The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations.

SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion.

Primary schools.

An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16).

The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %).

The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.

To examine the effectiveness of a workplace sugar-sweetened beverage (SSB) sales ban on reducing SSB consumption in employees, including those with cardiometabolic disease risk factors.

A controlled trial of ethnically diverse, full-time employees who consumed SSB heavily (sales ban n 315; control n 342). Outcomes included standardised measures of change in SSB consumption in the workplace (primary) and at home between baseline and 6 months post-sales ban.

Sutter Health, a large non-profit healthcare delivery system in Northern California.

Full-time employees at Sutter Health screened for heavy SSB consumption.

Participants were 66·1 % non-White. On average, participants consumed 34·7 ounces (about 1 litre) of SSB per d, and the majority had an elevated baseline BMI (mean = 29·5). In adjusted regression analyses, those exposed to a workplace SSB sales ban for 6 months consumed 2·7 (95 % CI –4·9, –0·5) fewer ounces of SSB per d while at work, and 4·3 (95 % CI –8·4, –0·2) fewer total ounces per d, compared to controls. Sales ban participants with an elevated BMI or waist circumference had greater post-intervention reductions in workplace SSB consumption.

Workplace sales bans can reduce SSB consumption in ethnically diverse employee populations, including those at higher risk for cardiometabolic disease.

The goal of this study is to evaluate university students’ perceptions of tap water safety and water filter use and determine how these perceptions and behaviours affect water and sugar-sweetened beverage intake.

Cross-sectional; online survey conducted in Fall 2021.

A large, public Midwestern university in the USA.

Seven-hundred ninety-three university students.

Students who experienced food insecurity, were on a Pell grant, were first-generation college students or were racial/ethnic minorities were less likely to trust tap water safety. Tap water filtration behaviour also varied by age and race/ethnicity. Students who did not agree with the statement ‘my local tap water is safe to drink’ had lower odds of consuming ≥ 3 cups of total water per day (OR = 0·45, 95 % CI: 0·32, 0·62), lower odds of consuming tap water ≥ 3 times/d (OR = 0·46, 95 % CI: 0·34, 0·64), higher odds of drinking bottled water ≥ 1 time per day (OR = 1·80, 95 % CI: 1·22, 2·66) and higher odds of drinking SSB ≥ 1 time per day (OR = 1·47, 95 % CI: 1·01, 2·14) than those who agreed. Students who always or sometimes filtered their tap water had lower odds of consuming ≥ 3 cups of total water per day (OR = 0·59, 95 % CI: 0·39, 0·90) than students who never filtered their tap water.

Tap water perceptions and behaviours affect tap and bottled water and SSB intake among university students. Tap water perceptions and behaviours in this demographic provide important context for university programming promoting healthy beverage initiatives.

To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents.

Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, ‘appropriate eating contexts at breakfast, lunch and dinner’; cluster 2, ‘inappropriate eating context at breakfast’ and cluster 3, ‘inappropriate eating context at dinner’. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference.

Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil.

Adolescents, 14–19-year-olds (n 835).

We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14–15-year-olds (less likely in cluster 2) and higher mother’s schooling (more likely in cluster 3).

We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother’s schooling).

To determine the reach, adoption, implementation and effectiveness of an intervention to increase children’s vegetable intake in long day care (LDC).

A 12-week pragmatic cluster randomised controlled trial, informed by the multiphase optimisation strategy (MOST), targeting the mealtime environment and curriculum. Children’s vegetable intake and variety was measured at follow-up using a modified Short Food Survey for early childhood education and care and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework.

Australian LDC centres.

Thirty-nine centres, 120 educators and 719 children at follow-up.

There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared with non-vegetable consumers for intake (OR = 0·70, (95 % CI 0·34–1·43), P = 0·32) or variety (OR = 0·73 (95 % CI 0·40–1·32), P = 0·29). Among vegetable consumers (n 652), there was no difference between groups in vegetable variety (exp(b): 1·07 (95 % CI:0·88–1·32, P = 0·49) or vegetable intake (exp(b): 1·06 (95 % CI: 0·78, 1·43)), P = 0·71) with an average of 1·51 (95 % CI 1·20–1·82) and 1·40 (95 % CI 1·08–1·72) serves of vegetables per day in the intervention and control group, respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all P < 0·001). Intervention fidelity was moderate (n 16/20 and n 15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22 % eligible centres.

The pragmatic self-delivered online intervention positively impacted educator’s knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children’ vegetable intake.

This study aimed to assess the validity of a portable anthropometer against the gold standard among 2-year-old infants from the 2015 Pelotas (Brazil) Birth Cohort.

Birth cohort study.

A fixed Harpenden® infant anthropometer was considered as the gold standard for measuring infant length due to its greater precision and stability. The portable SANNY® (model ES2000) anthropometer was the instrument to be validated. The acceptable mean difference in length between the anthropometers was 0·5 cm. In order to compare length estimates, the interviewers carried out two length measures for each of the anthropometers (fixed and portable) and for each child. The mean of the two lengths was calculated for each anthropometer, and their difference was calculated.

A subsample of 252 24-month-old members of the 2015 Pelotas (Brazil) birth cohort study.

Children’s mean age was 23·5 months. According to Bland–Altman plot, there were no differences in overall lengths between the portable and the fixed anthropometers, or in lengths according to sex. There was a high overall concordance between the length estimates of the fixed and portable anthropometers (ρ = 0·94; 95 % CI 0·92, 0·95).

The portable anthropometer proved to be accurate to measure the length of 24-month-old infants, being applicable to studies using the same standardised protocol used in the present study.

To analyse the Na content of bread by comparing the amount of salt and Na among the label, laboratory analysis and international guidelines.

Ten selected bakeries provided 3239 randomly selected samples of bread, which were weighed on-site. Triplicate samples were retrieved from each bakery (thirty samples) for analysis. Bread production was observed, and ingredient labels were queried to determine salt weights, which were used for comparison with the laboratory analysis. Flame photometry and the method for chlorides were utilised for analysing Na. Laboratory findings were compared to nine different international nutritional guidelines for Na consumption.

Florianopolis, south of Brazil.

Ninety independent bakeries locally producing Portuguese rolls were queried; rolls from ten conveniently selected bakeries were retrieved for further analysis.

The average weight of the rolls was 50·2 ± 5·3 g. The average amount of salt (g) per roll, by laboratory and label analyses, was 0·69 ± 0·0 and 0·62 ± 0·1 g, respectively. The mean level of Na (mg) reported on nutrient labels (478·2 ± 93·4/100 g) was significantly lower than by laboratory analysis (618·2 ± 73·8/100 g), P < 0·001. There was a difference for Na in rolls produced in the bakeries considering the unit weight of rolls (P ≤ 0·001) per 100 g (P = 0·026) and the mode of production. The consumption of two averaged units of rolls was equivalent to 51·7 % of the Brazilian guideline daily amount for Na for children and 31 % for adults.

The nutrient labels underreported Na values. This study strengthens the importance of monitoring Na of breads in Brazil.

We examined the association between serum antioxidant status and mortality from influenza and pneumonia in US adults.

Serum concentrations of antioxidants included vitamin C, vitamin A, vitamin E, sum of α- and β-carotene, β-cryptoxanthin, lutein + zeaxanthin and lycopene. We computed total antioxidant capacity (TAC) as a measure of composite antioxidant status in serum. Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HR) and 95 % CI comparing quartiles of each antioxidant and TAC.

Data from the US National Health and Nutrition Examination Survey (NHANES)-III.

A total of 7428 NHANES-III participants ≥45 years of age.

With a weighted-median follow-up of 16·8 years, 154 participants died from influenza/pneumonia. After adjustment for covariates, serum vitamin C, the sum of α- and β-carotene and TAC were nonlinearly associated with influenza/pneumonia mortality, with the statistically significant smallest HR at the third quartile v. the first quartile (HR = 0·38 (95 % CI: 0·19, 0·77), 0·29 (0·16, 0·51) and 0·30 (0·15, 0·59), respectively). HR comparing the fourth v. the first quartiles were weaker and nonsignificant: 0·57 (95 % CI: 0·27, 1·17), 0·70 (0·41, 1·19) and 0·65 (0·31, 1·35), respectively. Serum lycopene had a monotonic association with influenza/pneumonia mortality (HR = 0·43 (95 % CI: 0·23, 0·83) comparing the fourth v. the first quartile, Pfor trend = 0·01).

The current study suggests that antioxidant intake as reflected by serum concentrations may reduce mortality risk from influenza or pneumonia in the US general population. These findings warrant further confirmation in other populations with different settings (e.g. a shorter-term association with influenza infection).

To determine predictors of the association between being a Veteran and adult food security, as well as to examine the relation of potential covariates to this relationship.

Data collected during 2011–2012, 2013–2014 and 2015–2016 National Health and Nutrition Examination Survey (NHANES) were pooled for analyses. Veterans (self-reported) were matched to non-Veterans on age, race/ethnicity, sex and education. Adjusted logistic regression was used to determine the odds of Veterans having high food security v. the combination of marginal, low and very low food security compared with non-Veterans.

2011–2012, 2013–2014 and 2015–2016 NHANES.

1227 Veterans; 2432 non-Veterans.

Veteran status had no effect on the proportion of food insecurities between Veterans and non-Veterans reporting high (Veterans v. non-Veteran: 79 % v. 80 %), marginal (9 % v. 8 %), low (5 % v. 6 %) and very low (8 % v. 6 %) food security (P = 0·11). However, after controlling for covariates, Veterans tended to be less likely to have high food security (OR: 0·82 (95 % CI 0·66, 1·02), P = 0·07). Further, non-Hispanic White Veterans (OR: 0·72 (95 % CI 0·55, 0·95), P = 0·02) and Veterans completing some college (OR: 0·71 (95 % CI 0·50, 0·99), P < 0·05) were significantly less likely to experience high food security compared with non-Veterans.

This study supports previous research findings that after controlling for covariates, Veterans tend to be less likely to have high food security. It also highlights ethnicity and level of education as important socio-economic determinates of food security status in Veterans.

Nutritional status has remained inadequate among disadvantaged mothers and small children in South Africa. Several supplementation programmes are administered through primary health clinics (PHC). The present study examined the perceptions of mothers who attend PHC and of the PHC staff on the purpose, management and eligibility of the vitamin A and nutritional supplementation components of the Nutrition Supplementation Programme (NSP).

Observational study based on anthropometry and questionnaires.

Random selection of ten urban and ten rural PHC from the Western Cape Province of South Africa.

Mothers (n 176) and their children (n 179) aged <5 years, and various PHC staff categories.

Half (56 %) of the households were classified as food insecure and about one-third of the children were malnourished, as evidenced by stunting, wasting or underweight. A majority of mothers complained about poor information related to the programmes. More than half of the children who were eligible for NSP were not included. In contrast, the staff felt that they managed both programmes well and problems with implementation were mostly attributed to clients.

In general, the mothers expressed more dissatisfaction and ignorance about the vitamin A programme and the NSP than was perceived by the staff. This apparent discrepancy might, at least in part, explain why these programmes do not work optimally.