To assess the role of sociodemographic and nutritional factors in the incidence of births affected by neural tube defects (NTD) in the North Indian population.

Case–control study.

Government hospitals of Delhi, India.

Subjects comprised 284 mothers of NTD children (cases) and 568 mothers of healthy children (controls).

Significant differences were found between case and control mothers with respect to maternal age (P = 0·005), type of drinking water (P = 0·03) and consumption of milk (P = 0·01). Univariate and multivariate analysis suggested an association of unpasteurized milk use, low consumption of vegetables, low consumption of fruits and vegetarian dietary habits with NTD births. Further, variation in the risk factors for upper and lower NTD types was also observed, pointing towards phenotypic heterogeneity in the aetiology.

The results of the present study suggest an increased risk of NTD infants in mothers with low consumption of vegetables, fruits and milk and having vegetarian dietary habits. So, in order to reduce these devastating birth defects in future offspring, better nutritional care should be provided to mothers by suggesting dietary modifications and augmenting additional micronutrient supplementation during the periconceptional period.

Ready to eat fried liver meat balls (LMB) were developed to fight anaemia and vitamin A deficiency and promote cognitive function.

Randomised controlled trial consisting of two arms: control group with no supplement and LMB group receiving LMB supplement three times a week for 90 d. Criteria of evaluations included dietary assessment, anthropometric measurements, laboratory investigations and cognitive function by Wechsler test.

Kinder Garten and primary school in Urban Giza.

Sixty boys and girls aging 3–9 years.

The LMB supplement contributed to significant increases in the intakes of high bioavailable Fe and vitamin A in the diets of all children. Initial overall prevalence of mild and moderate anaemia was 43 %, which disappeared completely from all children aging < 72 months and from 88 % of children ≥ 72 months after the 90 d dietary intervention with the LMB. Faecal systemic immune globulin A, urinary hydroxyproline index and urinary iodine excretion increased significantly (P < 0·05) only after the dietary intervention with the LMB supplement for 90 d. The standard scores of verbal and non-verbal cognitive function tests (Δ day 90–day 0) increased significantly (P < 0·05) among the LMB group compared with the respective changes observed among the control group. The increase in height-for-age Z score and blood Hb were good predictors for improvement in cognitive function.

LMB supplement is effective sustainable nutritious biotherapeutic food in fighting hidden hunger and promoting the cognitive function.

In February 2020, San Francisco proposed mandatory health warnings for sugar-sweetened beverage (SSB) advertisements. Industry legal challenges stated that the warning would detract from advertisers’ ability to convey their intended message and mislead consumers into believing that SSB cause weight gain regardless of consumption amount, lifestyle or intake of other energy-dense foods.

Online between-group experiments tested the impact of SSB warnings on advertising outcomes and consumer perceptions. Respondents were randomised to view six SSB print advertisements with or without a health warning (‘Warning’ and ‘No Warning’ condition, respectively). Linear and binary logistic regression models tested differences between groups, including ad recall, brand perceptions and beliefs about SSB health effects.

Panelists from the US Nielsen Global Panel.

Sixteen to 65-year-old respondents (n 1064).

Overall, 69·2 % of participants in the ‘Warning’ condition recalled seeing warnings on SSB ads. Compared with the ‘No Warning’ condition, participants in the ‘Warning’ condition who reported noticing the warnings were equally likely to recall the brands featured in the SSB ads and to recall specific attributes of the final ad they viewed. Similarly, no differences were observed between groups in perceptions of SSB, such as perceived taste, or in the prevalence of false beliefs regarding the health effects of SSB and intake of other sugary foods on weight gain.

Overall, there was no evidence that SSB health warnings detracted from attention to promotional elements in advertisements or that the warnings misled consumers into false beliefs about SSB as the exclusive cause of weight gain.

The association between high sugar-sweetened beverages (SSB) intake during pregnancy and offspring overweight/obesity has been reported only from Western countries. The objective of this study was to examine the association between SSB intake before and during pregnancy and offspring overweight/obesity among Japanese women.

Japanese prospective birth cohort study.

We analysed mother–offspring pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study from 2013 to 2017. SSB intake during pregnancy was evaluated using the FFQ and classified into three groups: none (0 g/d), medium (<195 g/d) and high (>195 g/d). Overweight or obesity at 1 year of age in offspring was defined as having a BMI Z-score greater than 2 sd, calculated based on the BMI reference data for Japanese children. Multiple logistic regression analyses were performed to examine the associations between SSB intake before and during pregnancy and offspring overweight/obesity, after adjusting for covariates.

Japanese mother–offspring pairs (n 7114).

The overweight/obesity rate of the offspring was 8·8 %. Pregnant women with a high intake of SSB in early to mid-pregnancy had a higher risk of overweight/obesity in their offspring compared with those who did not; the OR was 1·52 (95 % CI (1·09, 2·12)).

High SSB intake in early to mid-pregnancy was associated with an increased risk of offspring overweight/obesity at 1 year of age.

Young children lack basic skills related to recognizing the types of foods they consume and dietary surveys often rely on parents’ response. The present study aimed to evaluate how well parents of children aged from 3 months to 10 years perceive images of portions of foods commonly consumed by young children.

Pre-weighed, actual food portions (n 2314) were shown to the study participants who were asked to indicate the picture that corresponded to the food in view. Mean differences between picture numbers selected and shown were estimated and compared using unpaired t tests or Tukey–Cramer pairwise comparisons.

Real-time testing of parents’ perception of food images presenting portion sizes consumed by children up to 10 years old.

A convenience sample of 138 parents/caregivers of young children (69 % females).

Individuals selected the correct or adjacent image in about 97 % of the assessments. Images presenting amorphous solids (i.e. pies and pastries with a filling), liquid or semi-liquid dishes (i.e. soups, porridges, fruit and vegetable purées) were more prone to bias. There was no indication that personal characteristics (gender, age, educational background, age, number of offspring) were associated with differences in the way parents/caregivers perceived the food pictures.

Food pictures may not be appropriate to quantify the intake of liquid, semi-liquid or amorphous solid foods in surveys addressing young children and studies evaluating their performance as food portion anchors should ensure the inclusion of several and various amorphous foods in the assessment.

To investigate changes in mean sugar content of non-alcoholic beverages (overall and sugar-sweetened beverages (SSB)) available for purchase in Australia and to compare signatories v. non-signatories of the Australian Beverages Council voluntary pledge from 2018

Retrospective observational study.

Australia.

About 1500 non-alcoholic beverages per year included in the FoodSwitch Monitoring Datasets for 2015–2019.

Overall, mean sugar content fell by 1·3 g/100 ml (17·1 %) from 7·5 g/100 ml in 2015 to 6·2 g/100 ml in 2019. SSB have accounted for about 56 % of all beverages available for purchase since 2015. Between 2015 and 2019, the sugar content of SSB dropped by about 10 % (0·8 g/100 ml). Soft drinks and milk-based drinks were the categories with the largest decrease in sugar content. The greater reduction in sugar observed for beverages overall than SSB suggests at least some of the overall decrease in sugar content is due to the appearance of new products with low or no sugar rather than reformulation. Over the same period, beverages with added non-nutritive sweeteners increased from 41 % to 44 %. The decrease in sugar content for all beverages and SSB was, in general, larger for non-signatories than signatories of the voluntary industry pledge.

Between 2015 and 2019, the small reduction in sugar content of non-alcoholic beverages in Australia resulted from the combined effects of introducing low- or no-sugar products and reformulation of some categories of SSB. Further policy and regulatory measures are required to reap the most benefit that sugar reduction among non-alcoholic beverages can bring to population health.

Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing.

Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050).

FCCH in Oklahoma, USA.

FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01).

The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0–43·8 % to 4·1–16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9–84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63–67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006).

Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.

Iodine is an essential micronutrient needed for the production of thyroid hormones. Pregnant mothers who are deficient in iodine provide less iodine to the fetal thyroid. This results in low production of thyroid hormones by the fetal thyroid, thereby leading to compromised mental and physical development of the fetus. The current study aimed to assess the current status of iodine nutrition among pregnant mothers in Himachal Pradesh, India, a known endemic region for iodine deficiency.

Three districts, namely Kangra, Kullu and Solan, were selected.

In each district, thirty clusters (villages) were identified by utilizing the population-proportional-to-size cluster sampling methodology. In each cluster, seventeen pregnant mothers attending the antenatal clinics were included.

A total of 1711 pregnant mothers (647 from Kangra, 551 from Kullu and 513 from Solan) were studied. Clinical examination of the thyroid of each pregnant mother was conducted. Spot urine samples were collected from ten pregnant mothers in each cluster. Similarly, salt samples were collected from eleven pregnant mothers in each cluster.

Total goitre rate was 42·2 % (Kangra), 42·0 % (Kullu) and 19·9 % (Solan). The median urinary iodine concentration was 200 μg/l (Kangra), 149 μg/l (Kullu) and 130 μg/l (Solan). The percentage of pregnant mothers consuming adequately iodized salt (iodine content of 15 ppm and more) was found to be 68·3 % (Kangra), 60·3 % (Kullu) and 48·5 % (Solan).

Pregnant mothers in Kullu and Solan districts had iodine deficiency as indicated by a median urinary iodine concentration less than 150 μg/l.

To explore adolescents’ perceptions, knowledge and behaviours regarding nutrition and physical activity in low-income districts of Abidjan, Côte d’Ivoire, taking into consideration their caregivers’ perspectives.

Two investigators conducted six focus group discussions.

The study was carried out in two low-income suburbs, Yopougon and Port-Bouët, in Abidjan, Côte d’Ivoire.

Adolescents and their caregivers were recruited into the study via local head teachers and heads of settlement.

Overall, seventy-two participants, including forty-six adolescents and twenty-six caregivers, took part. Participants demonstrated good nutrition knowledge, relating nutritional health to a balanced diet and hygiene. Sustained physical activity was reported. However, adopting good practices was challenging due to participant’s economic circumstances. Their environment was a barrier to improving health due to dirtiness and violence, with a lack of space limiting the possibility to practice sport. Adolescents and their caregivers differed in their response to these constraints. Many caregivers felt powerless and suggested that a political response was the solution. Alternatively, adolescents were more likely to suggest new creative solutions such as youth-friendly centres within their community.

Participants were aware that their nutritional habits were not in line with what they had learnt to be good nutritional practices due to socio-economic constraints. Physical activity was part of adolescent life, but opportunities to exercise were restricted by their environment. Strategies for improving adolescent health in these settings need to be developed in collaboration with adolescents in a manner that accommodates their opinions and solutions.

Dietary patterns express the combination and variety of foods in the diet. The partial least squares method allows extracting dietary patterns related to a specific health outcome. Few studies have evaluated obesity-related dietary patterns associated with telomeres length. This study aims to identify dietary patterns explaining obesity markers and to assess their association with leukocyte telomere length (LTL), a biological marker of the ageing process.

Cross-sectional study.

University campuses in the state of Rio de Janeiro, Brazil

478 participants of a civil servants’ cohort study with data on food consumption, obesity measurements (total body fat, visceral fat, BMI, leptin and adiponectin) and blood samples.

Three dietary patterns were extracted: (1) fast food and meat; (2) healthy and (3) traditional pattern, which included rice and beans, the staple foods most consumed in Brazil. All three dietary patterns explained 23·2 % of food consumption variation and 10·7 % of the obesity-related variables. The fast food and meat pattern were the first factor extracted, explaining 11–13 % variation of the obesity-related response variables (BMI, total body fat and visceral fat), leptin and adiponectin showed the lowest percentage (4·5–0·1 %). The healthy pattern mostly explained leptin and adiponectin variations (10·7 and 3·3 %, respectively). The traditional pattern was associated with LTL (β = 0·0117; 95 % CI 0·0001, 0·0233) after adjustment for the other patterns, age, sex, exercise practice, income and energy intake.

Leukocyte telomere length was longer among participants eating a traditional dietary pattern that combines fruit, vegetables and beans.

To examine energy drink consumption among adolescents in the UK and associations with deprivation and dietary inequalities.

Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis.

UK.

Quantitative data: nationally representative sample of 2587 adolescents aged 11–18 years. Qualitative data: 20 parents, 9 teachers and 28 adolescents from Hampshire, UK.

NDNS data showed adolescents’ consumption of energy drinks was associated with poorer dietary quality (OR 0·46 per sd; 95 % CI (0·37, 0·58); P < 0·001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1·40; 95 % CI (1·16, 1·69); P < 0·001; OR 0·98 per £1000; 95 % CI (0·96, 0·99); P < 0·001, respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (P = 0·04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents do not know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work.

This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents’ energy drink intake.

The current study aimed to analyse the prospective association between perceived work demand and changes in eating behaviours in schoolteachers.

This was a prospective cohort study with self-reported information obtained on the Demand Control Support Questionnaire and eating behaviours at baseline and after a 2-year follow-up. The analyses were performed using mixed-effects models adjusted for the main confounders.

The setting consisted of elementary and secondary schools located in a large city in southern Brazil.

The participants were 502 schoolteachers (65·9 % females, median age of 42·7 years [interquartile range 34·2, 49·4]).

A total of 39·2 % of the schoolteachers were classified at baseline with job strain, 28·9 % with passive job, 12·2 % with active job and 19·7 % with low-strain job. In the fully adjusted models, compared with teachers who reported low-strain job, those with higher levels of job strain were more likely to reduce (coefficient = 0·064; 95 % CI 0·018, 0·109) and less likely to increase (coefficient = −0·066; 95 % CI −0·115, −0·016) their frequency of fruit consumption regardless of sociodemographic, lifestyle, health conditions and social support at work.

Job strain plays a relevant role in the frequency of fruit consumption over time in schoolteachers. The balance between demand and control at work must be considered in strategies for promoting healthy eating despite perceived social support.

To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.

Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.

Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.

Consumers and food operators perceived a high-salt intake within Malaysia’s out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.

These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia’s out-of-home sectors.

Shifting from meat-centric to plant-rich diets may help to enable healthier and more sustainable food systems. Here we present the results of a 1-week intervention to promote plant-based eating in a meat-centric food context (i.e. canteen).

The intervention included environmental restructuring strategies (e.g. promotional materials and menu redevelopment) and improvements to the offer of plant-based meals. The evaluation (sales data; pre-registered) spanned 3 weeks prior to the intervention (baseline), 1 week during the intervention (immediate/short-term impact) and 3 weeks after the intervention (follow-up). Opinion surveys were also used to collect data with customers during the intervention.

Canteen unit of a university campus in Portugal (Lisbon metropolitan area).

In addition to sales data (baseline: 7965 meals; immediate/short-term: 2635 meals; follow-up: 7135 meals), we used opinion surveys to assess customers’ meal appraisals during the intervention (n = 370).

The odds of a sold meal being vegetarian were 24 % higher in the intervention week compared with the pre-intervention period [OR = 1·24, 95 % CI (1·10, 1·40)] and 9 % higher in the post-intervention period compared with the pre-intervention period [OR = 1·09, (95 % CI (1·00, 1·19)]. Survey data showed that vegetarian meals compared favourably to meat and fish alternatives in liking, sustainability and satiety.

A short-term, theory-driven, operationally feasible intervention was effective in promoting increased plant-based meal choices in a collective meal context. Nevertheless, these changes were not entirely sustained over time. Future studies could test whether prolonged or more transformative interventions are necessary to unlock entrenched food practices more effectively in meat-centric collective meal contexts.

Inadequate iodine intake during pregnancy increases the risk of neonatal morbidity and mortality. We aimed to evaluate whether prenatal supplements containing iodine affect urinary iodine concentrations (UIC) of pregnant women in Malawi.

A randomised controlled trial. Pregnant women (n 1391) were assigned to consume 60 mg/d Fe and 400 µg/d folic acid (IFA) or 18 vitamins and minerals including 250 µg/d iodine (MMN) or 20 g/d small-quantity lipid-based nutrient supplements (SQ-LNS) with similar nutrient contents as MMN group, plus macronutrients (LNS) until childbirth. In a sub-study (n 317), we evaluated group geometric mean urinary iodine concentration (UIC) (µg/L) at 36 weeks of gestation controlling for baseline UIC and compared median (baseline) and geometric mean (36 weeks) UIC with WHO cut-offs: UIC < 150, 150–249, 250–499 and ≥500 reflecting insufficient, adequate, above requirements and excessive iodine intakes, respectively.

Mangochi District, Malawi.

Women ≤20 weeks pregnant.

Groups had comparable background characteristics. At baseline, overall median (Q1, Q3) UIC (319 (167, 559)) suggested iodine intakes above requirements. At 36 weeks, the geometric mean (95 % CI) UIC of the IFA (197 (171, 226)), MMN (212 (185, 243)) and LNS (220 (192, 253)) groups did not differ (P = 0·53) and reflected adequate intakes.

In this setting, provision of supplements containing iodine at the recommended dose to pregnant women with relatively high iodine intakes at baseline, presumably from iodised salt, has no impact on the women’s UIC. Regular monitoring of the iodine status of pregnant women in such settings is advisable. Clinicaltrials.gov identifier: NCT01239693.

In common narratives of emergency food assistance, donors likely believe their efforts directly manifest as people consuming their donated food. For example, a person donating canned lima beans during a canned food drive may visualise someone eventually eating those lima beans. However, cultural and socio-economic barriers often exist that prevent people from accessing and consuming the donated food. These barriers are often complex and otherwise well-intentioned donors, volunteers and organisations may not initially consider them.

This commentary article, which draws from existing US emergency food systems literature, uses the imagery of an acorn squash one might find at a US food pantry to conceptualise these barriers in a straightforward way.

Examining emergency food assistance through the lens of the acorn squash problem can help donors, volunteers and organisations better connect with food-insecure people. The lens of the acorn squash problem also allows for deeper critiques of some practices of emergency food systems.

Religious/spiritual beliefs and behaviours (RSBB) have been associated with health outcomes, with diet a potential mediator of this relationship. We therefore explored whether RSBB were associated with differences in diet.

Dietary patterns and nutrient intakes were derived from food frequency questionnaire completed by pregnant women in 1991–1992 (mean age = 28·3 years, range = 15–46) and by the mothers and partners 4 years post-partum (mothers mean age = 32·3, range = 19–49; partners mean age = 34·5, range = 18–74). RSBB exposures measured in pregnancy included religious belief, affiliation and attendance. We first explored whether RSBBs were associated with dietary patterns in confounder-adjusted linear regression models. If associations were found, we examined whether RSBB were associated with nutrient intake (linear regression) and following nutrient intake guidelines (logistic regression).

Prospective birth cohort study in Southwest England (Avon Longitudinal Study of Parents and Children; ALSPAC).

13 689 enrolled mothers and their associated partners.

In pregnant women, RSBB were associated with higher ‘traditional’ (i.e. ‘meat and two veg’) and lower ‘vegetarian’ dietary pattern scores. Religious attendance and non-Christian religious affiliation were associated with higher ‘health-conscious’ dietary pattern scores. Religious attendance was associated with increased micronutrient intake and following recommended micronutrient intake guidelines, with weaker effects for religious belief and affiliation. Comparable patterns were observed for mothers and partners 4 years post-partum, although associations between RSBB and nutrient intakes were weaker for partners.

RSBBs are associated with broad dietary patterns and nutrient intake in this cohort. If these reflect causal relationships, diet may potentially mediate the pathway between RSBB and health.

The project aimed to validate a short questionnaire (CoCu pregnancy – Composition and Culture of Eating during pregnancy) and to investigate associations with age and socio-economic status (SES).

The questionnaire was developed according to the validated CoCu for children and adolescents containing a diet composition (fourteen items) and a culture of eating part (six items). A Nutritional Health Score (NHS) was calculated based on diet composition (–120 and +120, with higher scores indicating healthier diets). The validity was assessed by comparing answers in CoCu pregnancy with a FFQ. In a subsample (n 97), we assessed the percentage of having chosen the same (or adjacent) response categories in the 24th and 36th week of pregnancy (wp).

Data were collected within the LIFE Child study in Leipzig, Germany.

We evaluated 430 questionnaires of pregnant women (24th wp).

The results indicated a healthy diet in the present sample (NHS at 24th wp = 49·74 (95 % CI 47·27, 52·22)). The analyses revealed significant positive correlations between CoCu and FFQ (rho ranging from 0·32 to 0·61). For each food item, >90 % of women had chosen the same (50–60 %) or adjacent response categories in the 24th and 36th wp. The analysis revealed associations of the NHS with age (β = 0·11, P = 0·027), SES (β = 0·21, P < 0·001), snacking (β = –0·24, P < 0·001) and media use (β = –0·18, P < 0·001).

The questionnaire represents a useful tool for surveying the diets during pregnancy for research and clinical practice.