concerns in specific sub-regions., Competing Interests: The authors have declared that no competing interests exist.

Objective: To develop a questionnaire to measure food nutrition, food expenditures and time spent in food-related activities; and to assess the association between diet quality, time spent in food-related activities and food expenditures using data from a pilot study., Design: Cross-sectional study. Multiple linear regression models were used to analyse participants' survey response behaviours and the relationship between food nutritional quality and time and money expenditures., Setting: Online survey using Qualtrics software in a public university located in West Texas, USA., Participants: Faculty and staff aged 18 years and older from a public university located in West Texas, USA., Results: Combining questions from three survey instruments that collect data on food nutrition, food expenditures and time spent in food-related activities resulted in a thirty-page survey instrument. The median completion time of the survey instrument was about 30 min. Preliminary results suggest that time and money expenditures are associated with food quality but that their role is small relative to sociodemographic characteristics such as race and gender., Conclusions: Time and money expenditures are associated with food quality but their role is small relative to sociodemographic characteristics such as race and gender.

Purpose of Review: This is a review of the patterns, conceptualization, and suggested mechanisms underlying the relationship of socioeconomic status (SES) to obesity in childhood and the implications of these data for interventions going forward., Recent Findings: Adiposity and SES are negatively associated in high-income countries and positively associated in medium to low-income countries. Several mechanisms, such as early introduction of solid food and parental behaviors, which may explain the association of SES and adiposity, have been identified. Parental education and adiposity and early pediatric nutrition appear to be particularly salient SES-related effectors on adiposity. There is a clear association of SES and adiposity which is affected by population affluence. Evaluation of the relationship of SES and obesity in children are complicated by the complexity of SES and lack of common definition. A number of SES-related interventional targets have been identified. Intervention research should ensure they are addressing SES-associated issues in the study population.

Background: Aedes aegypti is a major vector of arboviruses that may be controlled on an area-wide basis, using novel approaches such as Sterile Insect Technique (SIT) and Incompatible Insect Technique (IIT). Larval diet is a critical factor to be considered in mass rearing of Aedes mosquitoes for SIT and IIT programs. Therefore, the current study is aimed at evaluating the effects of two novel diets developed from dry fish powder on the growth and development of immature stages and adult fitness-related characteristics of Ae. aegypti in Sri Lanka., Method: Three batches of the first instar Ae. aegypti larva, each containing 250 larvae, were exposed to three different larval diets as standard dry fish powder (D 1 ), dry fish powder meal and brewer's yeast (D 2 ), and International Atomic Energy Agency- (IAEA-) recommended diet (D 3 ), separately. Morphometric and developmental parameters of the 4 th instar larvae, pupae, and adult mosquitoes reared under different dietary treatments were measured. The entire experimental setup was replicated thrice. A General Linear Model (GLM) in the form of two-way ANOVA was used for the statistical analysis., Results: Significant diet-based variations were observed in the head length, head width, thoracic length, thoracic width, abdominal length, abdominal width, and total length ( F 2,87 > 4.811; P < 0.05) of Ae. aegypti larvae. The highest pupation success and the larval size were observed from the larvae fed the D 2 diet, while the lowest was reported from D 1 . All adult morphometric parameters of adult male and female Ae. aegypti mosquitoes also denoted significant dietary variations, reporting the best-sized adults from the D 2 diet ( F 2,87 > 3.54; P < 0.05). Further, significantly higher fecundity and male longevity were also shown by the adult Ae. aegypti ( F 2,6 > 7.897; P < 0.01) mosquitoes reared under diet D 2 ., Conclusion: Based on all the growth and developmental parameters, the D 2 diet tends to perform similar to the IAEA-recommended diet in mass rearing of Ae. aegypti mosquitoes, while being more inexpensive. Therefore, larval diet D 2 could be suggested as the ideal diet for mass rearing of Ae. aegypti for IIT and SIT-based vector control in Sri Lanka., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Umesha Senevirathna et al.)

The work assessed the productive response and estimated enteric methane (CH 4 ) emissions of dairy cows grazing in small-scale dairy systems. Treatments were grazing annual pasture (AP) mainly of annual ryegrass and perennial pasture (PP) mainly of perennial ryegrass, complemented daily with 3.72 kg DM/cow of commercial concentrate. Eight Holstein cows were used in a double cross-over design with three 14-day-each experimental periods for animal variables and CH 4 emissions. Pasture variables were analysed with a split-plot design. AP showed higher sward height (P < 0.05) with no differences (P > 0.05) in net herbage accumulation or in herbage chemical composition. Cows on AP yielded 24.6% more milk (P < 0.001) than grazing PP, but there were no differences in milk fat and protein content. There were differences (P ≤ 0.05) among periods for milk yields, but no differences among periods for milk fat and protein. Milk urea nitrogen was significantly higher (P < 0.001) in PP than in AP with no differences among periods. There was higher (P < 0.001) DMI for AP than PP with a significant decline (P < 0.05) as periods progressed. There was a trend (P = 0.08) for higher daily CH 4 /cow in AP, but significantly lower emissions (7.2%) in AP/kg DMI, and 20.1% lower emission intensity of g CH 4 /kg milk. The proportion of gross energy lost as CH 4 for AP was lower (P < 0.01). Higher milk yields in AP resulted in a 26% higher margin over feed costs than for PP. Results show that grazing annual pastures with moderate concentrate supplementation results in higher milk yields, higher incomes, and reduces the intensity of CH 4 emissions.

Introduction: An optimal diet is imperative in preparing women for pregnancy and this may be influenced by socio-economic status (SES). This research aims to investigate the role of SES on the dietary energy density (ED) in Australian women of preconception age., Methods: A secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12 for females aged 18-39 years (n = 1617) was conducted. Dietary intake was assessed by 24-hr recalls and dietary ED by dietary energy per weight (kJ.g -1 ). ED was further categorised as ED of foods and beverages separately. SES was assessed by three variables: Socio-Economic Indexes for Areas (SEIFA), developed by the Australian Bureau of Statistics; income decile; and level of education. Linear mixed model regressions were used to identify associations between ED and SES., Results: The median ED for food, beverages and combined food and beverages was 9.38 kJ g -1 , 1.02 kJ g -1 and 7.11 kJ g -1 , respectively. No significant variation was explained by SES variables when analysing combined ED in the adjusted model or ED from foods. Income decile reduced ED of beverages, although with little effect (coefficient: -0.04, P = 0.002). Significant confounders included inactivity, which increased ED in both combined ED and ED foods (coefficient: 0.51, P = 0.001 and coefficient: 0.78, P < 0.001)., Conclusions: SES explained little variation in dietary ED in women of childbearing age. A large proportion of women had high energy-dense diets regardless of their SES. These findings suggest that a large proportion of women, who may become pregnant, have diets that exceed the international recommendations for dietary energy density., (© 2020 The British Dietetic Association Ltd.)

The U.S. Department of Agriculture's (USDA) Child and Adult Care Food Program (CACFP) updated meal pattern standards took effect in October 2017. The aim of this quasi-experimental, pre-post study is to identify changes in food and beverage practices of CACFP-participating centers due to implementation of updated CACFP meal patterns over a 21-month period. Eight hundred and fifty-eight centers located in 47 states and the District of Columbia completed a survey (primarily electronic) at both time points (67.6% follow-up response rate). Multivariable logistic regressions with robust standard errors assessed changes over time, accounting for repeated observations within each site. From baseline to follow-up, centers reported the increased familiarity and implementation, albeit with time, money, and staffing-related challenges. Significant improvements were seen in not serving sugary cereals or flavored milk, in serving 100% whole grains, and serving processed meats less than once a week. While CACFP-participating centers reported making significant progress in meeting the updated meal pattern standards and suggested best practices within 15-19 months of their effective date, reported compliance and adherence to the standards and best practices was not universal. USDA, state agencies, and technical assistance providers should work to provide centers with additional guidance to help them with implementation.

This study aimed to determine the impact of 2017 revisions to the Child and Adult Care Food Program (CACFP) nutrition standards on foods and beverages served and meal costs in family child care homes (FCCHs). Our pre-post study utilized four weeks of menus and food receipts from 13 FCCH providers in Boston, MA prior to CACFP nutrition standards changes in 2017 and again one year later, resulting in n = 476 menu observation days. We compared daily servings of food and beverage items to the updated standards. Generalized estimating equation models tested for changes in adherence to the standards and meal costs. FCCHs offered more whole grains and less juice and refined grains from baseline to follow-up. FCCHs were more likely to meet the revised whole grain standard at follow-up (OR = 2.7, 95% CI: 1.4, 5.2, p = 0.002), but rarely met all selected standards together. Inflation-adjusted meal costs increased for lunch (+$0.27, p = 0.001) and afternoon snack (+$0.25, p = 0.048). FCCH providers may need assistance with meeting CACFP standards while ensuring that meal costs do not exceed reimbursement rates.

Background: This study estimated the monetary cost of diets with higher and lower caloric shares of ultraprocessed food products (UPF) and unprocessed/minimally processed foods (MPF) in Belgium for various sociodemographic groups., Methods: Data from the latest nationally representative Food Consumption Survey (FCS) 2014-2015 ( n = 3146; 3-64 years) were used. Dietary data were collected through two nonconsecutive 24-hour recalls (food diaries for children). Average prices for >2000 food items (year 2014) were derived from GfK ConsumerScan panel data and linked with foods consumed in the FCS. Foods eaten were categorized by their extent of processing using the NOVA classification. The average caloric share (percentage of daily energy intake) of UPF and MPF were calculated. The mean diet cost was compared across the UPF and MPF contribution tertiles, using linear regression., Results: The average price per 100 kcal for UPF was significantly cheaper (EUR 0.55; 95%CI = 0.45-0.64) than for MPF (EUR 1.29; 95% CI = 1.27-1.31). UPF contributed between 21.9% (female adults) and 29.9% (young boys), while MPF contributed between 29.5% (male adolescents) and 42.3% (female adults) to the daily dietary cost. The contribution of MPF to the daily dietary cost was significantly higher for individuals with a higher household education level compared to those with a lower household education level ( p < 0.01). Adjusted for covariates, the average dietary cost per 2000 kcal was significantly lower for individuals in the highest compared to the lowest tertile for the proportion of daily energy consumed from UPF (EUR -0.37 ± 0.13; p = 0.006), and significantly higher for individuals in the highest compared to the lowest tertile for proportion of daily energy consumed from MPF (EUR 1.18 ± 0.12, p < 0.001)., Conclusion: Diets with a larger caloric share of UPF were significantly cheaper than those with a lower contribution of these products, while the opposite was found for MPF. Policies that improve relative affordability and accessibility of MPF are recommended.

Background: Previous research indicates that income inequality is associated with risk for mortality, self-rated health status, chronic conditions, and health behavior, such as physical activity. However, little is known about the relationship between income inequality and dietary intake, which is a major risk factor for common chronic diseases including heart disease, stroke, diabetes, and certain types of cancers. The objective of this study is to determine the association between US state income inequality and fruit and vegetable consumption among adults., Methods: Cross-sectional data on 270,612 U.S. adults from the U.S. 2013 Behavioral Risk Factor Surveillance System was used. Fruit and vegetable consumption was assessed from the six-item fruit and vegetable frequency questionnaire, which is part of the Behavioral Risk Factor Surveillance System. Multilevel modeling was used to determine whether US state-level income inequality (measured by the z-transformation of the Gini coefficient) was associated with fruit and vegetable consumption adjusting for individual-level and state-level covariates., Results: In comparison to men, women were more likely to consume fruits and vegetables ≥5 times daily, fruits ≥2 times daily, vegetables ≥3 times of daily, and less likely to consume fruit juice daily. Among both men and women, a standard deviation increase in Gini coefficient was associated with an increase in consuming fruit juice daily (OR = 1.07, 95% CI = 1.03, 1.11). However, among women, a standard deviation increase in Gini coefficient was associated with a decreased likelihood in meeting daily recommended levels of both fruits and vegetables (OR = 0.93; 0.87-0.99), fruits only (OR = 0.95; 95% CI, 0.92-0.99) and vegetables only (OR = 0.92; 95% CI, 0.89-0.96)., Conclusions: This study is one of the first to show the relationship between income inequality and fruit and vegetable consumption among U.S. adults empirically. Women's health is more likely to be detrimentally affected when living in a state with higher income inequality., Competing Interests: The authors have no conflicts of interest relevant to this article to disclose.