Public health approaches for addressing diet-related health in the United States (US) include nutrition incentive (NI) and produce prescription (PPR) projects. These projects, funded through the US Department of Agriculture Gus Schumacher Nutrition Incentive Program (GusNIP), aim to support intake of fruits and vegetables through healthy food incentives. Measuring GusNIP impact is vital to assessing the ability of incentives to improve public health nutrition outcomes across populations. Shared measures used across GusNIP projects assess fruit and vegetable intake, food security, demographics, among other variables, through a participant survey. This study explored challenges and opportunities to support evaluation across GusNIP.

This qualitative study used a sociodemographic survey, semi-structured interviews, and focus groups. Descriptive statistics were used to summarize survey data and applied thematic analysis was used to identify patterns in interview and focus group data.

Data collection occurred in the United States virtually using Qualtrics and Zoom, fall 2021 to fall 2022.

18 GusNIP PPR and NI data collectors, 24 external evaluators, and 11 GusNIP Training, Technical Assistance, Evaluation, and Information Center’s (NTAE) staff participated.

Opportunities to improve evaluation among GusNIP’s participants include tailoring surveys to specific subpopulations, translations, culturally appropriate food examples, avoiding stigmatizing language, using mixed methods, and intentional strategies to enhance representation.

To increase applicability, evaluation tools must reflect the experiences across populations. This study provides insights that can guide future NI and PPR evaluations, helping to more effectively measure and understand outcomes of all communities.

This study aimed to examine the association between ultra-processed food intake and dyslipidemia risk, and whether this association varied by the polygenic score for dyslipidemia in the adult Korean population.

Prospective cohort study

Ultra-processed foods were identified under the NOVA classification. Participants were categorized into <5, 5 to <10, 10 to <15, 15 to <20, and ≥20%E/d of ultra-processed food intake. The polygenic scores for dyslipidemia were calculated from 53,950 single nucleotide polymorphisms. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariate logistic regression models.

20,044 Korean adults aged ≥40 years in the Health Examinees (HEXA) study, the Cardiovascular Disease Association Study (CAVAS), and the Korea Association Resource (KARE) study

During median follow-ups of 4.09, 8.67, and 15.67 years in the HEXA, CAVAS, and KARE studies, respectively, there were a total of 7,331, 786, and 1,732 incident dyslipidemia events. Ultra-processed food intake was not significantly associated with dyslipidemia risk. Compared with <5%E/d, the pooled OR (95% CI) of ≥20%E/d of ultra-processed food intake for dyslipidemia incidence was 1.01 (0.90, 1.13; p for trend=0.83). There was no interaction by dyslipidemia-related genetic variations; ORs (95% CIs) were 1.04 (0.89, 1.22; p for trend=0.91) and 0.98 (0.84, 1.15; p for trend=0.72) for individuals with high and low polygenic scores, respectively (p for interaction=0.90).

No significant association was observed between ultra-processed food intake and the overall risk of dyslipidemia, nor in subgroups of polygenic scores for dyslipidemia among Korean adults with low ultra-processed food intake.

This paper explores the characteristics of Ghanaian households’ consumption of obesogenic versus protective foods, including their retail, distribution, and origin.

A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers.

Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide.

612 households, 209 retailers and 185 wholesalers/distributors.

About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported.

Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment.

To understand caregivers’ perceptions about their children’s mealtime social experiences at school, and how they believe these social experiences impact their children’s consumption of meals at school (both meals brought from home and school meals).

Qualitative data were originally collected as part of a larger mixed methods study using an embedded-QUAN dominant research design.

Semi-structured interviews were conducted with United States (U.S.) caregivers over ZoomTM in English and Spanish during the 2021-2022 school year. The interview guide contained 14 questions on caregivers’ perceptions about their children’s experiences with school meals.

Caregivers of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n=46) and Maine (n=20) were interviewed. Most (60.6%) were caregivers of children who were eligible for free or reduced-price meals.

Caregivers reported that an important benefit of eating meals at school is their child’s opportunity to socialize with their peers. Caregivers also stated that their child’s favorite aspect of school lunch is socializing with friends. However, some caregivers reported the cafeteria environment caused their children to feel anxious and not eat. Other caregivers reported that their children sometimes skipped lunch and chose to socialize with friends rather than wait in long lunch lines.

Socializing during school meals is important to both caregivers and students. Policies such as increasing lunch period lengths and holding recess before lunch have been found to promote school meal consumption and could reinforce the positive social aspects of mealtime for students.

Ultra-processed beverages (UPBs) have known adverse impacts on health, but their impact on the environment is not well understood across different environmental indicators. This study aimed to quantify the environmental impacts of water-based UPBs and bottled waters sold in Australia and assess the impacts of various scenarios which may reduce such impacts in the future.

This study presents a quantitative environmental impact assessment of a major sub-category of UPBs (water-based UPBs, including soft drinks, energy drinks, cordials, fruit drinks) and non-UPBs (bottled waters) in Australia. Alternative mitigation scenarios based on existing health and environmental targets were also modelled using sales projections for 2027. Sales data from Euromonitor International were matched with environmental impact data from peer-reviewed lifecycle assessment databases. Environmental impact indicators included greenhouse gas emissions, land use, eutrophication potential, acidification potential, water scarcity and plastic use.

The Australian beverage supply in 2022 and projected sales for 2027.

N/A

Environmental impacts of UPBs were higher than bottled waters. UPBs accounted for 81-99% of total environmental impacts, partly driven by the volume of sales. Reformulation, reducing UPB consumption and increasing recycling all led to meaningful reductions in environmental impacts but with diverse effects across different environmental indicators. The largest reductions occurred when policy scenarios were combined to represent a suite of policy actions which aimed to meet health and environmental targets (30-82% environmental savings).

The results indicate that implementing a suite of policies which act to target multiple drivers of environmental harm are likely to lead to the most environmental benefits.

To examine power and governance arrangements in food and nutrition policy formulation and agenda-setting in South Africa

Analysis of the policy implementation environment and in-depth interviews were conducted focussing on: existing policy content and priorities across food system sectors; institutional structures for cross-sectoral and external stakeholder engagement; exercise of power in relation to food system policies; and opportunities to strengthen action on nutrition.

South Africa

Interviews were conducted with 48 key stakeholders involved in the food and nutrition policy sphere: government sectors relevant to food systems (n=21), the private sector (n=4), academia (n=10), NGOs (n=11) and farmers (n=2).

This study found that there are power dynamics involved in shaping the planning agenda that is inadvertently generating a food system that undermines the right to food. The concept of nutrition governance remains poorly defined and applied in different ways and usually based on a relatively narrow interpretation – therefore limiting policy coherence and coordination. South Africa has strong legal institutions and practices, and social policies that support public provisioning of food, but a non-interventionist approach to the food system.

The right to food and nutrition, as outlined in the South African Constitution, has not yet been effectively utilized to establish a robust normative and legal basis for tackling the dual challenges of food insecurity and malnutrition. Currently, the governance of the food system is grappling with substantial obstacles, balancing the influence of powerful stakeholders who uphold the status quo against its responsibilities for food justice.

To characterise children’s lunchbox contents for food, waste, and packaging.

A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.

23 sites across metropolitan Adelaide, South Australia including 14 preschools and 9 primary schools in low (n=8), medium (n=7), and high (n=8) socioeconomic areas.

Preschool (3-5 years) to Grade 7 (6-13 years) school students.

673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92% of lunchboxes having at least one item from that category, followed by fruits (78%), snacks (62%), dairy (32%), and vegetables (26%). Lunchboxes of preschool children contained more fruits (92% vs 65%; χ2(1)=73.3, P<0.01), vegetables (36% vs 16%; χ2(1)=34.0, P<0.01), and dairy items (45% vs 19%; χ2(1)=53.6, P<0.01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68%) than preschool (55%; χ2(1)=11.2, P<0.01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53%) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.

Sandwiches, fruits, and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.

While fast-food is typically considered highly processed, an analysis to demonstrate this has yet to be conducted. Therefore, the objective of this research was to examine the menu items and ingredients from six fast-food restaurant menus using the NOVA Classification.

Cross-sectional study.

Data were collected from the top six highest selling United States restaurants, per each food category, identified using the Quick Service and Fast Casual Restaurants (QSR) 2020 Report.

A total of 740 menu items were identified and classified according to their degree of processing based on ingredient lists using the NOVA Classification: Minimally Processed (MPF), Culinary Processed Ingredient (CPF), Processed (PRF), or Ultra-processed (UPF). In addition, individual ingredients that appeared on at least three menus were classified into NOVA groups, and the 20 most common ingredients were identified based on frequency of appearance in ingredient lists.

Across all menus, 85% (Range: 70-94%) of items were UPFs with only 11% (Range: 6-25%) being MPF (p<0.001). Additionally, 46% of the ingredients that appeared on at least three menus were ultra-processed ingredients. Three ultra-processed ingredients appeared on all six menus: natural flavors, xanthan gum, and citric acid.

These findings show that the vast majority of menu items from major fast-food restaurants are UPFs and there are few options for MPFs. Fast-food companies should consider reformulation or the addition of MPF to the menu to increase healthful food options for their patrons.

To analyze the global cancer burden associated with dietary factors across 204 countries and regions from 1990 to 2019.

A population-based study

Global Burden of Disease Study

Using data from the 2019 global burden of disease, we calculated Population Attributable Fractions (PAFs), death and disability-adjusted life years (DALYs). A comparative risk assessment framework was employed, along with estimated annual percentage changes (EAPCs).

In 2019, approximately 6.01% of cancer mortality and 5.50% of DALY rates can be attributed to dietary risk factors, particularly low intake of whole grains, milk, and fruits and vegetables. The High Socio-Demographic Index (SDI) region had the highest cancer mortality and DALY PAFs, mainly due to high consumption of red and processed meats, while the Low SDI region showed the highest PAFs from low fruit and vegetable consumption. In 2019, the High-middle SDI region had the highest age-standardized death rate (ASDR) and DALY rate attributable to dietary factors. Among geographic regions, Southern Latin America had the highest ASDR, and Central Europe had the highest age-standardized DALY rate. At the country level, Mongolia exhibited the highest rates for both ASDR and DALYs attributable to dietary risks. From 1990 to 2019, the largest increase in ASDR was observed in Western Sub-Saharan Africa, with Bulgaria showing the largest country-specific increase. Similarly, the largest increase in the age-standardized DALY rate was seen in Western Sub-Saharan Africa, with Lesotho experiencing the highest increase at the country level.

Our findings underscored the importance of increasing the consumption of whole grains, milk, and calcium, which can inform global dietary guidelines and cancer prevention strategies.

Early education and care (ECEC) is part of the everyday life of most children in developed economies presenting exceptional opportunity to support nutrition and ongoing food preferences. Yet, the degree to which such opportunity is captured in policy-driven assessment and quality ratings of ECEC services is unknown.

Abductive thematic analysis was conducted, guided by key domains of knowledge in nutrition literature and examining identified themes within these domains.

ECEC services (n=38) in Queensland, Australia.

Data were a random sample of field notes pertaining to mealtimes and food provision (n=182) collected as evidence to inform quality ratings during assessment visits to ECEC services.

The field notes mapped to three theory-driven domains: Provisions, Practices and Education. Reflecting policy specification, health, hygiene, and safety were a key focus but food quality and quantity were not. Assessors noted promotion of child autonomy at mealtimes yet little evidence pertaining to characteristics of educator-child interactions.

Despite evidence that childhood nutrition is crucial for optimal development and learning, quality and quantity of food is not directly assessed. Relationships and interactions at mealtimes provide an environment ideal for promoting learning and development yet the policy guiding inspection and assessment of ECEC services directs focus to a more limited lens of safety, hygiene and promotion of ‘healthy foods’. Our findings identify a narrow conceptualisation of mealtimes focused on ‘health’ as limiting the potential to leverage mealtimes as places to support children’s nutrition and attendant development and learning.

In response to increasing hypertension rates, South Africa implemented a regulation which set a maximum total sodium content for certain packaged food categories. We assess changes in reported sodium intake among 18-39 year old adults living in one township in the Western Cape as a result of the implementation of the regulation in 2016.

By linking one set of 24 hour dietary recall data to two versions of the South Africa Food Composition Database which reflect the pre-regulation and post-regulation periods, we calculated changes in sodium intake due to reformulation of food products, not behavior change. We statistically tested differences in mean consumption in this sample with paired t-tests.

Langa, Western Cape, South Africa

Surveyed participants were residents of Langa between 18-39 years old (n=2,148)

Before and after the implementation of the regulation there was a statistically significant decrease in the estimated sodium intake among adults of 189.4 mg (137.5, 241.4; p=0.00). Reported sodium from cured meat (such as Russians) and certain types of soup powder, cereals, and salted peanuts had a 9 to 33 percent lower calculated sodium consumption.

Our conclusions show that independent of any behavioral changes on the part of consumers, it is possible to lower sodium intake by using regulations to induce food manufacturers to lower the sodium levels in their products. As countries explore similar regulatory strategies, this work can add to that body of evidence to inform policies to improve the food system.

To investigate the relationship between violence and the nutritional status of pregnant women, and whether mental health could be a mediator in this relationship.

Cross-sectional study. Violence and mental health status were investigated using the following questionnaires: World Health Organization Violence Against Women (WHO-VAW), Abuse Assessment Screen (AAS), Patient Health Questionnaire (PHQ-9), and General Health Questionnaire (GHQ). Demographic, socioeconomic, obstetric, and lifestyle factors (smoking/alcohol consumption) were also investigated. The nutritional status of the women was assessed by the body mass index.

Data were collected from February 2021 to August 2022 in Araraquara city, Brazil.

Four hundred pregnant women recruited at 34 health units and the municipal maternity hospital.

Experience of violence was reported by 52.2% of the women and psychological violence in the last 12 months was the most prevalent type of domestic violence (19.5%). Approximately 43% of the women showed mental health changes and 59.7% had a risk of major depression. Women with mental health changes had an increased risk (OR=2.34) of obesity. Psychological violence in the last 12 months was associated with obesity (p=0.01) when mediated by mental health changes. The mediation effect was significant (β=0.708; 95%BCa CI=0.004-1.460), with mental health changes mediating 46.1% of the relationship between psychological violence and obesity.

The relationship between psychological violence and obesity during pregnancy was mediated by changes in mental health. This original study shows that nutritional status is not limited to biological factors and highlights the importance of social, mental, and psychological factors.

To determine the associations among iron status, depressive/anxiety symptoms, and quality of life (QoL) throughout pregnancy.

This longitudinal study recruited participants in their 1st trimester (< 13 weeks; n=116) and followed in their 2nd (n=71) and 3rd (n=71) trimesters. Sociodemographic, food security, anxiety, depressive symptoms, and QoL questions were collected. Hemoglobin (Hb), ferritin (Ft), and transferrin saturation (TSAT) were determined. Women were categorized as iron improvers or non-improvers based on changes in iron status. Associations were assessed using difference-in-difference analyses.

Cape Coast, Ghana between October 2017 to September 2018.

Pregnant women, 18-38 years.

Improvement in Ft levels from the 1st to 2nd trimester were associated with reduced depressive symptoms (-2.96 vs -0.58, p=0.028), and higher overall QoL (13.99 vs 1.92, p=0.006) particularly role physical (23.32 vs -2.55, p=0.025) and role emotional (27.50 vs 10.06, p=0.025) subscales. Improvement in Hb levels during the same period were linked to less anxiety, particularly fear factor (-2.62 vs -0.51, p=0.020); and worsened physical health aspect of QoL (-21.80 vs -3.75, p=0.005). Improvement in TSAT levels from 2nd to 3rd trimester were associated with increased total anxiety (1.56 vs -0.64, p=0.030) and panic factor (0.45 vs -0.26, p=0.004) and decreased total QoL (-1.08 vs 7.94, p=0.017), specifically role physical (-10.98 vs 11.93, p=0.018).

Increases in iron status from first to second trimester were related to improvements in psychosocial wellbeing, implying potential benefit of iron supplementation on affect in early pregnancy. Larger studies are needed to confirm these findings.