In 2019, California and Wilmington, Delaware‘ implemented policies requiring healthier default beverages with restaurant kids’ meals. The current study assessed restaurant beverage offerings and manager perceptions.

Pre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t tests. Post-implementation, managers were interviewed.

Inside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7–12 months after policy implementation.

Restaurant observations (California n 110; Wilmington n 14); managers (California n 75; Wilmington n 15).

Pre-implementation, the most common kids’ meal beverages on California menus were unflavoured milk and water (78·8 %, 52·0 %); in Wilmington, juice, milk and sugar-sweetened beverages were most common (81·8 %, 66·7 % and 46·2 %). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9·7 % to 66·1 %, P < 0·0001), but remained constant in Wilmington (30·8 %). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5·0 % to 1·0 %, P = 0·002). Few managers (California 29·3 %; Wilmington 0 %) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff.

While the proportion of menus offering only policy-consistent kids’ meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions, managers lacked policy knowledge, and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids’ meal beverage policies.

To investigate: (i) how lunch frequency of adolescents varies between schools and between classes within schools; (ii) the associations between frequency of lunch and individual sociodemographic factors and school characteristics; and (iii) if any observed associations between lunch frequency and school characteristics vary by gender and age groups.

Cross-sectional study in which students and school headmasters completed self-administered questionnaires. Associations were estimated by multilevel multivariate logistic regression.

The Danish arm of the Health Behaviour in School-Aged Children study 2010.

Students (n 4922) aged 11, 13 and 15 years attending a random sample of seventy-three schools.

The school-level and class-level variations in low lunch frequency were small (intraclass correlation coefficient <2·1 %). At the individual level, low lunch frequency was most common among students who were boys, 13- and 15-year-olds, from medium and low family social class, descendants of immigrants, living in a single-parent family and in a reconstructed family. School-level analyses suggested that having access to a canteen at school was associated with low lunch frequency (OR=1·47; 95% CI 1·14, 1·89). Likewise not having an adult present during lunch breaks was associated with low lunch frequency (OR=1·44; 95% CI 1·18, 1·75). Cross-level interactions suggested that these associations differed by age group.

Lunch frequency among Danish students appears to be largely influenced by sociodemographic factors. Additionally, the presence of an adult during lunch breaks promotes frequent lunch consumption while availability of a canteen may discourage frequent lunch consumption. These findings vary between older and younger students.

To evaluate the correlation among nutritional status, tooth wear and quality of life in Brazilian schoolchildren.

The study followed a cross-sectional design. Nutritional status was measured via anthropometry using BMI and tooth wear was measured using the Dental Wear Index; both these assessments were carried out by a trained recorder according to standard criteria. A modified version of the Child Oral Impacts on Daily Performances was used to assess quality of life.

City of Bauru, in Brazil.

A cluster sample of 396 schoolchildren (194 boys and 202 girls) aged 7–10 years.

The anthropometric assessment showed similar situations for both sexes regarding underweight (31·40 % in boys and 30·20 % in girls) and overweight/obesity (33·96 % in boys and 33·17 % in girls). The underweight children showed a greater severity of tooth wear in the primary teeth (OR=0·72; CI 0·36, 1·42), although in the permanent dentition the obese children had a greater severity of tooth wear (OR=1·42; 95 % CI 0·31, 6·55). The tooth wear was correlated with age for both dentitions.

Tooth wear in the primary and permanent dentition may be related to nutritional status. Tooth wear and obesity did not have a significant impact on the schoolchildren’s perception of quality of life.

Few studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD).

A retrospective cohort study.

The largest regional hospital renowned for haemodialysis in northern Taiwan.

A total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated.

The rate of overall use of rhEPO, vitamin D3 or Fe therapy was 62 %. The 10-year survival rate in patients with rhEPO supplementation was statistically more favourable than that in patients without rhEPO (hazard ratio (HR) = 0·38, 95 % CI 0·30, 0·47, P < 0·0001). Similar findings were noted for patients receiving vitamin D3 (HR = 0·36, 95 % CI 0·21, 0·64, P = 0.0004) and Fe (HR = 0·45, 95 % CI 0·33, 0·61, P < 0·0001). After adjusting for age, education and aetiology, the administration of rhEPO resulted in statistically significant improvements in long-term survival rate either with (HR = 0·30, 95 % CI 0·22, 0·42) or without (HR = 0·48, 95 % CI 0·38, 0·61) combined use of Fe or vitamin D3.

We demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D3 and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.

Obesity as well as job strain is increasing, and job strain might contribute to weight gain. The objective of the current study was to examine associations between longitudinal alterations in the components of job strain and subsequent weight gain.

The study was designed as a prospective cohort study with three questionnaire surveys enabling measurement of job-strain alterations over 6 years and subsequent measurements of weight gain after further 10 years of follow-up. ANCOVA and trend analyses were conducted. Job demands were measured as job busyness and speed, and control as amount of influence.

Employed nurses in Denmark.

We included a sub-sample of 6188 female nurses from the Danish Nurse Cohort, which consisted of the nurses who participated in surveys in 1993, 1999 and 2009.

A linear trend in weight gain was seen in nurses who were often busy in 1999 between those who were rarely v. sometimes v. often busy in 1993 (P=0·03), with the largest weight gain in individuals with sustained high busyness in both years. Loss of influence between 1993 and 1999 was associated with larger subsequent weight gain than sustained high influence (P=0·003) or sustained low influence (P=0·02). For speed, no associations were found.

Busyness, speed and influence differed in their relationship to subsequent weight gain. A decrease in job influence and a sustained burden of busyness were most strongly related to subsequent weight gain. Focus on job strain reduction and healthy diet is essential for public health.

To study the total goitre rate (TGR), urinary iodine concentration (UIC) and salt iodine content among schoolchildren in a previously endemic area for severe iodine deficiency disorder (IDD).

Cross-sectional epidemiological study.

The study was carried out in the Gonda district (sub-Himalayan region) of North India.

Nine hundred and seventy-seven schoolchildren (6–12 years) were studied for parameters such as height, weight, UIC and salt iodine content. Thyroid volume (TV) was measured by ultrasonography to estimate TGR.

The overall TGR in the study population was 2·8 % (95 % CI 1·8, 3·8). No significant difference in TGR was observed between boys and girls (3·5 % v. 1·9 %, P = 0·2). There was a non-significant trend of increasing TGR with age (P = 0·05). Median UIC was 157·1 μg/l (interquartile range: 94·5–244·9). At the time of the study, 97 % of salt sample were iodised and nearly 86 % of salt samples had iodine content higher than or equal to 15 part per million. Overall, TGR was significantly lower (2·8 % v. 31·0 %, P < 0·001), and median UIC was significantly higher (157·1 v. 100·0 μg/l, P < 0·05) than that reported in the same area in 2009.

A marked improvement was seen in overall iodine nutrition in the Gonda district after three and a half decades of Universal Salt Iodisation (USI). To sustainably control IDD, USI and other programmes, such as health education, must be continuously implemented along with putting mechanisms to monitor the programme at regular intervals in place.

Both physical activity (PA) and diet are important contributors to health and well-being; however, there is limited information on the association of these behaviours and whether observed associations differ by weight. The present study aimed to evaluate whether nutrient intake is associated with PA and if this association varies by weight in young adults.

Cross-sectional study to analyse the association between PA and nutrient intake.

Participants were stratified as normal weight (18·5 kg/m2 <BMI <25·0 kg/m2) and overweight/obese (BMI≥25·0 kg/m2). PA level (PAL) was calculated (PAL=total daily energy expenditure/RMR) and used to stratify groups (PAL<1·6, 1·6≤PAL<1·9, PAL≥1·9).

Adults (n 407; age 27·6 (sd 3·8) years, 48 % male), with BMI between 20 and 35 kg/m2, having at least two 24 h diet recalls and at least 5 d (including two weekend days) of valid, objectively measured PA data were included in the analysis.

In normal-weight participants, higher PAL was associated with higher intakes of minerals (except Ca, Fe and Zn), B-vitamins and choline (P for trend <0·05). In the overweight/obese group, higher PAL was associated with higher intakes of fibre, K, Na and Cu (P for trend <0·05). These differences, however, were no longer significant after additionally controlling for total energy intake.

More active young adults have higher intakes of essential micronutrients. The benefits of PA may be predominantly due to a higher overall food intake while maintaining energy balance rather than a healthier diet.

The aim of the study was to assess the potential association between serum 25-hydroxyvitamin D (25(OH)D) and whole-body bone mineral density (BMD) among 16-year-old adolescents and to study the prevalence of 25(OH)D insufficiency, defined as concentration under 50 nmol/l.

A cross-sectional study.

Reykjavik, Iceland, latitude 64°08′N. Measurements took place in the Icelandic Heart Association's research lab during April–June 2015.

In total, 411 students in Reykjavik, Iceland, were invited to participate, 315 accepted the invitation (76·6 %) and 289 had valid data (mainly Caucasian).

25(OH)D < 50 nmol/l was observed in 70 % of girls and 66·7 % of boys. 25(OH)D ≥ 50 nmol/l was significantly associated with higher whole-body BMD after adjusting for the influence of sex, height, fat mass and lean mass. A linear relationship between 25(OH)D and whole-body BMD was significant for 25(OH)D < 50 nmol/l (n 199, P < 0·05) but NS for 25(OH)D ≥ 50 nmol/l (n 86, P = 0·48).

Our results are in line with some but not all previous studies on the relationship between BMD and 25(OH)D in adolescents. The observed difference in BMD between those with above v. below a 25(OH)D concentration of 50 nmol/l was of about a fifth of one SD, which may have a clinical relevance as one SD decrease in volumetric BMD has been associated with a 89 % increase in 2 years risk of fracture. Icelandic adolescents should be encouraged to increase their vitamin D intake as it is possible that their current intake is insufficient to achieve optimal peak bone mass.

The aim of the current study was to establish whether the neighbourhood food environment, characterised by the healthiness of food outlets, the diversity of food outlets and fast-food outlet density within a 500 m or 1000 m street network buffer around the home address, contributed to ethnic differences in diet quality.

Cross-sectional cohort study.

Amsterdam, the Netherlands.

Data on adult participants of Dutch, South-Asian Surinamese, African Surinamese, Turkish and Moroccan descent (n total 4728) in the HELIUS study were analysed.

The neighbourhood food environment of ethnic minority groups living in Amsterdam is less supportive of a healthy diet and of less diversity than that of participants of Dutch origin. For example, participants of Turkish, Moroccan and South-Asian Surinamese descent reside in a neighbourhood with a significantly higher fast-food outlet density (≤1000 m) than participants of Dutch descent. However, we found no evidence that neighbourhood food environment characteristics directly contributed to ethnic differences in diet quality.

Although ethnic minority groups lived in less healthy food environments than participants of ethnic Dutch origin, this did not contribute to ethnic differences in diet quality. Future research should investigate other direct or indirect consequences of residing in less supportive food environments and gain a better understanding of how different ethnic groups make use of their neighbourhood food environment.

To estimate the prevalence of the metabolic syndrome (MS) in a population of patients with overweight and obesity of the A Coruña and Granada health areas, using the definitions of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III) and of the International Diabetes Federation (IDF).

During a period extending from 1996 to 2003, only those patients attending endocrinology outpatient clinics for whom all the anthropometric and biochemical parameters used to define the MS, both according to the ATP IIII and the IDF, were available were selected. The final study sample consisted of 285 patients, 198 females (69.5%) and 87 males (30.5%).

The prevalence of the MS was 29.8% when the ATP III definition was applied, and 41.1% according to the IDF criteria. Prevalence by sex was 32.2% in men and 28.8% in women according to the ATP III, and 42.5% and 40.4%, respectively, according to the IDF.

In a patient population with overweight or obesity, the prevalence of the MS is higher when the IDF criteria, instead of the ATP III criteria, are used. These findings may have significant implications when it comes to addressing early diagnosis of cardiovascular disease and diabetes mellitus in these patients, in order to perform therapeutic measures at the initial stages and thereby reduce metabolic and cardiovascular complications.

The face and construct validity of the Iranian version of the Yale Food Addiction Scale (YFAS) was evaluated, and the convergent validity and test–retest reliability of both Iranian and original versions of YFAS for obese women were assessed.

The internal consistency of the YFAS was analysed. Exploratory factor analysis for dichotomous data was performed by varimax rotation, polychoric correlation coefficients and confirmatory factor analysis (CFA). Convergent validity was established by evaluating the correlation between the original and the Iranian versions of YFAS and the Binge Eating Scale (BES). The intraclass correlation coefficient (ICC) was measured between test–retest results.

A weight management clinic in Tehran.

450 obese women.

The single-factor structure indicated that the factor loadings for all the items were > 0·5, except for three items (explained proportion variance = 51 %). Based on CFA, the single factor had a better fit to the data after excluding three items. The Kuder–Richardson-20 coefficient was 0·86 for the total twenty-two items. The symptom count and diagnostic version of both the Iranian (ICC = 0·92 and 0·87, respectively) and original YFAS (ICC = 0·92 and 0·86, respectively) were stable over 2 weeks. Both the symptom count and the diagnostic version of these two scales had significant correlations with the measures of BES (P < 0·001).

The initial reliability and validity of the Iranian version of the YFAS among obese women are supported. Further studies should be conducted on men and normal/overweight samples.

To investigate whether awareness of the Japanese Food Guide (JFG) can promote changes in eating behaviour.

A longitudinal study was conducted in 2007 and 2009 by means of an Internet-based survey. Awareness status of the JFG and a sixteen-item scale for calculating eating behaviour scores were obtained.

Japan.

In total, 787 Japanese adults (20–59 years) who registered with an Internet research service organization were included in the study. The respondents were divided into three groups. The respondents who were aware of the JFG in 2007 were categorized into Group 1. Those who were not aware of the JFG in 2007 were categorized into either Group 2 or Group 3. Group 2 became aware of the JFG by 2009, and Group 3 was not aware of the JFG in 2009.

In Group 2, the eating behaviour score increased significantly by 0·8 points from 4·7 in 2007 to 5·5 in 2009 (P = 0·004). The eating behaviour score of Group 1 (6·5 points in 2007; 6·3 points in 2009) and Group 3 (3·8 points in 2007; 4·1 points in 2009) did not change significantly from 2007 to 2009.

Awareness of the JFG promoted eating behaviour change in the Japanese population. The results indicate that awareness of nutrition information from sources such as the JFG would promote healthy eating.

The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods.

Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys.

Washington State policy process.

Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers).

In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports.

Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

Food packaging often pictures supplementary extras, such as toppings or frosting, that are not listed on the nutritional labelling. The present study aimed to assess if these extras might exaggerate how many calories† are pictured and if they lead consumers to overserve.

Four studies were conducted in the context of fifty-one different cake mixes. For these cake mixes, Study 1 compared the calories stated on the nutrition label with the calories of the cake (and frosting) pictured on the box. In Studies 2, 3 and 4, undergraduates (Studies 2 and 3) or food-service professionals (Study 4) were given one of these typical cake mix boxes, with some being told that cake frosting was not included on the nutritional labelling whereas others were provided with no additional information. They were then asked to indicate what they believed to be a reasonable serving size of cake.

Laboratory setting.

Undergraduate students and food-service professionals.

Study 1 showed that the average calories of cake and frosting pictured on the package of fifty-one different cake mixes exceed the calories on the nutritional label by 134 %. Studies 2 and 3 showed that informing consumers that the nutritional information does not include frosting reduces how much people serve. Study 4 showed that even food-service professionals overserve if not told that frosting is not included on the nutritional labelling.

To be less misleading, packaging should either not depict extras in its pictures or it should more boldly and clearly state that extras are not included in calorie counts.

It is unknown how well menu labelling schemes that enforce the display of kilojoule (kJ) labelling at point-of-sale have been implemented on online food delivery (OFD) services in Australia. This study aimed to examine the prevalence of kJ labelling on the online menus of large food outlets with more than twenty locations in the state or fifty locations nationally. A secondary aim was to evaluate the nutritional quality of menu items on OFD from mid-sized outlets that have fewer locations than what is specified in the current scheme.

Cross-sectional analysis. Prevalence of kJ labelling by large food outlets on OFD from August to September 2022 was examined. Proportion of discretionary (‘junk food’) items on menus from mid-sized outlets was assessed.

Forty-three unique large food outlets on company (e.g. MyMacca’s) and third party OFD (Uber Eats, Menulog, Deliveroo) within Sydney, Australia. Ninety-two mid-sized food outlets were analysed.

N/A.

On company OFD apps, 35 % (7/23) had complete kJ labelling for each menu item. In comparison, only 4·8 % (2/42), 5·3 % (2/38) and 3·6 % (1/28) of large outlets on Uber Eats, Menulog and Deliveroo had complete kJ labelling at all locations, respectively. Over three-quarters, 76·3 % (345/452) of menu items from mid-sized outlets were classified as discretionary.

Kilojoule labelling was absent or incomplete on a high proportion of online menus. Mid-sized outlets have abundant discretionary choices and yet escape criteria for mandatory menu labelling laws. Our findings show the need to further monitor the implementation of nutrition policies on OFD.

To investigate the ability of each metabolic syndrome (MetS) criterion, defined by the International Diabetes Federation, to predict insulin resistance (IR).

A cross-sectional study. IR was defined as homeostasis model assessment of IR (HOMA-IR) ≥3·04. The MetS criteria considered were TAG ≥ 1·69 mmol/l, HDL cholesterol (HDL-C) <1·29 mmol/l, blood pressure (BP) ≥130/85 mmHg and fasting glucose (FG) ≥5·6 mmol/l.

Busan, South Korea.

Ninety-six apparently healthy Korean women (mean age 42 (sd 10·6) years) with abdominal obesity (waist circumference (WC) ≥80 cm) were studied.

Of the ninety-six obese women, 11 % were insulin-resistant and 33 % fulfilled the criteria for IDF-defined MetS. Glucose and TAG were more likely to predict IR than BP and HDL-C when assessed using receiver-operating characteristic curves, multiple regression and multiple logistic regression analyses. Of the variation in HOMA-IR, TAG, FG, WC and age explained 42 %. High FG was independently associated with the presence of IR (OR = 8·6, 95 % CI 1·8, 41·8) even after adjusting for other components of MetS. The positive predictive value and positive likelihood ratio to detect IR were the highest for the FG criterion (33 % and 3·9, respectively), followed by TAG (28 %, 3·0), BP (19 %, 1·8) and HDL-C criteria (18 %, 1·7). The IDF definition of MetS exhibited a positive predictive value of 29 % and a positive likelihood ratio of 3·1.

Of the MetS criteria, high FG and high TAG seem to be more suitable for identifying obese women with IR than high BP and low HDL-C.

This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and to test its practicality.

This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-h recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analysed by χ2 test, Fisher’s exact test, t-test, Mann–Whitney U test and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model.

Four public residential homes in central region, Thailand.

249 older residents residing in public residential homes and eight intended users.

26·9 % had PEM (serum albumin <3·5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥ 9 types of medicine daily. These predictors were included in PEM screening tool. Regarding the tool performance test, area under the ROC curve was 0·8 (P < 0·001) with sensitivity and specificity of 83·9 and 45·5 %, respectively. For its practicality, eight intended users reported that it was useful and easy to use.

New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.