To evaluate the implementation of a school-based intervention, Helping Hands Ending Hunger (HHEH), to distribute food, including fresh produce supplementation, to families.

We conducted a convergent mixed-methods evaluation that collected data from family HHEH participants and key informants (KIs). At two points (Winter and Spring), family representatives responded to a brief survey of closed- and open-ended questions. KIs were school-based implementers who participated in semi-structured interviews. Data were analysed separately and then integrated.

United States: Georgia-based HHEH schools implementing fresh produce supplementation (n 11).

Family survey respondents (Winter n 95; Spring n 35) and school-based KIs (eleven representatives from eight schools).

The family survey data indicated that HHEH reaches people in need (more than 75 % food insecure; more than 55 % receiving free- or reduced-priced meals), with room for expansion. Families reported an average of 13·3 (Winter) and 15·5 (Spring) different types of fruit and vegetables at home in the past week. About 31 % (Winter) and 49 % (Spring) indicated that all or most of the fruit and vegetables they eat comes from HHEH. KIs indicated that they adopted the program to offer more support to the families of students. Identifying a team to implement the program, dedicating time to establish the program, and testing protocols were recommended to ease implementation. KIs expressed certainty about continuing the program.

HHEH was well-received by families and school-based implementers. With the potential need for more families to receive HHEH food, this evaluation could inform wider adoption.

To examine how food agency is associated with frequency of cooking dinner at home, frequency of consuming fast food and diet quality among adults in the USA.

Analysis of cross-sectional survey and dietary intake data. The survey measured food agency, dinner cooking frequency, fast-food frequency, dietary intake (Prime Diet Quality Score-30 Day (PDQS-30D)) and sociodemographic characteristics. Multivariable Poisson and linear regression models adjusted for sociodemographic characteristics were used to estimate the association between food agency and dinner cooking frequency, fast-food frequency and diet quality.

A national, web-based survey in the USA fielded in November 2023.

Adults aged >18 years living in the USA (n 4453).

Compared with the lowest quartile of food agency, the highest quartile was associated with greater dinner cooking frequency (incidence rate ratio (IRR) = 1·27, P < 0·001), lower fast-food frequency (IRR = 0·74, P < 0·001) and higher diet quality (β = 6·28, P < 0·001). Higher self-efficacy, more positive attitudes and fewer structural barriers to cooking were associated with greater dinner cooking frequency, lower fast-food frequency and higher diet quality (P < 0·001 for all). Overall, comparing the highest to lowest quartile of food agency, predicted values were significantly higher for diet quality (Q4: 57·2, Q1: 50·8, P < 0·001) and dinner cooking frequency (Q4: 5·37, Q1: 4·09, P < 0·001) and lower for fast-food frequency (Q4: 4·74, Q1: 6·83, P < 0·001).

Food agency is associated with higher dinner cooking frequency, lower fast-food consumption and higher diet quality. Utilising a food agency framework in policies and interventions may be useful to promote greater home cooking and healthier dietary behaviours.

To estimate the national prevalence and distribution of food insecurity (FI) among households with children younger than 5 years in Ecuador and to evaluate the psychometric properties of the Food Insecurity Experience Scale (FIES) using two consecutive nationally representative surveys.

This cross-sectional study employed descriptive statistics and Tobit regression models using STATA v17.

We used secondary data from the National Survey on Child Malnutrition in Ecuador, including food security (FS) information for 2022–2023 and 2023–2024, to construct the prevalence time series.

We analysed data from 19 187 households (22 260 children) surveyed in the first round and 20 186 households (23 187 children) surveyed in the second round.

FIES showed adequate reliability in both rounds (Rasch reliability 0·80 and 0·79). Seven of eight FIES items showed significant reductions between rounds. The prevalence of moderate-or-severe FI remained high, decreasing from 40·79 % in 2022–2023 to 39·18 % in 2023–2024 (p = 0·239). Severe FI declined significantly from 4·83 % to 3·52 % (p = 0·002). In both rounds, FI was more prevalent in rural areas, the Amazon region, priority territories, Indigenous and Afro-descendant populations and households experiencing poverty or unmet basic needs. In 2023–2024, FI was associated with priority area residence, Indigenous ethnicity, poverty due to unmet basic needs, older child age groups and stunting.

Despite reductions in severe FI, nearly four in ten households with young children in Ecuador continue to experience moderate-or-severe FI, with persistent territorial, ethnic and socio-economic inequalities. Integrated policies linking FS, child nutrition and poverty reduction are needed.

To understand how special and alternative education settings implement national school food standards and policy and identify challenges to and support for implementation.

Mixed methods study comprising (1) cross-sectional quantitative assessment of: (a) compliance with standards through menu review and researcher observation; (b) implementation of actions from the School Food Plan (SFP) through survey and (2) qualitative interviews with school staff.

State-funded special and alternative education settings with pupils aged 4–18-years in England.

Eight settings and thirty-seven school staff with a role in school food, including catering staff, school leadership, teaching staff and school governors.

The median level of compliance for all standards was 66·7 % (interquartile range (IQR) = 61·3–70·0), with highest compliance for lunchtime standards (median = 73·3 %, IQR = 68·2–75·3) and standards aiming to promote dietary variety (median = 73·3 %, IQR = 66·7–73·3) and lowest for standards that apply across the whole school day (median = 50·0 %, sd = 36·4–59·1) and standards aiming to restrict foods/drinks high in fat, salt and sugar (median = 57·7 %, IQR = 50·0–71·2). Most schools carried out independent monitoring of standards (71·4 %), but none had a healthy eating award. Three qualitative themes demonstrated challenges in meeting the standards, including accommodating the complex needs of pupils and varied staff engagement and school food monitoring processes.

Special and alternative education settings had intensive, highly individualised approaches to school food that often conflicted with standards compliance. School food standards and policy need consider the unique challenges for these settings and the need for flexibility, adequate funding, tailored resources and staff training to improve quality of diets in this population.

To examine trends and determinants of women’s nutritional status over the last two decades in Bangladesh, using BMI distribution and BMI-based categories of underweight and overweight/obesity.

We analysed women’s data from the Bangladesh Demographic Health Surveys, conducted between 1996 and 2022. Sociodemographic characteristics, changes in BMI distribution and underweight and overweight prevalence were estimated at national and urban–rural levels. Associated factors were identified using multilevel mixed-effect logistic regression, with survey year as a random intercept. Multinomial regressions were used for the individual survey waves.

Nationally representative cross-sectional survey.

90 510 reproductive-aged women.

There is an epidemiological transition from underweight to overweight by approximately 5 kg/m2 over the period. The prevalence of underweight women declined by 41·34 %, while overweight/obesity increased by 33·62 %. For urban–rural disparities, the prevalence of underweight was consistently higher among rural women, whereas overweight was more common among urban women. Increased age and higher education had higher odds of being overweight/obese and relatively higher socio-economic status had higher odds of being overweight and lower odds of being underweight. Access to television had mostly higher odds of being overweight. Age, education, socio-economic status and watching television showed consistent risks over time, while other factors showed inconsistent risks at different survey times.

There was an epidemiological transition in BMI, with a declining trend in underweight and a substantial increase in overweight. Targeted interventions are needed to tackle the persistent undernutrition in rural areas and the rapidly escalating epidemic of overweight/obesity, particularly in urban settings.

To examine the extent of socio-economic inequality in the consumption of egg and/or flesh foods among children aged 6–23 months in Indonesia and identify key contributing factors.

Secondary analysis of the 2017 Indonesia Demographic and Health Survey. We applied the Wagstaff normalised concentration index to quantify inequality in the consumption of egg, flesh food and their combination. A decomposition analysis was conducted to assess the relative contributions of child, parental, household and regional factors.

Indonesia.

A total of 4925 children aged 6–23 months were included.

The consumption of egg and/or flesh foods was disproportionately concentrated among children from wealthier households. The concentration index was highest for flesh food consumption (Cnorm = 0·175, P < 0·001), followed by egg and/or flesh food (Cnorm = 0·147, P < 0·001) and egg only (0·065, P = 0·002). Household wealth was the largest contributor to inequality across all outcomes, particularly for flesh food. Other key contributors included the father’s occupation, maternal education and media access. In egg consumption, antenatal care use and maternal decision-making also played substantial roles.

Significant pro-rich inequalities exist in the consumption of animal-source foods among young children in Indonesia, primarily driven by household wealth and parental socio-economic characteristics. Targeted policies are needed to reduce these disparities and improve dietary equity in early childhood.

Sugar-sweetened beverage taxes have been widely evaluated; however, less is known about the effects of taxes on unhealthy foods. This study examines the effects of Tonga’s food taxes on food prices and import volumes.

Interrupted time series analysis using segmented linear regression was used to evaluate tax impacts on both retail prices and import volumes of taxed foods. Observed post-tax trends were compared with a counterfactual. The counterfactual was the projected pre-tax trends, with adjustment for autocorrelation and changes in GDP, tourism, season, exchange rates and oil prices over time. Random effects meta-analysis was used to summarise outcomes across food types.

Nine Tongan food tax increases were examined, varying from US$0·17/kg to US$1·08/kg, and averaging 28 % of import value.

In the first-year post-tax, retail prices increased for ten of eleven taxed foods, with an average increase of 13 % (95 %CI: 5 % to 21 %). Price increases for chicken pieces (46 % and 39 %), mutton flaps (20 %), corned beef (20 %), ice cream (11 %), salted beef (6 %) and mayonnaise (3 %) were statistically significant. Import volumes decreased for eight of nine taxed foods with a mean decrease of 41 % (95 %CI: 17 % to 58 %). Import decreases for sausages (68 %) and ice cream (72 %) were significant.

Consistent with economic theory, excise taxes on unhealthy foods in Tonga were associated with increases in retail prices and decreased imports of taxed foods. These findings add to the limited evidence base that excise taxes on unhealthy foods can effectively raise prices and reduce supply.

The aim of the study is to assess the nurses’ knowledge, attitudes and practices related to malnutrition (M-KAP), as well as their general nutrition knowledge about food groups and nutrient sources (GNKQ2), and diet and disease relationships (GNKQ4) and determine the associated factors.

A cross-sectional study was conducted among nurses, using a multi-component questionnaire that assessed the socio-demographic characteristics, health and eating habits, M-KAP and sections Methodology and Discussion of the general nutritional knowledge questionnaire (GNKQ2 and GNKQ4).

Hospitals located in North Lebanon.

Nurses working in Lebanese hospitals (n 404).

A positive association was detected between malnutrition knowledge and each of malnutrition-attitudes (P < 0·001) and malnutrition-practices (P < 0·001) and between malnutrition-practices and malnutrition-attitudes (P < 0·001). Regression analysis revealed that males had lower GNKQ2 compared with females (P = 0·035), and compared with supervisor/chief nurses, practical and head nurses had lower GNKQ2 (P < 0·001 and P = 0·046, respectively). Additionally, practical nurses had lower GNKQ4 compared with supervisor/chief nurses (P = 0·011). M-KAP levels were significantly associated with occupational title and nationality (P = 0·032 and P = 0·008, respectively). Finally, M-practices were associated with hospital district (P = 0·043), and practical and head nurses had better adequate M-practices compared with supervisor/chief nurses (P = 0·001 and P = 0·016, respectively).

A better knowledge is significantly associated with better attitudes and practices, therefore, in order to improve the nutritional status of these patients; it is of prime importance to increase knowledge among nurses.

To explore the multi-level factors (barriers and facilitators) influencing maternal and child nutrition (MCN) from community perspectives using the socioecological model (SEM) as the guiding framework.

An exploratory qualitative study combining semi-structured online interviews (Microsoft Teams) and photovoice method. Data were audio-recorded, translated, transcribed and analysed inductively using Braun and Clarke’s thematic approach, with final themes mapped to the SEM levels.

Two semi-urban communities in Ado-Odo Ota Local Government Area, Ogun State, Nigeria.

Twenty-five participants (aged 25–75 years), including pregnant and lactating mothers, fathers, grandmothers, community leaders and health workers, were recruited through purposive and snowball sampling.

Despite basic nutrition awareness, maternal diets were predominantly carbohydrate-based while infant feeding was characterised by delayed breastfeeding initiation, prelacteal feeding and inconsistent complementary feeding practices. At the interpersonal level, strong familial and community support was evident; however, grandmothers strongly influenced dietary taboos and health-seeking decisions. Organisational barriers, including poor facilities and negative staff attitudes, reduced trust in primary healthcare centres and encouraged reliance on private clinics and traditional providers. Community-level challenges such as poverty, rising food prices, unreliable water supply and inadequate waste disposal systems increased the risk of malnutrition. Nonetheless, some households demonstrated resilience through home gardening, bulk food purchasing and adequate hygiene practices.

MCN is shaped by interconnected factors. Sustainable progress requires moving beyond individual knowledge transfer towards integrated, system-based actions that strengthen nutrition and health services, improve access to diverse foods, safe water and sanitation, and leverage existing community strengths.

To provide a snapshot of the food landscape around New Zealand (NZ) primary schools and to examine the association between food outlet density and the healthiness of primary school canteen menus.

Cross-sectional analyses of external food outlets around schools and school canteen menus.

NZ primary schools.

Seventy-one primary schools provided their school canteen menu, and all external food outlets within 1·6 km of these schools were mapped using Google’s Places API.

The average number of food outlets around primary schools was 45, with a median health score of –3·12. Unhealthy food outlets outnumbered healthy ones (23 v. 6, P < 0·001), with takeaways and convenience stores most prevalent (29·8 % and 17·6 %, respectively). 83 % of schools had ≥1 takeaway outlet within 1·6 km. Higher deprivation scores were associated with greater outlet density (13 % increase per unit rise in deprivation score, P = 0·019). School canteen menus comprised 19·7 % healthy ‘green’, 35·1 % occasional ‘amber’ and 35·5 % unhealthy ‘red’ food items. There was a weak association between types and density of external food outlets and school canteen menus.

The food environment around NZ primary schools is highly obesogenic, with greater exposure to unhealthy outlets observed in more deprived areas, reinforcing the need for zoning regulations to promote health equity. The healthiness of school canteen menus showed little association with the external food environment. Despite widespread exposure to nearby takeaway outlets, schools demonstrated variable adherence to national nutrition guidance. Strengthening implementation support for schools may be more impactful than regulating the surrounding foodscape alone.

To quantify greenhouse gas (GHG) emissions associated with animal-source food procurement in Brazil’s National School Feeding Program (PNAE) and to assess the mitigation potential of alternative procurement strategies.

Retrospective analysis of federal procurement invoices (2013–2022), with identification of animal-source foods and estimation of associated GHG emissions using product-specific emission factors. Deterministic mitigation scenarios were modelled, including partial substitution of beef with lower-emission animal proteins and adoption of deforestation-free sourcing.

PNAE, one of the world’s largest public school feeding programmes.

All federal procurement invoices related to animalsource food purchases within the PNAE between 2013 and 2022.

Between 2013 and 2022, the PNAE purchased 815 136 tonnes of animal-source foods, predominantly beef and poultry, generating an estimated cumulative 58·1 MtCO₂e with substantial variation across regional food-system clusters. Beef was responsible for 77·8 % of total emissions despite accounting for 35·3 % of purchased volume. Scenario analyses indicated that partial substitution of beef with lower-emission animal proteins (poultry, pork, fish and eggs) could reduce emissions by up to 41 %, whereas adopting sustainable sourcing excluding deforestation-linked suppliers could reduce emissions by 31 %. Combined strategies could reduce emissions by more than 50 %.

Beef procurement is the primary driver of GHG emissions in Brazil’s school feeding programme and represents the greatest opportunity for emission reductions. By quantifying the mitigation potential of alternative procurement strategies, this study provides evidence to inform discussions on the environmental implications of public food procurement within school feeding programmes.

To assess whether participants from a transtheoretical model-based intervention maintained increases in fruit and vegetables (FV) intake 48 months after baseline.

Randomised controlled community trial.

A Brazilian primary health care service.

Primary health care service users. The control group (CG) received usual care, and the intervention group (IG) received usual care and a 7-month collective intervention to promote FV intake. We analysed individuals with positive changes 12 months after baseline (baseline intake <400 g/d with any increase at 12 months or baseline intake ≥400 g which remained ≥400 g at 12 months, n 2·232). Outcomes were FV intakes at 36 and 48 months after baseline compared to previous intakes to identify maintenance. We used generalised estimating equations models to assess time and intervention effects in follow-up intake.

Participants were mostly adult women. We identified decreases of 54.4 g/d in fruit intake and 38.5 g/d in vegetable intake at 36 months and increases of 6.9 g/d in fruit intake and 23.4 g/d in vegetable intake at 48 months. According to adjusted models, at 36 months, CG and IG participants presented similar decreases in FV intakes, which means initial changes in the IG were not maintained. At 48 months, small increases in intakes were also similar between IG and CG.

Intervention participants did not maintain initial changes on FV intake in the long term, and boosters might be necessary to maintain initial increases.

University students with celiac disease (CD) are considered a vulnerable group. The number of qualitative studies examining the challenges faced by this group is limited. The aim of the study was to analyse the social and economic impacts of the CD among university students diagnosed with CD who live away from their families.

A qualitative phenomenological design was utilised. Semi-structured, face-to-face interviews were conducted. Data were analysed using Colaizzi’s seven-stage strategy.

Türkiye.

Nine university students (mean age: 22 ± 1·6 years) diagnosed with CD.

The students were living independently at home or dormitory in Konya. The qualitative analysis yielded six main themes: ‘encountering the disease’, ‘adapting to the disease’, ‘living with the disease’, ‘impact on relationships’, ‘economic burden’ and ‘patient expectations’. Participants reported significant challenges regarding social isolation, lack of societal awareness (confusion between gluten and glucose) and food insecurity within university cafeterias and dormitories. The high cost of gluten-free products was identified as a major economic barrier, with the student described CD as a ‘disease of the wealthy’.

This study highlights that CD is not merely a clinical condition but a complex lifestyle challenge affecting all aspects of a student’s educational and social life. Recognising CD from this holistic perspective is crucial for developing effective interventions, including targeted psychological counselling and institutional support mechanisms.

This cohort study aims to explore weight gain and stunting in the Syracuse, NY paediatric refugee population.

Demographics, height and weight were collected through chart review and electronic abstraction in 2019–2020 for N 941. BMI was calculated using Centers for Disease Control and Prevention software and metrics; obesity was defined as a BMI ≥ 95th percentile while overweight was a BMI percentile ≥85th but <95th percentile. Stunting was based on the WHO’s definition of a height-for-age Z score <−2·0. Differences in BMI percentiles were assessed using chi-square tests, t-tests or one-way ANOVA while BMI change over time was analysed using linear mixed modelling.

Pediatric International Health Clinic at an academic medical centre from 2012 to 2017.

Paediatric refugees.

The cohort was 49 % female with a mean age (sd) upon arrival of 8·9 (4·7) years. Sixty-one percent of refugees were from Africa, with 33 % from the Middle East. Stunting was observed in 9·7 % of participants upon arrival and varied significantly by region of origin. Obesity was observed in 24 % of refugees after living in the US for 5 or more years while the frequency of overweight at 5 plus years was 19·4 %. In linear mixed modelling, stunting, region of origin and duration of residence in the US were found to be significant predictors of BMI change over time.

Results support implementing targeted obesity prevention interventions in the Pediatric International Health Clinic refugee population and highlight additional risk for those arriving with stunting.

To examine the association between long-term poverty exposure and census tract-level food insecurity rates across the USA.

Cross-sectional study using nationwide census data. Spatial error models were used to estimate differences in food insecurity rates by long-term poverty exposure, adjusting for rurality–urbanicity.

All census tracts in the USA.

US census tracts with complete data on food insecurity, long-term poverty status and rural–urban classification. Due to historical differences in data availability, sample sizes varied across models.

In the inclusive framework, tracts classified as Persistent Poverty Since 1990 had food insecurity rates 7·2 percentage points higher than other tracts (P < 0·001); tracts classified as Enduring Poverty Since 1980 had rates 7·1 points higher (P < 0·001); and those classified as Enduring Poverty Since 1970 had rates 6·3 points higher (P < 0·001). In the mutually exclusive framework, where each tract was assigned to only one poverty category based on the earliest qualifying decade, food insecurity was 6·3 points higher in tracts with Persistent Poverty only, 4·7 points higher in tracts with Enduring Poverty Since 1980 only, and 6·3 points higher in tracts with Enduring Poverty Since 1970 only (all P < 0·001). All models adjusted for Rural-Urban Commuting Area (RUCA) codes and accounted for residual spatial autocorrelation.

Long-term poverty exposure is strongly associated with elevated food insecurity at the census tract level. These findings underscore the importance of integrating historical measures of disadvantage and the value of tract-level analysis for identifying communities at risk of food insecurity.

To analyse the frequency and distribution of alcoholic beverage advertisements and to identify patterns of co-occurring marketing strategies on the three highest-rated broadcast television channels in Brazil between 2018 and 2020.

Cross-sectional study based on 1296 h of television programming recorded between 2018 and 2020. Alcoholic beverage advertisements were analysed to assess their frequency and distribution according to day of the week and programme audience ranking, while empirical patterns of co-occurring marketing strategies were identified using principal component analysis (PCA).

The three highest-rated free-to-air television channels in Brazil.

All alcoholic beverage advertisements.

Of the advertisements identified (n 2369), 11·2 % promoted alcoholic beverages (n 269). Overall, alcoholic beverage advertisements were more frequently aired on weekends than on weekdays and were predominantly aired outside programmes included in the monthly top 10 audience rankings. Four empirical patterns of co-occurring marketing strategies were identified: ‘Brand Characteristics,’ ‘Sports and Well-being,’ ‘Relationships’ and ‘Celebrity and Pleasure.’ Each pattern showed a distinct temporal distribution across the study period, with ‘Celebrity and Pleasure’ being more prominent in 2018 than in 2019, ‘Relationships’ showing the highest representation in 2019, ‘Sports and Well-being’ in 2018 and 2020 and ‘Brand Characteristics’ standing out in 2020.

Alcoholic beverage marketing was widely present on Brazil’s major broadcast television channels and showed distinct patterns of co-occurring marketing strategies over time. The limitations of current regulations reinforce the need for stricter policies to reduce exposure to alcohol marketing and its potential impact on alcohol consumption.