Front-of-package labelling informs consumers about the ‘healthiness’ of foods based on different classification schemes. These schemes reflect competing worldviews for assessing a food’s healthiness, represented by nutrient-, food- or diet-based indices. The Health Star Rating scheme (HSR) has been criticised for failing to appropriately score unhealthy products. Updates to the HSR algorithm were implemented over a two-year period from November 2020. This study investigated alignment between a nutrient-based scheme (HSR), food-based scheme (Nova food processing system) and diet-based scheme (Australian Dietary Guidelines (ADG)).

Mintel Global New Products Database

Retail foods displaying HSR launched or updated onto the Australian market between November 2020 and June 2023.

Products were categorised according to the ADG and Nova, descriptive statistics performed for each category and proportion displaying HSR ≤ 2·0 and ≥ 2·5 calculated for discretionary foods, five food group foods, ultra-processed foods (UPF) and non-UPF. Agreement between categories obtained by Kappa.

Median HSR for UPF and discretionary foods were 3·5 and 2·5, respectively, and 73·7 % of UPF and 58·2 % of discretionary foods displayed HSR ≥ 2·5. Agreement between HSR and Nova was none to slight (k = 0·09, P < 0·001) and HSR and ADG was fair (k = 0·38, P < 0·001). Between 2020–2023, the proportion of UPF displaying HSR ≥ 2·5 increased from 60·2 % to 78·5 % and for discretionary foods 47·0 % to 62·5 %.

The HSR algorithm calculates ‘healthy’ HSR (≥ 2·5) for a high proportion of UPF and discretionary foods. The HSR’s nutrient-based approach to translate food-and diet-based nutrition recommendations into accurate food ‘healthiness’ assessments is still problematic.

This study aims to determine the current status of the obesity epidemic in Türkiye from a global perspective by examining gender-specific socio-economic inequalities at national and regional socio-economic development (SED) levels.

A cross-sectional analysis was conducted using data from the 2022 Türkiye Health Survey, employing weighted binary logistic regression models, age-standardised prevalence estimates for national obesity prevalence and model-based age-adjusted prevalence estimates for regional comparisons, with analyses stratified by sex.

Türkiye.

Data included 20 725 nationally representative adults aged 20 years and older (10 808 women and 9917 men).

The national age-standardised obesity prevalence was substantially higher (OR: 1·558; 95 % CI: 1·556, 1·560) in women (28·0 %) than men (18·4 %). In low-SED regions, the gender disparity (women 28·4 %, men 17·9 %) was larger. Higher education was consistently associated with lower obesity risk, more pronounced in women and low-SED regions. The income–obesity relationship was complex. An inverted U-shaped pattern across income quintiles was observed among men in high regional SED and among women both nationwide and across all levels of regional SED.

As of 2022, Türkiye maintains a high obesity prevalence reflecting socio-economic patterns typical of developing countries experiencing nutritional transition. The epidemic stage varies by regional SED, emphasising the necessity for prevention strategies designed with a focus on socio-economic determinants, regional and gender sensitivity.

To examine the prevalence, financial value and marketing leveraging methods of food sponsorship agreements and food service contracts in Canadian recreation and sport facilities (RSF).

Cross-sectional survey using descriptive analysis. RSF managers and directors reported the number, value and types of marketing leveraging methods used in food-related sponsorship agreements and food service contracts.

Publicly funded RSF in nine Canadian provinces that provide indoor sport programming for children and youth.

Eighty-six RSF representatives completed the survey (response rate: 73·9 %). Most facilities were municipally owned and located in urban settings; over 70 % served children under 13 years of age.

Food sponsorship agreements and food service contracts were reported by 36·5 % and 65·5 % of RSF, respectively. Financial donations were included in 88·6 % of sponsorship agreements and 27·4 % of contracts. Sponsors contributed a median of 25·0 % (IQR: 13·9–83·3 %) of total sponsorship income, with a median annual donation per sponsor of $500 (IQR: $288–$1375). Nearly all agreements and contracts included at least one food marketing leveraging method. Branded signage was the most common in sponsorship agreements (64·6 %), while equipment donation was the most common in food service contracts (52·2 %).

Food sponsorship and service agreements are prevalent in Canadian RSF and include financial and in-kind contributions that may benefit facilities. However, the marketing leveraging methods used – such as branded signage and product provision – may also increase children’s exposure to food marketing. Greater monitoring and evaluation of these marketing practices are needed, especially in the context of proposed national marketing restrictions.

To synthesise and quantify the association between household food insecurity (HFI) and various forms of malnutrition that include stunting, wasting, underweight, overnutrition and anaemia among Indonesian children under 5 years of age.

A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study included literature search, screening, data extraction, quality assessment using Joanna Briggs Institute (JBI) tools and meta-analysis using Review Manager 5.4.

Studies conducted in Indonesia, covering urban, rural and mixed settings across multiple provinces.

Children under 5 years of age residing in Indonesia, from households assessed for food insecurity using validated tools.

A total of thirty-two studies met the inclusion criteria, of which twenty-six were eligible for meta-analysis. HFI was significantly associated with higher odds of stunting (case–control: OR = 4·66; 95 % CI: 3·39, 6·40; P < 0·001; cross-sectional: OR = 4·61; 95 % CI: 4·17, 5·11; P < 0·001), wasting (OR = 1·92; 95 % CI: 1·60, 2·32; P < 0·001), underweight (OR = 5·26; 95 % CI: 2·12, 13·04; P < 0·001) and overnutrition (OR = 1·66; 95 % CI: 1·49, 1·85; P < 0·001). Children in food-secure households had significantly lower odds of anaemia (OR = 0·41; 95 % CI: 0·30, 0·58; P < 0·001).

HFI is strongly associated with multiple forms of malnutrition among Indonesian children under 5 years of age. These findings highlight the urgent need for integrated, nutrition-sensitive strategies that address food security to improve child health and reduce malnutrition in Indonesia.

To co-create with rangatahi (young people) evidence-based eating and wellbeing guidelines for young people in Aotearoa New Zealand (NZ), informed by mātauranga Māori (traditional Māori knowledge).

Rangatahi collaborated with Māori and non-Māori experts to review existing health guidelines covering sustainable eating, physical activity, screen time, sleep and mental wellbeing and develop their own set of guidelines. Peer feedback on the draft guidelines was used to produce the final guidelines. The process integrated scientific evidence with mātauranga Māori, following tikanga Māori (Māori custom) to ensure a culturally centred process.

Wānanga (learning workshops) were held at a local marae (traditional meeting house), and feedback presentations were held in four secondary schools in Hawke’s Bay, NZ.

Seventeen rangatahi from four schools with high Māori student enrolment participated in the wānanga, and ninety-four students provided peer feedback through surveys.

The rangatahi created ten eating and ten wellbeing guideline messages. These messages were invitational (beginning ‘Let’s try to…’) acknowledging the challenging journey for many rangatahi from current to recommended behaviours. Only one quantification (8–10 h of sleep) was included. Three eating and three physical activity guidelines incorporated the concepts of ‘mauri’ (life force). The guidelines addressed contemporary issues including sustainable eating, ultra-processed foods, social dimensions of eating and physical activity, screen time and cyberbullying. They also emphasised respect, rights and responsibilities, concluding with a motivational whakatauki (proverb) about aspirations.

Innovative, relevant and contemporary eating and wellbeing guidelines have been successfully co-created by rangatahi Māori for all young people across NZ.

Food insecurity (FI) prevalence has increased globally, including in the USA, and disproportionately affects certain subgroups (e.g. women). Both food-related and non-food-related sociopolitical indicators may impact FI rates; however, these associations are underexplored. This study assessed select state-level sociopolitical indicators among states with higher and lower FI rates compared to the national average.

Cross-sectional

US

We identified twenty-five states representing lower (n 18) and higher (n 7) FI prevalence compared to the 2021–2023 US average (12·2 %) and used national data sources to characterise sixteen sociopolitical indicators (selected via prior review) across three categories: (1) proximal to FI (related to food access/income/resources), (2) inequality (contributing to disparities) and (3) tobacco/alcohol/cannabis regulation (may exacerbate/perpetuate financial constraints). We described each indicator and explored their associations (using t tests or Fisher’s tests) with state FI status (high v. low).

For proximal indicators, low-FI (v. high-FI) states had greater food environment scores, nutrition assistance programme participation, minimum wage and insured individuals. For inequality indicators, low-FI (v. high-FI) states had narrower gender wage gaps, greater racial equity and more protective policies for sexual/gender minority populations and abortion rights. For substance-related indicators, low-FI (v. high-FI) states had higher cigarette taxes and were more likely to have comprehensive smoke-free laws, legalised non-medical cannabis and provisions for expunging/pardoning prior cannabis-related convictions.

Low-FI states had more sociopolitical indicators aimed at improving food access, financial resources, equality and substance use-related regulations. Findings highlight the importance of adopting a holistic, sustainable, multilevel approach to effectively address the broader determinants of FI.

There is growing public health interest in ultra-processed foods (UPF), but limited research exploring consumers’ perceptions of these foods in the United States. We aimed to characterise consumers’ beliefs about UPF, the association between perceived food processing and perceived food healthfulness and alignment between consumers’ perceptions and objective measures of food processing and healthfulness.

In a cross-sectional survey, participants answered questions regarding their beliefs about UPF. They rated the healthfulness and processing levels of a random selection of ten out of forty possible foods. We used descriptive statistics to examine participant beliefs about UPF. We used linear regression models to test associations between perceived processing and perceived healthfulness and between objective and perceived measures of food healthfulness and processing.

We fielded an online survey in the USA in November 2023.

This study included US adults aged ≥ 18 years (n 4455).

Fifty-four percent of participants correctly identified UPF as ‘Food products submitted to a series of industrial processing’ and 52 % correctly identified UPF as, ‘Food products that contain artificial ingredients’. However, one-third of participants believed UPF were genetically modified products. While foods with higher perceived processing tended to have lower perceived healthfulness and individuals perceived UPF as more processed and less healthful than minimally processed foods, healthfulness perceptions better aligned with Food Compass 2.0, a measure that integrates food processing and nutrient-profile.

Educational and policy efforts (e.g. food labeling) are needed to help consumers distinguish UPF and holistically assess the healthfulness of foods and beverages.

To evaluate food marketing techniques used in Canadian recreation and sport facilities and assess the healthfulness of foods and beverages marketed by the techniques.

Cross-sectional content analysis of photographed food marketing instances coded for marketing techniques according to Health Canada’s Monitoring Protocol, developed for monitoring food marketing techniques across settings, supplemented with new inductively identified codes and sport-related marketing techniques. Healthfulness was classified as ‘of concern’ or ‘not of concern’ according to cut-offs of sodium, sugar and saturated fat established by Health Canada.

Recreation and sport facilities in Canada

134 facilities with 2576 food marketing instances

91·4 % of food marketing instances included at least one general marketing technique. Branded infrastructure, displays and furniture was the most prevalent (87·9 %) and appeared with another technique half of the time. Sport-related marketing appeared in 12·2 % of marketing instances, with most referring to sponsors. Most (86·5 %) marketing instances were ‘of concern’. Food marketing instances with sport-related marketing (97·6 %) were significantly more likely to be ‘of concern’ than without sport-related marketing (84·6 %) (χ2 = 20·54, P < 0·001). Three new indicators – appeals to taste, appeals to emotion, and cross-channel references – captured persuasive elements not addressed by the current monitoring protocol.

This study highlights the presence of food branding and the use of sport-related marketing to promote unhealthy products/brands in recreation and sports facilities. Monitoring protocols may underestimate exposure to persuasive food marketing by overlooking subtle, symbolic and cross-channel techniques. Future research can be improved by including subtle techniques and reinforced messages across marketing channels.

This study aimed to determine the prevalence of mother–child double burden of malnutrition (DBM) based on anthropometric indices and its associated factors in Burkina Faso.

This cross-sectional study used nationally representative data from the 2021 Burkina Faso Demographic and Health Survey (BFDHS-V). DBM was defined as follows: overweight mother with stunted child (OM/SC); overweight mother with wasted child (OM/WC); overweight mother with underweight child (OM/UC); overweight mother with stunted or wasted or underweight child (OM/SC-WC-UC). Generalised linear model of regression using R programming was performed to identify factors associated with DBM.

Burkina Faso

5286 mother–child dyads living in the same household.

The prevalence of DBM in mother–child dyads was 4·9 % for OM/SC-WC-UC. Urban residence was inversely associated with 3 forms of dyads DBM. OM/SC-WC-UC: aOR = 0·60, 95 % CI (0·37, 0·96), OM/WC: aOR = 0·23, 95 % CI (0·11, 0·45), and OM/UC: aOR = 0·51, 95 % CI (0·29, 0·89). Higher child birth order was associated with increased odds of OM/WC: aOR = 3·82, 95 % CI (1·21, 12·10) and OM/UC: aOR = 4·75, 95 % CI (1·65–13·62). Older maternal age was associated with OM/SC: aOR = 3·17, 95 % CI (1·44, 7·00) and belonging to a wealthier household was associated with OM/SC-WC-UC: aOR = 3·43, 95 % CI (1·61, 7·30).

The finding suggests that household-level DBM is an emerging problem in Burkina Faso. The most prevalent form of DBM includes an overweight mother with a stunted child, and common associated factors include urban residence and high socio-economic status. Urgent strategies and actions need to be put in place in order to avert this trend.

Behavioural interventions can be delivered via online school canteens to improve healthy purchasing for students. However, no evaluations of the cost or cost-effectiveness of online canteen interventions have been conducted. The objective was to conduct a cost and cost-effectiveness analysis of implementing an online school canteen intervention to improve healthy purchasing.

The ‘Click & Crunch’ cluster randomised controlled trial was conducted in seventeen Australian primary schools.

Eight control schools (848 students) received the standard online canteen. Nine intervention schools (1359 students) received a behavioural intervention delivered through the online canteen.

Incremental cost-effectiveness ratios (ICER) were calculated for the cost per student to achieve (1) a unit decrease in the mean energy (kJ) content and (2) a percentage increase in the mean proportion of healthier ‘Everyday’ items purchased in their online lunch orders (from a health service and societal perspective).

It costs AUD$568 per school (range $343–$806) to implement. The ICER for mean energy content was AUD$0·06 and AUD$0·46 for mean proportion of ‘Everyday’ foods (from a health perspective). At a willingness to pay of AUD$0·20 and AUD$1·20 per student, the intervention would have a 95 % and 99 % probability of being cost-effective for the energy (kJ) content and proportion of ‘Everyday’ items, respectively.

‘Click & Crunch’ has the potential to be a cost-effective intervention to reduce the energy content and increase the proportion of ‘Everyday’ items from primary school online canteen lunch orders.

To estimate the effect of integrating responsive care, early learning and development monitoring into a community-based package of activities on nutrition, sanitation and hygiene, on improvements in early childhood development (ECD) outcomes.

This was a quasi-experimental study with nonequivalent comparison groups. The study’s primary outcome, ECD, was measured using the Ages and Stages Questionnaire (ASQ-3) and the Global Scales for Early Development (GSED). We also collected data on the early learning home environment, nutritional practices and caregiver depressive symptoms as secondary outcomes.

This study was conducted across twelve districts in Nampula Province, Mozambique. Half of the districts received holistic nurturing care with responsive care, early learning, nutrition, sanitation and hygiene packages (intervention) and the other half received only nutrition, sanitation and hygiene packages (comparison).

We recruited an age-stratified random sample of 961 caregivers and their children, aged 0–23 months.

We found a significantly higher mean caregiver engagement total score (mean difference: 0·36; P ≤ 0·001) and a higher number of activities to support learning (mean difference: 0·30, P = 0·004) in the intervention group than in the control. There were no measurable impacts on the remaining early stimulation activities or the primary outcomes of the ASQ and GSED developmental scores.

We discuss the challenges in the integration of nurturing care interventions into existing programmes in high-vulnerability contexts, highlighting the aspects needed to achieve effective caregiver behavioural changes that can translate into improved ECD outcomes.

This study aimed to develop and validate a questionnaire assessing the nutrition knowledge (NK) of Italian adult women regarding the relationship between diet, lifestyle and bone health.

A thirty-item questionnaire in Italian was developed by experts based on a literature review. Participants completed the questionnaire twice, with a 2–4 week gap between the two administrations. During the initial administration, weight and height were recorded using a mechanical scale and a stadiometer, while bone mineral density (BMD) of the lumbar spine (L1-L4), femoral neck and total femur were assessed via dual-energy X-ray absorptiometry (DXA).

Centre for Metabolic Bone Diseases at the Parma University Hospital, from January 2022 to June 2024.

Women aged 45–75 years old, native Italian speakers, undergoing DXA at the Centre participated.

The sample included 295 women with a median age of 63 years (interquartile range 11·5). The questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0·698) and high temporal stability (R = 0·810, P = 0·002), effectively differentiating between individuals with and without a nutritional background. Regression analysis indicated negative associations between NK score and age (β1 = –0·130, P < 0·001) and BMI (β1 = –0·193, P < 0·001).

The NutriBone questionnaire is a valid and reliable tool for evaluating NK related to bone health in Italian adult women undergoing DXA, with potential for future research applications.

To examine the association between household food insecurity (HFI) and low subjective well-being (SWB) among pregnant and postpartum women and determine whether these potential associations differed by maternal age and pregnancy status.

We conducted a secondary analysis of nationally representative cross-sectional data from women of reproductive age (15–49 years). HFI was measured using the Food Insecurity Experience Scale and categorised as none/mild, moderate or severe. Weighted multilevel logistic regression models were used to estimate OR and 95 % CI for the association between HFI and low levels of three SWB measures: happiness, life satisfaction and optimism. Analyses were stratified by age and pregnancy status.

Data were drawn from the 2021 Nigeria Multiple Indicator Cluster Survey, Round 6.

The analytic sample comprised 12 587 women who were pregnant at the time of the survey or within 24 months postpartum.

HFI was significantly associated with all three measures of SWB, although the magnitude of associations varied by outcome, even after adjusting for individual-, household-and community-level characteristics. Stratified analyses revealed heterogeneity in the associations between HFI and SWB by age and pregnancy status. Overall, HFI was associated with lower levels of happiness, life satisfaction and optimism among pregnant and postpartum women in Nigeria.

Our findings demonstrate a negative association between HFI and SWB among pregnant and postpartum women in Nigeria. These associations were modified by maternal age and pregnancy status, suggesting that strategies to mitigate HFI should account for subgroup differences in order to effectively improve maternal well-being.

This study explores associations between clusters characterising urban Canadians’ retail food environments and their acceptability levels of three policies aimed at promoting healthier restaurant food environments (RFE).

The three examined policies related to (1) proposing healthier menu default options, (2) restricting the establishment of fast-food restaurants near schools and (3) eliminating unhealthy foods from municipal buildings’ food outlets. Retail food environment clusters were available for 1- and 3-km buffer zones from the centroid of participants’ residential dissemination area. Retail food environment data were extracted from Can-FED, whereas acceptability data were provided by the THEPA dataset.

Retail food environments present across Canada’s seventeen most populated census metropolitan areas.

Urban-dwelling Canadians (n 27 162).

Results from multivariate multilevel logistic regression analyses showed that those who were surrounded by the greatest relative density of both healthy food outlets (HFO) and fast-food outlets (FFO) within a 3-km buffer zone were less likely to be in complete agreement with the fast-food zoning policy than the reference category. Findings also indicated that, within a 1-km buffer zone, those whose retail food environment was categorised as being the least healthy (no HFO and highest relative density of FFO) were less likely to be in complete agreement with the unhealthy food elimination policy than the reference category.

This study provides new evidence of associations between retail food environments and RFE policy acceptability, which may help orient the implementation of these policies.

To investigate food consumption behaviour and self-perceived nutrition knowledge among university students, and to draw implications for nutrition education in contexts where formal nutrition education before university is limited.

A mixed-methods approach was adopted. A survey was first conducted to examine participants’ food consumption behaviour and self-perceived nutrition knowledge. Thirty-four participants were then invited to take part in semi-structured interviews to gain more in-depth insights into their self-declared knowledge and related behaviours.

Universities in China, representing a context of limited formal nutrition education in pre-university schooling.

190 university students.

Interview transcripts were reviewed to verify participants’ self-declared nutrition knowledge and identify misconceptions or gaps in understanding. Questionnaire data were analysed using descriptive statistics.

Students with higher education levels reported paying more attention to nutrition labels and selecting healthier snacks. However, interviews revealed that students who claimed to read nutritional claims during food purchases often misunderstood the meaning of sugar and fat content information. A significant ‘illusion of knowing’ was observed, and participants generally lacked awareness of authoritative food standards.

Illusion of knowing is common among students who have not received formal systematic nutrition education. Nutrition education programmes should prioritise raising students’ understanding of basic food concepts and improving their ability to interpret nutrition information accurately, as part of broader health promotion efforts.

To optimise school food baskets in Ghana to meet newly proposed food and nutrition targets while considering cultural acceptability and cost.

This was a modelling study. Data on existing school meal menus were collected from various regions to provide baseline inputs. Linear programming (LP) was used to model school meal baskets that satisfied minimum nutrient and food targets for school meals while meeting cost and acceptability constraints. Five LP models were tested, each varying in budget constraints and acceptability/food-based parameters.

Ghana.

NA.

Baseline school food baskets were significantly deficient in energy, protein, Fe, Zn, vitamin A, folate, vitamin B12 and vitamin C compared to food and nutrient standards for school meals in Ghana. Optimisation resulted in school food baskets that met cost, nutrient and food-based/acceptability targets but with substantial deviations from baseline. Achieving nutritional adequacy within cost limits increased reliance on animal-source foods and led to higher environmental impacts, indicating trade-offs between nutrition, affordability and environmental sustainability.

The study underscores LP’s potential for enhancing school meals in Ghana but highlights the need for increased financial investment for reaching dietary goals. Addressing local realities and cultural preferences is essential for implementing effective, sustainable school meal strategies and improving child health.

To assess the purchases and prices of unprocessed or minimally processed foods according to the type of food outlet and household income.

Cross-sectional study conducted with data from the 2017–2018 Brazilian Household Budget Survey. Food acquisition and income were the variables of interest. Unprocessed or minimally processed foods were identified according to the NOVA classification, and the shares of energy (kcal) and quantity (grams), as well as prices paid, were analysed. Food outlets were grouped into nine types. Household income per person was assessed in quintiles (Q). Descriptive analyses were conducted.

Brazil.

A nationally representative sample of 57 920 households.

The amount of unprocessed or minimally processed foods acquired varied from 320 g (Q1 of income) to 493 g (Q5). The increase in income had a positive effect on the share of foods purchased in supermarkets (Q1: 27·6 % v. Q5: 63·8 %) and fruit and vegetable retailers (Q1: 1·5 % v. Q4: 4·6 %). In contrast, an inverse relation was observed for Mini-markets (Q1: 34·9 % v. Q5: 16·2 %), butchers (Q1: 6·8 % v. Q5: 2·3 %), street markets (Q1: 13·3 % v. Q5: 3·8 %) and street food vendors (Q1: 5·3 % v. Q5: 1·0 %). The price paid for unprocessed or minimally processed foods in supermarkets, mini-markets, butchers and street markets was positively associated with income, which means that a higher mean price was observed in the highest income quintile.

The availability and affordability of unprocessed or minimally processed foods differed according to food outlets and were influenced by income level.

This research was conducted to determine if and how Australian and Canadian dietetic regulatory bodies incorporate social justice into regulatory documents and how this compares between two otherwise demographically and politically similar countries.

Quantitative and qualitative content analysis of Australian and Canadian dietetic regulatory documents was performed to determine how often and in what context social justice terms were incorporated into dietetics regulation.

Australia and Canada

Regulatory documents in Australia and Canada

Findings reveal that social justice is framed differently between the two countries, particularly related to working with people who experience marginalisation. Regulatory documents seldom addressed issues of systemic injustice, focusing instead on self-awareness and individualistic approaches to care.

Social justice is currently framed in nutrition and dietetics regulatory documents in ways that do not align with core principles of social justice. Social justice should be reframed in regulatory documents to shift attention away from awareness, towards action, and should be done in a way that addresses systemic injustices in healthcare. Developing a clear and consistent definition of what social justice is is a critical first step in achieving this goal to overcome the challenges identified in this research study.