This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age.

Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children’s BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years).

Population based.

Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old.

At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively.

Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother’s education level or age, which is important in community-based interventions.

Describe how dietary intake patterns of US young adults align with the EAT-Lancet Planetary Health Diet (PHD) sustainable diet goals and identify personal, behavioural, and socio-environmental correlates of sustainable intake.

Data on past-year dietary intake were captured using a FFQ. The PHD was applied to specific food groups, and a total PHD score was calculated. Linear regression models were used to identify associations between personal, behavioural and socio-environmental factors and PHD scores.

This cross-sectional analysis uses data from the second wave of EAT 2010–2018 (Eating and Activity over Time), a population-based longitudinal study recruited in Minnesota.

Ethnically/racially diverse group of participants (n 1308) with a mean age of 22·1 (sd 2·0) years.

The mean PHD score was 4·1 (sd 1·4) on a scale of 0–14, with 14 representing the most sustainable. On average, participants consumed fewer whole grains, fish, legumes, soya, and nuts than ideal for a sustainable diet, and an excess of eggs, added sugar, and meat. The PHD score was higher for participants with higher socio-economic status (SES) and greater educational attainment. Higher home availability of healthy food (β = 0·24, P < 0·001) and less frequent fast-food consumption (β = –0·26, P < 0·001) were the strongest correlates of PHD scores.

Results suggest that a high percentage of participants may not be achieving the sustainable diet goals defined by the PHD. Reductions in meat consumption and increases in plant-based foods are necessary to increase the sustainability of US young adults’ diets.

To identify the regulatory governance factors that lead to food policies achieving improvements in food environment, consumer behaviour and diet-related health outcomes.

Qualitative comparative analysis (QCA) was used to investigate the relationship between regulatory governance conditions and population nutrition outcomes. The regulatory governance conditions examined entailed: high industry involvement in the policy process, regulatory design, policy instrument design, policy monitoring and enforcement.

n 29 policy cases in the policy areas of food reformulation, nutrition labelling, food taxation and food marketing.

Policies implemented in thirteen countries.

Comprehensive monitoring was identified as a necessary regulatory governance condition for food policies to have an impact and was present in 94 % of policy cases that had a positive impact on nutrition outcomes. We identified two sufficient combinations of regulatory governance conditions. The first sufficient combination of conditions comprised an absence of high industry involvement in the policy process, combined with the presence of strict regulatory design, best-practice instrument design, and comprehensive monitoring and enforcement. Ninety-six percent of policy cases with positive impacts on nutrition outcomes displayed this combination. The second sufficient combination of conditions comprised an absensce of high industry involvement in the policy process, best practice instrument design and comprehensive monitoring. Eighty-two percent of policy cases with positive impacts on nutrition outcomes displayed this combination.

These findings show the importance of regulatory governance on policy outcomes. They suggest a need for more government-led nutrition policy processes and transparent monitoring systems that are independent from industry.

To make a tentative assessment of the consumption of cassava in three countries in South-east Asia and the cyanogenic potential (CNp) of the crop as a possible food safety issue.

We used data from the Ministry of Health in Vietnam and Statistics Authorities in Indonesia and Philippines (mean household consumption per province) to assess cassava consumption. Conversions of units were needed to facilitate the comparison of cassava consumption between countries. The most up-to-date data available regarding both cassava consumption and the CNp of cassava grown in the respective countries were assessed.

Vietnam, Indonesia and Philippines.

Respondents from provinces in Vietnam (nineteen), Indonesia (thirty-three) and Philippines (eighty-one) were asked to complete a recall questionnaire detailing either the previous 24-h’ or the 7-d’ cassava consumption.

Among the three countries, available data indicated that the highest median cassava-consumption figures percapita were from Indonesia and the Philippines (9·01 and 7·28 g/capita per d, respectively), with Vietnam having the least (1·14 g/capita per d). Published information regarding the CNp of cassava in the three countries was limited.

While the findings of the present study are somewhat limited by a lack of available information regarding both the extent of cassava consumption and the CNp of cassava consumed in the three countries, it appears likely that cyanogen intake arising from cassava consumption among the three countries exceeds the FAO/WHO Provisional Maximum Tolerable Daily Intake, although any risk to public health appears limited to a minority of provinces in each country.

To investigate food insecurity and related coping strategies, and their associations with the risk of anxiety and depression, among South African households with children.

Nationally representative cross-sectional study. Tools for assessing food insecurity, coping strategies, risk of anxiety and depression were assessed from the Community Childhood Hunger Identification Project, Coping Strategies Index, Generalised Anxiety Disorder-7 and Patient Health Questionnaire-9, respectively. We used ordered logistic regression to test associations of food insecurity and coping strategies with the risk of anxiety and depression. Moderating effects of each coping strategy were tested in the associations of food insecurity with anxiety and depression.

South Africa, post COVID-19 restrictions, May–June 2022.

1,774 adults, weighted to 20,955,234 households.

Food insecurity prevalence was 23·7 % among households with children. All coping strategies were used to some extent, but relying on less preferred and less expensive foods was the most used strategy (85·5 % of food-insecure households). Moving to a higher level of food insecurity was associated with >1·6 greater odds of being in a higher risk of anxiety and depression. Sending a household member to beg for food was the strongest associated factor (OR = 1·7, P < 0·001). All coping strategies partly moderated (lessened) the associations of food insecurity with a higher risk of anxiety and depression.

Food insecurity among households with children was high following the COVID-19 pandemic. Collaborative efforts between government, private sector and civil society to eradicate food insecurity should prioritise poorer households with children, as these populations are the most vulnerable.

In the field of nutritional epidemiology, principal component analysis (PCA) has been used extensively in identifying dietary patterns. Recently, compositional data analysis (CoDA) has emerged as an alternative approach for obtaining dietary patterns. We aimed to directly compare and evaluate the ability of PCA and principal balances analysis (PBA), a data-driven method in CoDA, in identifying dietary patterns and their associations with the risk of hypertension.

Cohort study. A 24-h dietary recall questionnaire was used to collect dietary data. Multivariate logistic regression analysis was used to analyse the association between dietary patterns and hypertension.

2004 and 2009 China Health and Nutrition Survey.

A total of 3892 study participants aged 18–60 years were included as the subjects.

PCA and PBA identified five patterns each. PCA patterns comprised a linear combination of all food groups, whereas PBA patterns included several food groups with zero loadings. The coarse cereals pattern identified by PBA was inversely associated with hypertension risk (highest quintile: OR = 0·74 (95 % CI 0·57, 0·95); Pfor trend = 0·037). None of the five PCA patterns was associated with hypertension. Compared with the PCA patterns, the PBA patterns were clearly interpretable and accounted for a higher percentage of variance in food intake.

Findings showed that PBA might be an appropriate and promising approach in dietary pattern analysis. Higher adherence to the coarse cereals dietary pattern was associated with a lower risk of hypertension. Nevertheless, the advantages of PBA over PCA should be confirmed in future studies.

To assess the short- and long-term effectiveness of a lottery incentive intervention to promote the purchase of healthy products in school cafeterias.

A quasi-experiment in which students’ purchases in intervention schools were analysed in a pre–post analysis and also compared with a control school in a difference-in-differences model. A hierarchical linear model assessed the mean number of promoted healthy products purchased daily per participant before (twenty-six weekdays), during (nine weekdays) and after (twenty-eight weekdays) the intervention period. Sex, age and prior purchasing behaviour served as covariates.

Convenience sample of school cafeterias using a debit-card payment method that allowed for the assessment of students’ purchasing behaviour.

Students who used the pre-paid card to buy snacks at the school cafeteria. A total of 352 students (208 in intervention schools and 144 in control school) were included in the final analyses.

The incentives programme significantly increased the purchase of promoted healthy products during (v. before) the intervention period in intervention schools (P<0·001), especially among younger children (P=0·036). Among the students who purchased the promoted healthier products during the intervention, there was an increase in total number of purchased products (healthy non-promoted, but also of less healthy products). Sex and past consumption behaviour did not influence the response to incentives in the short term. On average, no long-term effect was observed.

Long-term and negative spillover effects must be taken into consideration for a complete understanding of the effects of incentives on healthier eating.

Measurement of mean population Na and K intakes typically uses laboratory-based assays, which can add significant logistical burden and costs. A valid field-based measurement method would be a significant advance. In the current study, we used 24 h urine samples to compare estimates of Na, K and Na:K ratio based upon assays done using the field-based Horiba twin meter v. laboratory-based methods.

The performance of the Horiba twin meter was determined by comparing field-based estimates of mean Na and K against those obtained using laboratory-based methods. The reported 95 % limits of agreement of Bland–Altman plots were calculated based on a regression approach for non-uniform differences.

The 24 h urine samples were collected as part of an ongoing study being done in rural China.

One hundred and sixty-six complete 24 h urine samples were qualified for estimating 24 h urinary Na and K excretion.

Mean Na and K excretion were estimated as 170·4 and 37·4 mmol/d, respectively, using the meter-based assays; and 193·4 and 43·8 mmol/d, respectively, using the laboratory-based assays. There was excellent relative reliability (intraclass correlation coefficient) for both Na (0·986) and K (0·986). Bland–Altman plots showed moderate-to-good agreement between the two methods.

Na and K intake estimations were moderately underestimated using assays based upon the Horiba twin meter. Compared with standard laboratory-based methods, the portable device was more practical and convenient.

Given the aggressive marketing of foods and beverages to teenagers on digital platforms, and the paucity of research documenting teen engagement with food marketing and its persuasive content, the objective of this study is to examine what teenagers see as teen-targeted food marketing on four popular digital platforms and to provide insight into the persuasive power of that marketing.

This is an exploratory, participatory research study, in which teenagers used a special mobile app to capture all teen-targeted food and beverage marketing they saw on digital media for 7 d. For each ad, participants identified the brand, product and specific appeals that made it teen-targeted, as well as the platform on which it was found.

Online (digital media) with teenagers in Canada.

Two hundred and seventy-eight teenagers, aged 13–17 years, were participated. Most participants were girls (63 %) and older teenagers (58 % aged 16–17 years).

Participants captured 1392 teen-targeted food advertisements from Instagram, Snapchat, TikTok and YouTube. The greatest number of food marketing examples came from Instagram (46 %) (with no difference across genders or age), while beverages (28·7 %), fast food (25·1 %) and candy/chocolate were the top categories advertised. When it comes to persuasive power, visual style was the top choice across all platforms and participants, with other top techniques (special offer, theme and humour), ranking differently, depending on age, gender and platform.

This study provides insight into the nature of digital food marketing and its persuasive power for teenagers, highlighting considerations of selection and salience when it comes to examining food marketing and monitoring.

Adequate energy and nutrient intakes are important for workers who spend at least one-third of their day working. We investigated differences in these intakes among Korean workers because few studies have reported on energy or nutrient intakes, related to working conditions (long working hours, shift work and non-standard work).

Dietary intake was assessed using 1-d 24-h recall. Energy and nutrient intakes were evaluated using age- and sex-specific dietary reference intakes for Korean citizens. Occupational characteristics were obtained from self-reported Korean National Health and Nutritional Examination Survey (KNHANES) data (occupational classification, working hours, shift work and non-standard workers). An age, education and household income-adjusted logistic regression model was applied to investigate differences in inappropriate energy and nutrient intakes, by sex and occupation.

Cross-sectional study.

From KNHANES (2007–2016), 11 145 participants (5401 males; 5744 females) were included, finally.

Males with long working hours had higher inappropriate carbohydrate, protein, water, vitamin B2 and phosphate intakes than those who worked ≤60 h/week. Long working hours among females were significantly associated with total energy and nutrient ‘under-intake’. Male shift and non-standard workers had higher inappropriate protein, water, mineral and vitamin intakes. Multivariate logistic regression revealed that white- and male pink-collar workers had significantly increased risks of water and vitamins A, C, B1 and niacin ‘under-intake’.

We found different rates of inappropriate energy and micronutrient intakes according to working conditions. Younger workers with long hours and shift work schedules were vulnerable to inappropriate energy and nutrient intakes.

To examine changes in the spatial clustering of malnutrition in children under 5 years of age (under-5s) for the period 1999 to 2011 in Bangladesh.

We used data from four nationally representative Demographic and Health Surveys (DHS) conducted in 1999–2000, 2004, 2007 and 2011 in Bangladesh involving a total of 24 211 under-5s located in 1661 primary sampling units (PSU; geographical unit of analysis) throughout Bangladesh. The prevalence of stunting (height/length-for-age Z-score <−2), underweight (weight-for-age Z-score <−2) and wasting (weight-for-height/length Z-score <−2) at each PSU site and for each survey year were estimated based on the WHO child growth standard. The extent of spatial clustering was quantified using semivariograms.

Whole of Bangladesh.

Children under 5 years of age.

Our results demonstrate that in 1999–2000 most PSU throughout Bangladesh experienced stunting, underweight and wasting prevalence which exceeded the WHO thresholds. By 2011, this situation improved, although in two of the six divisions (Barisal and Sylhet) PSU still exhibited higher levels of malnutrition compared with other divisions of the country. The pattern of spatial clustering for stunting, underweight and wasting also changed between 1999 and 2011 both at national and sub-national (division) levels.

We identified divisions where malnutrition indicators (stunting, underweight and wasting) remain highly clustered and other divisions where they are more widely spread in Bangladesh. This has important implications on how interventions for malnutrition need to be delivered (geographically targeted interventions v. random interventions) within each division of the country.

Survival rates for paediatric cancers have increased dramatically since the 1970s, but childhood cancer survivors (CCS) are at increased risk for several chronic diseases throughout life. Nutrition interventions promoting healthy family meals may support wellness for survivors, but little research has explored CCS family food preparation habits. The goal of the present study was to describe and compare food preparation practices of CCS and non-CCS families.

Observational.

Typical evening meal preparation events were observed and recorded in participant homes. Recordings and notes were analysed using the Healthy Cooking Index (HCI), a measure of nutrition-optimizing food preparation practices relevant to survivor wellness. Demographics, BMI and nutrient composition of prepared meals were also collected.

Forty parents with a CCS or non-CCS child aged 5–17 years were recruited.

There were no major differences between the CCS and non-CCS families with regard to summative HCI score or specific food preparation behaviours. Meals prepared by CCS and non-CCS families had similar nutrient compositions.

The study revealed areas for practical nutrition intervention in CCS and non-CCS families. Future studies should consider adopting and tailoring nutrition intervention methods that have been successful in non-CCS communities.

To estimate the prevalence of thinness, overweight and obesity among Tibetan adolescents aged 12–17 years.

Cross-sectional survey.

Shigatse City of Tibet municipality, with an average altitude of more than 4000 m.

Study participants included 2642 adolescents aged 12–17 years selected from six schools using a convenient cluster sampling method.

The prevalence of thinness/overweight/obesity among Tibetan adolescents was 9·4 %/5·4 %/1·4 % (China definition), 14·7 %/4·4 %/0·7 % (International Obesity Task Force (IOTF) definition), and 2·8 %/5·7 %/0·9 % (WHO definition). The prevalence of thinness and overweight was significantly different between both sexes based on each of three BMI classification criteria (P < 0·001). There was no significant difference in the prevalence of obesity between both sexes according to each of three BMI criteria. There was no clear trend in the prevalence of thinness across ages according to the China or IOTF definition (both P > 0·05), whereas an upward trend was observed for thinness in boys according to the IOTF definition (P for trend <0·05). In contrast, the prevalence of thinness tended to decrease with increasing age in girls according to the IOTF definition and in total sample according to the WHO definition (P for trend <0·05).

Among Tibetan adolescents, the prevalence of overweight and obesity is relatively low, while the prevalence of thinness is high, especially in boys. These data suggest urgent attention is needed to control adolescent thinness in Tibet.

To investigate dietary and non-dietary characteristics of wholegrain bread eaters in the Norwegian Women and Cancer study.

Cross-sectional study using an FFQ.

Women were divided into two groups according to wholegrain bread consumption.

Adult women (n 69 471).

Median daily consumption of standardized slices of wholegrain bread was 2·5 in the low intake group and 4·5 in the high intake group. The OR for high wholegrain bread consumption was 0·28, 2·19 and 4·63 for the first, third and fourth quartile of energy intake, respectively, compared with the second quartile. Living outside Oslo or in East Norway and having a high level of physical activity were associated with high wholegrain bread consumption. BMI and smoking were inversely associated with wholegrain bread consumption. Intake of many food items was positively associated with wholegrain bread consumption (P trend <0·01). After adjustment for energy intake, consumption of most food items was inversely associated with wholegrain bread consumption (P trend <0·001). The mean intakes of thiamin and Fe were higher in those with high wholegrain bread consumption, even after taking energy intake into account.

Energy intake was strongly positively associated with wholegrain bread consumption. Geographical differences in wholegrain bread consumption were observed. Our study suggests that women with high wholegrain bread consumption do not generally have a healthier diet than those who eat less wholegrain bread, but that they tend to be healthier in regard to other lifestyle factors.

To examine the difference in the rehabilitation rate from underweight by child age at enrolment in the Positive Deviance (PD)/Hearth programme.

This secondary data analysis used programme monitoring records of underweight children aged 6–60 months attending a 2-week PD/Hearth session and followed up for 6 months from September 2018 to March 2019. Data were analysed using multilevel mixed-effect regression and Poisson regression with robust variance.

Rajshahi Division, Bangladesh.

A total of 5227 underweight (weight-for-age Z-score (WAZ) <-2) children attended the PD/Hearth sessions.

From enrolment to 6 months follow-up, the mean WAZ improved from −2·80 to −2·09, and the percentage of underweight children decreased to 54·5 %. Compared to the enrolment age of 6–11 months, the estimated monthly change in WAZ at 6 months of follow-up were 0·05 lower for 12–23 months, 0·06 lower for 24–35 months, and 0·09 lower for 36–60 months of the enrolment age (all P < 0·001). The probability of rehabilitation at 6 months of follow-up were lower by 16·7 % for 12–23 months (RR = 0·83; 95 % CI 0·77, 0·91), 15·5 % for 24–35 months (RR = 0·84; 95 % CI 0·78, 0·92), and 34·9 % for 36–60 months of the enrolment age (RR = 0·65; 95 % CI 0·59, 0·72), compared to the enrolment age of 6–11 months.

Enrolment in the PD/Hearth programme at a younger age had the advantage of greater rehabilitation from underweight than older age. Our findings provide a better understanding of the successes and failures of the PD/Hearth programme to achieve more sustainable and cost-effective impacts.

Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.

A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.

USA.

Toddlers aged 1–3 years, n 559; children aged 4–12 years, n 1540; adolescents aged 13–18 years, n 992; and adults aged ≥19 years, n 576.

Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2–82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.

Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.

To investigate the association between the intake of n-6 PUFA and subsequent change in body weight and waist circumference at different levels of the carbohydrate:protein ratio.

Follow-up study with anthropometric measurements at recruitment and on average 5·3 years later. Dietary intake was determined at recruitment by using an FFQ that was designed for the study and validated. We applied linear regression models with 5-year change in weight or waist circumference as outcome and including a two-way interaction term between n-6 PUFA and carbohydrate intakes, lower-order terms, protein intake, long-chain n-3 PUFA intake and other potential confounders. Due to adjustment for intake of protein, levels of carbohydrate indirectly reflect levels of the carbohydrate:protein ratio.

Diet, Cancer and Health follow-up study, Denmark.

Women and men (n 29 152) aged 55 years.

For a high intake of n-6 PUFA (6·9 % of energy) v. a low intake of n-6 PUFA (3·4 % of energy), the difference in 5-year weight change was −189·7 g (95 % CI −636·8, 257·4 g) at a low carbohydrate:protein ratio and −86·7 g (95 % CI −502·9, 329·6 g) at a high carbohydrate:protein ratio; the differences in 5-year waist circumference change were 0·26 cm (95 % CI −0·47, 0·98 cm) and −0·52 cm (95 % CI −1·19, 0·15 cm), respectively. Inclusion of the dietary glycaemic index did not change the results.

No consistent associations between the intake of n-6 PUFA and change in body weight or waist circumference at different levels of the carbohydrate:protein ratio were observed.