To understand the characteristics of food environments in the Pacific region, and the broader economic, policy and sociocultural surroundings that influence food choices and interventions to improve food environments for Pacific communities.

Systematic searches were conducted for articles related to food environments or factors influencing food choices from 1993 to 2024 in five academic databases, Google, Google Scholar and relevant organisations’ websites. Studies were included if they meet the eligibility criteria. Two authors independently reviewed the title and abstract of identified articles. Full-text screening was conducted before data were extracted from eligible studies. A narrative analysis was informed by an existing food environments framework.

Pacific Island countries or territories that are a member of the Pacific Community (SPC).

Not applicable.

From the sixty-six included studies (of 2520 records screened), it was clear that food environments in the Pacific region are characterised by high availability and promotion of ultra-processed unhealthy foods. These foods were reported to be cheaper than healthier alternatives and have poor nutritional labelling. Food trade and investment, together with sociocultural and political factors, were found to contribute to unhealthy food choices. Policy interventions have been implemented to address food environments; however, the development and implementation of food environment policies could be strengthened through stronger leadership, effective multisectoral collaboration and clear lines of responsibility.

Interventions focused on improving physical, economic, policy and sociocultural influences on food choices should be prioritised in the Pacific region to improve the food environment and mitigate barriers to healthy eating.

The South East Asian Nutrition Survey II Indonesia aimed to provide up-to-date data on dietary intake, nutritional and biochemical status of children aged 0·5–12 years in Indonesia 2019–2020.

Multistage cluster sampling, stratified by geographical location.

Out of forty-six targeted districts in Indonesia, the study only covered twenty-one districts/cities in Java and Sumatera islands, Indonesia due to COVID-19 pandemic.

A total of 2475 children aged 0·5–12 years were included.

The growth (weight-for-age, height-for-age, weight-for-height and BMI-for-age) of Indonesian pre-school- and school-aged children was below the WHO standards. The prevalence of stunting in Java and Sumatera islands was 20·6 and 33·4 % in urban and rural areas, respectively. Stunting was higher in the 1·0–3·9-year age group, boys and rural areas. Overall, 9–12 percent of all children were overweight -obese, with 23·7 % of urban 7–12-year-olds having the highest prevalence.

Anaemia was 22·8 % in < 5-year-old and highest in < 1-year-old children. Fe, Zn, vitamins A and D insufficiency was observed in 20·3 %, 11·9 %, 1·9 % and 27·1 % of the children. Dietary intakes of energy, fibre, Ca, Fe, Zn, vitamins A, B1, C and vitamin D below the Indonesian RDA were prevalent and observed in more than half of the children.

High stunting, increasing trends of overweight/ obesity, anaemia, serum vitamin D insufficiency, inadequate energy and micronutrient intake in children highlighted the triple burden of malnutrition in Java and Sumatera, Indonesia’s most populous regions in 2019–2020, shortly before COVID-19 pandemic era.

Despite bold commitments to reduce anaemia, little change in prevalence was observed over the past decade. We aimed to generate subnational maps of anaemia among women of reproductive age (WRA), malaria transmission and hemoglobinopathies to identify priority areas but also explore their geographical overlap.

Using the most recent Demographic and Health Surveys (DHS), we first mapped anaemia clusters across sub-Saharan Africa and identified the West and Central Africa (WCA) as a major cluster. Geographic clusters with high anaemia and related aetiologic factors were identified using spatial statistics. Multilevel regression models were run to identify factors associated with any, moderate and severe anaemia.

West and Central African countries (n 17).

WRA (n 112 024) residing in seventeen WCA countries.

There was a significant overlap in geographical clusters of anaemia, malaria and hemoglobinopathies, particularly in the coastal areas of the WCA region. Low birth interval (0·86 (0·77, 0·97)), number of childbirth (1·12 (1·02, 1·23)) and being in the 15–19 age range (1·47 (1·09, 1·98)) were associated with increased odds of any anaemia. Unimproved toilet facility and open defecation were associated with any anaemia, whereas the use of unclean cooking fuel was associated with moderate/severe anaemia (P < 0·05). Access to healthcare facility, living in malaria-prone areas and hemoglobinopathies (HbC and HbS) were all associated with any, moderate or severe anaemia.

Interlinkages between infection, hemoglobinopathies and nutritional deficiencies complicate the aetiology of anaemia in the WCA region. Without renewed efforts to integrate activities and align various sectors in the prevention of anaemia, progress is likely to remain elusive.

School-based interventions encouraging children to replace sugar-sweetened beverages with water show promise for reducing child overweight. However, students with child food insecurity (CFI) may not respond to nutrition interventions like children who are food-secure.

The Water First cluster-randomised trial found that school water access and promotion prevented child overweight and increased water intake. This secondary analysis used mixed-effects regression to evaluate the interaction between the Water First intervention and food insecurity, measured using the Child Food Security Assessment, on child weight status (anthropometric measurements) and dietary intake (student 24-h recalls, beverage intake surveys).

Eighteen elementary schools (serving ≥ 50 % children from low-income households), in which drinking water had not been previously promoted, in the San Francisco Bay Area.

Students in fourth-grade classes (n 1056).

Food insecurity interacted with the intervention. Among students with no CFI, the intervention group had a lower prevalence of obesity from baseline to 7 months (–0·04, CI –0·08, 0·01) compared with no CFI controls (0·01, CI –0·01, 0·04) (P = 0·04). Among students with high CFI, the intervention group had a pronounced increase in the volume of water consumed between baseline and 7 months (86·2 %, CI 21·7, 185·0 %) compared with high CFI controls (–13·6 %, CI –45·3, 36·6 %) (P = 0·02).

Addressing food insecurity in the design of water promotion interventions may enhance the benefit to children, reducing the prevalence of obesity.

Undernutrition among children under the age of five years is a prevalent global issue, especially in Bangladesh. This study aimed to explore the relationships of household environmental conditions (HECs) with child undernutrition in Bangladesh, with a specific focus on rural–urban variations.

We analysed children’s data from the 2017/18 Bangladesh Demographic Health Survey. The outcome variable considered were measures of child undernutrition, including stunting, wasting and underweight. The primary exposure variables considered were indicators of HEC. We used a hierarchical multilevel mixed-effect generalized linear models (GLM) modified with a Poisson regression to explore the association between outcomes and exposures, adjusting for potential confounders.

Nationally representative cross-sectional survey.

8,057 under-5 children.

The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8%, and 22%, respectively, with notable urban–rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1·17), exposed to household air pollution (aPR: 1·37), had unimproved drinking water sources (aPR: 1·28) or had poor handwashing facilities (aPR: 1·24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, with variations in the effect size across urban–rural areas.

The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs, therefore, integrated approaches should be adopted to address these environmental factors collectively. Policies and programmes should prioritse enhancing housing quality to achieve sustainable improvements in child nutritional outcomes.

To understand the dietary patterns of adults and explore their association with iodine nutritional levels and thyroid function in adults.

We randomly collected 5 ml of adult urine samples and measured urinary iodine concentration (UIC) by cerium arsenate-catalysed spectrophotometry. A serum sample of 5 ml was collected for the determination of free triiodothyronine, free thyroxine and thyrotropin, and diet-related information was collected through a FFQ. Dietary patterns were extracted by principal component analysis, and the relationship between dietary patterns and iodine nutrition levels and thyroid function was explored.

A cross-sectional study involving adults in Xinjiang, China, was conducted.

A total of 435 adults were enrolled in the study.

The overall median urinary iodine of the 435 respondents was 219·73 μg/l. The dietary patterns were PCA1 (staple food pattern), PCA2 (fruit, vegetable and meat pattern), PCA3 (fish, shrimp and legume pattern) and PCA4 (dairy-based protein pattern). The correlation analyses showed that PCA1 and PCA3 were positively correlated with the UIC. The results of the multivariable analysis showed that PCA1, Q1, Q2 and Q3 were associated with an increased risk of iodine deficiency compared with Q4 ((OR): 260·41 (95 % CI: 20·16, 663·70)), 59·89 (5·64, 335·81), and 2·01 (0·15, 26·16), respectively). In PCA2, Q3 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 0·16 (0·05, 0·53)). In PCA3, Q3 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 0·23 (0·06, 0·90)). In PCA4, Q1 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 31·30 (4·88, 200·64)).

This study demonstrated that of the four dietary patterns, the least dependent staple food pattern (Q1) had a higher risk of iodine deficiency compared with the most dependent staple food pattern (Q4). However, the current evidence on the effect of dietary patterns on thyroid function needs to be validated by further longitudinal studies that include long-term follow-up, larger sample sizes and repeated measures.

This study examines public support – and its drivers – for comprehensive policy packages (i.e. bundles of coherent policy measures introduced together) aimed at improving food environments.

Participants completed an online survey with a choice-based conjoint experiment, where they evaluated pairs of policy packages comprising up to seven distinct food environment measures. After choosing a preferred package or opting for a single policy, participants designed their ideal policy package. Based on their choices, respondents were categorised as resistant, inclined or supportive towards policy packaging according to their frequency of opting out for single measures and the number of policies they included in their ideal package.

The study was conducted in Germany via an online survey.

The sample included 1200 eligible German voters, recruited based on age, gender and income quotas.

Based on both opt-out frequency (44·7 %) and ideal policy packaging (72·8 %) outcomes, most respondents were inclined towards policy packages. The inclusion of fiscal incentives and school-based measures in packages enhanced support, while fiscal disincentives reduced it. Key drivers of support included beliefs about the importance of diet-related issues and the role of government in regulation, while socio-demographic factors, political leaning and personal experience with diet-related disease had minimal impact.

The results reveal public appetite for policy packages to address unhealthy food environments, contingent on package design and beliefs about the issue’s severity and legitimacy of intervention. Public health advocates should design and promote policy packages aligned with public preferences, especially given anticipated opposition from commercial interests.

To assess associations between dietary fat quality indices and risk of pre-diabetes and type 2 diabetes mellitus (T2DM) among Iranian adults.

Daily intakes of fatty acids were estimated using a validated FFQ with 168 food items. Adjusted hazard ratios (HR) and 95 % CI for pre-diabetes and T2DM were calculated across tertile categories of dietary fat quality indices including the atherogenic index, thrombogenic index, health-promoting index, ratio of PUFA to SFA (PUFA:SFA) and ratio of hypo- and hypercholesterolaemia (h:H).

Tehran Lipid and Glucose Study.

Iranian men and women.

The mean (sd) age of the 2042 pre-diabetes-free participants in pre-diabetes analysis was 38·84 (12·97), and 55·2 % were women. In T2DM analysis, the mean (sd) age of the 2295 T2DM-free participants was 40·06 (13·42), and 54·6 % of them were women. In the crude model, the PUFA:SFA ratio was positively associated with T2DM incidence (HR = 1·43; 95 % CI 1·04, 1·98). However, after adjustment for confounding variables, there were no significant associations between dietary fat quality indices and risk of pre-diabetes and T2DM.

We found no significant association between fat quality indices and risk of pre-diabetes and T2DM. Further prospective and clinical trial studies are needed to clarify the issue.

To investigate the co-existence of single and multiple anthropometric failures among children using an extended composite index of anthropometric failure (ECIAF). This study aims to elucidate the complex interplay between child-specific and maternal factors, highlighting the multifaceted nature of childhood malnutrition.

A multicentre cross-sectional study as part of the BESLEN project

Mother-Child Education Centre in the Pendik district of Istanbul, Türkiye

1283 children (preschool children, n 822, school-aged children, n 462) and 1044 mothers

Almost 1/3 of the children included in the study had an anthropometric failure as determined by ECIAF. Weight excess was the leading cause of the total anthropometric failures, most of which were observed to be slightly higher in boys, except for stunting only and co-occurrence of stunting and underweight. Among the mother-related factors, including higher BMI and waist circumference, low maternal age at delivery, low number of children in the household and being a single parent may be considered predisposing factors to any phenomenon of childhood malnutrition. Among child-related factors, birth weight being ≥ 3500 g had a higher risk for ECIAF failure, and children aged ≥ 60 months were more likely to experience stunting and underweight, while those < 60 months had a higher prevalence of weight excess.

The co-existence of stunting and overweight, the occurrence of weight excess in one in three stunted children and the high risk of central obesity are public health concerns. Also, ECIAF can better assess all aspects of childhood malnutrition than conventional measures.

Recent studies have shown that inclusion of eggs in young children’s diet can help meet nutritional requirements associated with cognitive development. This study aims to investigate the effect of egg consumption on early childhood development using Ages and Stages Questionnaire-3 in Burkina Faso.

The study presented here uses data collected during a follow-up of the Un Oeuf-a three-arm clustered randomised controlled trial (RCT), conducted roughly 4 months after the end of the RCT.

This research was conducted in eighteen rural villages within the Kaya Department of the Sanmatenga Province in Burkina Faso.

Participants of this study include a total of 244 children aged between 18 and 33 months, with seventy-eight children in the full intervention group, eighty-three in the partial group, and eighty-three in the control group.

Results show that children with consistent egg consumption (in all months) had a lower odd of falling below the cut-off scores in gross motor (${\rm{OR}} = {\rm 0\!\cdot\!13},{\it P} = \rm{0\!\cdot\!02}$) and personal social skills (${\rm{OR}} = 0\!\cdot\!34,{\it P} =0 \!\cdot\!05$). And a dose–response was established; for each additional egg/week, a 1·9 % increase in scores for problem-solving skills was observed.

Findings from this study contribute to a growing body of evidence that increasing egg consumption among children in low- and middle-income countries (LMIC) can improve growth and development. The study highlights the need for additional research in LMIC to better understand the multifactorial relationship between diet and childhood development.

To explore the meanings that newly arrived refugee adolescents residing in the Southeastern USA attribute to foods.

We used methods from cognitive anthropology to assess whether adolescents from different countries share a cultural model of eating behaviours.

A school-based study in a community in the Southeastern USA.

Adolescents (10–17 years) who arrived in the USA on a refugee visa in the previous year.

Adolescents showed consensus in grouping items and in identifying some foods as associated with adults and others with children. There was evidence of a shared model of eating practices across age, gender and number of siblings. Adolescents who had lived in a refugee camp were significantly different in how they grouped items.

Adolescents from nine countries shared a model of eating behaviours; these patterns are consistent with rapid dietary acculturation within 1 year of arrival or with shared models held from pre-arrival. Our finding that adolescents who recently arrived in the USA generally agree about how foods relate to one another holds promise for generalised nutrition and dietary interventions across diverse adolescent groups.

To co-design support strategies to enable sustainable, healthy, affordable food provision, including waste mitigation practices, in Australian Early Childhood Education and Care (ECEC) settings.

Based on the co-design IDEAS framework (Ideate, DEsign, Assess & Share), this co-design process involved iterative interviews and focus groups with ECEC centre staff and workshops with Nutrition Australia. Interview and workshop themes were coded to the Theoretical Domains Framework (TDF) to develop initial prototypes for support strategies that were further developed and refined in focus groups.

ECEC with onsite food provision, in Victoria, Australia.

ECEC staff and a Victorian Government-funded programme delivered through Nutrition Australia that provides nutrition support to ECEC services.

ECEC staff interviews (n 17) suggested a lack of knowledge on the topic of sustainable healthy food provision and a need for resources and support for all staff and children. Workshops with Nutrition Australia built on interviews and suggested a focus on lower intensity strategies and a suggestion to embed knowledge-related activities into the children’s curriculum. Focus groups (n 8) further informed co-design of strategies, producing a visual representation of sustainable healthy food provision with supporting tips and a whole-of-centre approach that includes children through a classroom activity.

The co-designed resources could provide feasible strategies for the adoption of sustainable, healthy and affordable provision practices in the ECEC setting. Involvement of a local government-funded health promotion service provides valuable research-to-practice contribution as well opportunity for scalable dissemination of resources through existing infrastructure.

For the past three decades, India has implemented several nutrition programmes to address malnutrition in the under-fives. To understand the programme’s impact, this study assesses the prevalence of acute malnutrition, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM), using mid-upper arm circumference (MUAC) among tribal children.

The survey was conducted in two tribal blocks (Desaiganj and Bhamragad) of the Gadchiroli district in Maharashtra to identify children registered in the ‘Anganwadi’ program.

A community-based cross-sectional survey was carried out.

The total sample size was 1055 children (aged 0–59 months).

The overall prevalence of SAM and MAM was 1·4 % (n 15) and 9·8 % (n 103). A higher prevalence of MAM was found in males (38·5 %, n 40) and females (27·1 %, n 28) in below 6 months. Additionally, a higher prevalence of MAM was observed in females (10·7 %, n 113) compared with males (9·0 %, n 95). The prevalence of SAM was significantly (P < 0·001) higher in females (1·7 %, n 18) than in males (1·0 %, n 11). Children aged between 12 and 17 months were sixteen times more likely (OR = 16·9, P < 0·001, CI = 4·8, 59·6) to have MAM (MUAC < 12·5 cm) than children aged between 6 and 11 months. Children from the Desaiganj block were significantly less likely (OR = 0·4, P < 0·001, CI = 0·2, 0·7) to have MAM compared with children from Bhamragad. Approximately 4 % (n 42) of children were classified as critically malnourished.

There is an urgent need for block-level monitoring of MAM and SAM, as well as evaluation of existing nutrition programmes, to address the disparity in the sex-specific prevalence of MAM and SAM in tribal areas.

To characterise the nature of digital food and beverage advertising in Singapore.

Food and beverage advertisements within twenty clicks on the top twelve non-food websites and all posts on the Facebook and Instagram pages of fifteen major food companies in Singapore were sampled from 1 January to 30 June 2018.

Advertised foods were classified as being core (healthier), non-core or mixed dishes (e.g. burger) using the WHO nutrient profile model and national guidelines. Marketing techniques were assessed using published coding frameworks.

NA

Advertisements (n 117) on the twelve non-food websites were largely presented as editorial content. Food companies posted twice weekly on average on social media sites (n 1261), with eatery chains posting most frequently and generating the largest amount of likes and shares. Key marketing techniques emphasised non-health attributes, for example, hedonic or convenience attributes (85 % of advertisements). Only a minority of foods and beverages advertised were core foods (non-food website: 16·2 %; social media: 13·5 %).

Top food and beverage companies in Singapore actively use social media as a platform for promotion with a complex array of marketing techniques. A vast majority of these posts were unhealthy highlighting an urgent need to consider regulating digital food and beverage advertising in Singapore.

The adoption of policies promoting healthier restaurant food environments is contingent on their acceptability. Limited evidence exists regarding individual characteristics associated with restaurant food environment policy acceptability, especially health-related characteristics. This study examined associations between health characteristics and restaurant food environment policy acceptability among urban Canadians.

Links between health characteristics and complete agreement levels with selected policies were examined using data in the cross-sectional Targeting Healthy Eating and Physical Activity survey study, that is, a large pan-Canadian study on policy acceptability. For each policy, several logistic multilevel regression analyses were conducted.

Canada’s seventeen most populated census metropolitan areas.

Urban Canadian adults responded to the survey (n 27 162).

Body mass index was not associated with acceptability after adjustments for other health and sociodemographic characteristics were made. Across all policies and analyses, those reporting excellent or very good health statuses were more likely to be in complete agreement with targeted policies than those with good health statuses. For selected policies and analyses, those reporting poor health statuses were also more likely to be in complete agreement than those describing their health status as good. For all policies and analyses, both those consuming restaurant-prepared foods daily and those never consuming these foods were more likely to be in complete agreement than those consuming these foods once per week.

More research is needed to explain discrepancies in acceptability according to health characteristics. Bringing this study’s findings to the attention of policymakers may help build momentum for policy enactment.

To develop a web-based food-frequency questionnaire (FFQ) measuring intake of plant-based protein foods (PBP) among older adults from the province of Quebec, Canada.

The questionnaire was adapted from an existing self-administered FFQ and first underwent expert panel evaluation for face and content validity. Then, three phases of cognitive testing were conducted in French, using the probe and think aloud approaches. Between each phase, the questionnaire was modified based on participants’ feedback to improve the clarity and comprehension of the questions.

Quebec City, Quebec, Canada.

Twenty adults aged 65 years and older participated. Purposive sampling was used to maximise variation in sociodemographic characteristics, including gender, age, education level and PBP consumption.

The expert panel found the twenty-eight-item questionnaire to be a comprehensive measure of PBP intake and suggested minor changes to improve its clarity. The cognitive interviews showed that our PBP-FFQ was generally well understood and identified issues requiring modifications to improve comprehension and accuracy.

Our FFQ provides a comprehensive measure of PBP intake, is well understood by older adults in Québec and will support rigorous assessment of PBP intake in this population but requires further validation to confirm its validity and reproducibility.

To examine the proportion of products offered by leading food brands in Canada that are ‘unhealthy’ according to Health Canada’s (HC) nutrient profile model for proposed restrictions on food marketing to children (M2K-NPM).

Nutritional information for products offered by top brands was sourced from the University of Toronto FLIP and Menu-FLIP 2020 databases, respectively. HC’s M2K-NPM, which includes thresholds for Na, total sugars and saturated fat, was applied to products.

Canada.

Overall, 1385 products from top breakfast cereal (n 15 brands, n 222 products), beverage (n 21 brands, n 769 products) and yogurt (n 10 brands, n 394 products) brands, and 3153 menu items from seventeen chain restaurants in Canada were assessed (n 60 unique brands overall).

For 42 % of brands (n 21), 100 % of their products exceeded ≥1 nutrient threshold(s), with ≥50 % of the products offered by twenty-three brands (46 %) exceeding two thresholds. Specifically, one or more nutrient thresholds were exceeded by ≥50 % of the products offered by 14/15 breakfast cereal brands, 18/21 beverage brands, all ten yogurt brands and all seventeen restaurant brands. Notably, 100·0 % of the products offered by ten breakfast cereal, six beverage, two yogurt and three restaurant brands exceeded ≥1 threshold(s).

Most products offered by top food brands in Canada exceeded HC’s M2K-NPM thresholds. Nonetheless, these brands could still be marketed under the proposed regulations, which exclude brand marketing (i.e. promotions without an identifiable product) despite its contribution to marketing power. These findings reinforce the need for Canada and other countries to include brand marketing in M2K policies.

To identify patterns of food taxes acceptability among French adults and to investigate population characteristics associated with them.

Cross-sectional data from the NutriNet-Santé e-cohort. Participants completed an ad hoc web-based questionnaire to test patterns of hypothetical food taxes acceptability (i.e. overall perception combined with reasons for supporting or not) on eight food types: fatty foods, salty foods, sugary foods, fatty and salty foods, fatty and sugary products, meat products, foods/beverages with unfavourable front-of-pack nutrition label and ‘ultra-processed foods’. Sociodemographic and anthropometric characteristics and dietary intakes (24-h records) were self-reported. Latent class analysis was used to identify patterns of food taxes acceptability.

NutriNet-Santé prospective cohort study.

Adults (n 27 900) engaged in the French NutriNet-Santé e-cohort.

The percentage of participants in favour of taxes ranged from 11·5 % for fatty products to 78·0 % for ultra-processed foods. Identified patterns were (1) ‘Support all food taxes’ (16·9 %), (2) ‘Support all but meat and fatty products taxes’ (28·9 %), (3) ‘Against all but UPF, Nutri-Score and salty products taxes’ (26·5 %), (4) ‘Against all food taxes’ (8·6 %) and (5) ‘No opinion’ (19·1 %). Pattern 4 had higher proportions of participants with low socio-economic status, BMI above 30 kg/m2 and who had consumption of foods targeted by the tax above the median.

Results provide strategic information for policymakers responsible for designing food taxes and may help identify determinants of support for or opposition to food taxes in relation to individual or social characteristics or products taxed.

Free school meals (FSM) are a crucial form of support for families. This study aimed to investigate whether the FSM allowance can provide what is perceived to be, healthy, sustainable and satisfying food.

A mixed methods study incorporating co-production, citizen science and participatory approaches was conducted. Citizen scientists were given a daily budget equivalent to the FSM allowance and asked to purchase a ‘tasty, healthy and sustainable’ school lunch for a week. Alongside keeping records of available and purchased foods, young people engaged in focus groups to capture information on perceptions of food offered and FSM allowance adequacy.

Secondary schools in Yorkshire, UK.

Citizen scientists (n 42) aged 11–15 years across seven schools.

Obstacles were faced in obtaining sustainable and healthful meals when restricted to an FSM allowance. Reasons included restrictions in what could be purchased due to costs, limitations in the use of allowances that restricted breaktime purchases leading to hunger, inadequate portion sizes, systemic barriers like hurried lunch breaks that encourage ‘grab and go’ options and broken water fountains that led students to purchase bottled drinks. Findings were reinforced by descriptive food record data.

Our findings suggest that schools would benefit from national policies to address the lack of funding, infrastructure issues and capacity to support optimal provision of food to those on FSM as well as provide greater flexibility in how pupils use their allowance. Young people verified these findings, which they presented to policymakers at a parliamentary event.

To investigate the relationship between maternal age and nutritional status, and test associations between maternal nutritional status and child mortality with a focus on maternal obesity.

Secondary analysis of data from nationally representative cross-sectional sample of women of reproductive ages (15–49 years) and their children under 5 years. The outcome variable for maternal nutritional status was BMI, classified into underweight (BMI < 18·50 kg/m2), normal weight (18·50–24·99 kg/m2), overweight (25·0–29·9 kg/m2) and obesity (>=30·0 kg/m2). Child mortality was captured with five binary variables measuring the risk of dying in specific age intervals (neonatal, post-neonatal, infant, childhood and under-five mortality).

The most recent Demographic and Health Surveys from Democratic Republic of Congo (DRC).

The final samples consisted of 7892 women of reproductive ages (15–49 years) and 19 003 children aged 0–59 months.

The prevalence of obesity was estimated at 3·4 %; it increased with maternal age. Furthermore, obesity unevenly affected provinces in the Democratic Republic of the Congo: Kinshasa, South Kivu, North Kivu and Maniema were most affected. Finally, maternal obesity showed mixed effects on child mortality.

The prevalence of obesity is still low; however, provinces are unevenly affected. Therefore, interventions and programmes to improve nutrition should incorporate geographical disparities to tackle adverse child outcomes associated with maternal obesity, to limit negative consequences of maternal obesity, including non-communicable diseases which might be a strong impediment to reach Sustainable Development Goals (SDG) 2 and 3.