This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

Prospective cohort study.

Ten schools in North West Province, South Africa.

950 children aged 5–9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.

This systematic review investigates the characteristics, effectiveness and acceptability of interventions to encourage healthier eating in small, independent restaurants and takeaways.

We searched five databases (CENTRAL, MEDLINE, Embase, CINAHL and Science Citation Index and Social Science Citation Index) in June 2022. Eligible studies had to measure changes in sales, availability, nutritional quality, portion sizes or dietary intake of interventions targeting customer behaviour or restaurant environments. We evaluated study quality using the Mixed Methods Appraisal Tool. Results are synthesised narratively, and interventions’ impact on personal autonomy is assessed using the Nuffield intervention ladder.

Small, independent or local restaurants or hot food takeaway outlets, with no restrictions by year or country.

Anyone selling or purchasing food in intervention settings (e.g. restaurant staff/owners, customers).

We screened 4624 records and included 12 studies describing 13 interventions in 351 businesses. Most studies were of poor quality. Customer-level intervention components mostly operated on the lower rungs of the Nuffield ladder, and most had limited positive effects on increasing demand, measured as sales or orders of healthy options. Whilst rare, most interventions measuring business outcomes operated on higher ladder rungs and showed small positive results. There was insufficient evidence to investigate differences in impact by intervention intrusiveness. Acceptability was greater for interventions that were low-effort, inexpensive and perceived as not negatively impacting on customer satisfaction.

Despite some evidence of small positive effects of healthy eating interventions on healthier purchases or restaurant/hot food takeaway practices, a weak evidence base hinders robust inference.

Humanitarian aid, including food aid, has increasingly shifted towards the provision of cash assistance over in-kind benefits. This paper examines whether food security mediates the relationship between receipt of humanitarian cash transfers and subjective wellbeing among Syrian refugee youth in Jordan.

Secondary analysis of the 2020–21 Survey of Young People in Jordan, which is nationally representative of Syrian youth aged 16–30. We employ stepwise model building and structural equation models.

Jordan.

Syrian refugee youth aged 16–30 (n 1572).

While 92 % of Syrian households with youth received cash transfers from a UN agency, 78 % of households were food insecure using the Food Insecurity Experience Scale. Fifty-one percent of youth suffered from poor wellbeing using the WHO-5 subjective wellbeing scale. Household food insecurity was associated with poorer youth wellbeing. Receiving larger cash transfer amounts was associated with better wellbeing among Syrian youth in unadjusted models. The relationship between receipt of cash transfers and youth wellbeing was not mediated by food security.

We do not find support for the hypothesis that food security is a mediator of the association between cash transfers and subjective wellbeing for this population.

The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) authorised the use of SNAP benefits online in Maryland in May 2020. We assessed shopping behaviour and intentions associated with uptake and intended future use of online grocery shopping during and after COVID-19 among SNAP-eligible households.

In this mixed-methods study, participants completed a survey on online grocery shopping, and a purposefully sampled subset participated in focus groups or in-depth interviews between November 2020 and March 2021.

Predominantly urban households in Maryland

Primary shoppers of SNAP-eligible households with young children (n 310)

Most participants reported first shopping for groceries online after the OPP was implemented (57 %). Families who purchased groceries in-store less frequently were less likely to report ever buying groceries online (rate ratio (RR): 0·66, 95 % CI 0·46, 0·93) compared with weekly grocery shoppers. Shoppers who intended to purchase more groceries online in the next 6 months were more likely to have online shopping experience, although this differed by timing of online grocery service adoption. Participants reported more negative attitudes towards in-store grocery shopping during the pandemic than prior to its onset and cited COVID-19 as a motivator for ordering groceries online in focus groups. Most participants who had shopped online planned to continue after the pandemic (79 %).

Most participants who shopped online started during the COVID-19 pandemic and considered the pandemic a key motivator. Findings suggest that low-income households will continue to shop online, affirming the need for policies that promote equitable access to healthy food online.

The aim of this study is to analyse complementary feeding practices, to assess the extent to which minimum dietary diversity (MDD) recommendations are being met in the population studied and to study factors that influence the achievement of MDD.

We pooled individual level data form the Demographic and Health Surveys (DHS) and Multi Indicator Cluster Surveys (MICS). We apply methods from poverty measurement to identify individual gaps towards achieving MDD. We further identify food groups that separate children who achieve MDD from those who do not.

West and Central Africa.

62 257 children aged between 6 and 23 months.

82·0 per cent of children do not achieve MDD and on average are lacking 2·5 out of five required food groups. For 19·0 per cent of children, the gap to MDD is one food group and for 23·7 per cent of children the gap is two food groups. Consumption of eggs, other fruits and vegetables as well as legumes and nuts is particularly low among children who are not achieving MDD. More than 90·0 per cent of children who do not achieve MDD do not consume these food groups compared to around half of children who achieve MDD.

Overall MDD is low, but there is large potential for improving MDD achievement if food consumption can be increased by one or two food groups. Available, affordable and culturally accepted food groups are identified that could be prioritised in interventions to close this gap.

While studies have highlighted a link between breakfast consumption and cognitive performance, evidence for how breakfast influences academic outcomes is mixed. This study explored the association between student breakfast skipping and academic achievement.

This cross-sectional investigation employed population data. Self-reported breakfast consumption was used to categorise students as never, sometimes and always breakfast skippers. Scores on five standardised literacy and numeracy tests were used to classify students to have low or high achievement according to national minimum standards. Poisson regression analyses estimated the relative risk (RR) of low academic achievement among students across breakfast skipping categories, adjusting for student, family and community-level confounding.

Government schools in South Australia.

Participants included 28 651 students in grades 5, 7 and 9 (aged 8–16 years).

Overall, 32·3 % of students reported never skipping breakfast, 57·6 % reported sometimes skipping and 10·1 % reported they always skip breakfast. Students who sometimes and always skipped breakfast had an increased risk of low achievement on all five tests, after adjustment for confounding. Greatest risk for low achievement was on numeracy (RR = 1·78, 95 % CI 1·64, 1·94) and reading (RR = 1·63, 95 % CI 1·49, 1·77) among students who always skipped breakfast. Students who sometimes skipped breakfast were also at increased risk for low achievement, though not as higher risk as that among students who reported skipping breakfast every day.

Results suggest breakfast consumption plays an important role in academic success. Supports to promote regular student breakfast consumption may be one mechanism through which education stakeholders and policymakers can strengthen academic achievement.

The public health nutrition workforce is well placed to contribute to bold climate action; however, tertiary educators are seeking practical examples of how to adequately prepare our future workforce. This study examines the responses of university students engaged in a co-designed planetary health education workshop as part of their public health nutrition training.

A mixed-methods approach was used to collect and interpret student responses to four interactive tasks facilitated during an in-person workshop. Data were analysed using statistical tests, frequency counting and content analysis.

The intervention was co-designed by students (n 5) and an educator over a 4-week period as part of a larger multi-disciplinary study at an Australian university.

The workshop engaged nutrition and dietetics students (n 44) enrolled in public health nutrition coursework.

Students reported an increase in self-perceived knowledge about planetary health as a concept and how they can promote it within their future professional roles. Students’ descriptions of what planetary health means to them were focused on humans’ role in protecting and preserving the ecosystem, the responsible and sustainable use of natural resources and a need to sustain a healthy life for future generations. Students prioritised the values of ‘collaboration’ and ‘respect’ as being critical to guide personal and professional practice to promote planetary health.

This study demonstrated that incorporating planetary health curricula designed by, and for, university students could be a feasible and effective way to prepare the future public health nutrition workforce to address planetary health challenges.

Explore the relationship between water insecurity (WI) and food security and their covariates in Mexican households.

A cross-sectional study with nationally representative data from the National Health and Nutrition Survey-Continuous 2021 (in Spanish, ENSANUT-Continua 2021), collected data from 12 619 households.

WI was measured using the Household Water Insecurity Experiences (HWISE) Scale in Spanish and adapted to the Mexican context. Food security was measured using the Latin American and Caribbean Food Security Scale. A generalised path model was used to produce two simultaneous logistical regression equations – WI (HWISE ≥ 12) and moderate-to-severe food insecurity (FI) – to understand key covariates as well as the contribution of WI to FI.

The head of the household, an adult of >18 years of age, consented to participate in the survey.

Households experiencing WI were more likely to experience moderate-to-severe FI (OR = 2·35; 95 % CI: 2·02, 2·72). The odds of WI were lower in households with medium (OR = 0·74; 95 % CI: 0·61, 0·9) to high (OR = 0·45; 95 % CI: 0·37, 0·55) asset scores. WI also depended on the region of Mexico. FI is more prevalent in indigenous people (OR = 1·29; 95 % CI: 1·05, 1·59) and rural households (OR = 0·42; 95 % CI: 1·16, 1·73). Notably, wealth and household size did not contribute directly to FI but did so indirectly through the mediating factor of WI.

Our study shows that there are structural factors that form part of the varied determinants of WI, which in turn is closely linked to FI.

The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators.

This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context.

Burkina Faso.

Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors.

Among the fifty-six indicators, it was assessed the level of implementation as ‘high’ for six indicators, ‘medium’ for twenty-four indicators, ‘low’ for twenty-two indicators and ‘very low’ for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a ‘very low’ level of implementation in Burkina Faso.

The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

To quantify and compare concurrent within-person trends in lifestyle risks, nutrition status and drivers of food choice among urban migrants in Central Asia.

We collected panel data on household structure, drivers of food choice, nutrition knowledge and diverse measures of nutrition status and lifestyle risk from urban migrants at 0, 3, 6 and 9 months using harmonised methodology in two cities. Trends were analysed using mixed-effects models and qualitatively compared within and between cities.

Ulaanbaatar, Mongolia, and Almaty, Kazakhstan.

200 adults (22–55 years) who migrated to these cities within the past 2 years.

Adjusting for age and sex, each month since migration was positively associated with fasting TAG in Almaty (0·55 mg/dl; 95 % CI: 0·13, 0·94) and BMI (0·04 kg/m2; 95 % CI: 0·01, 0·07), body fat (0·14 %; 95 % CI: 0·01, 0·26) and fasting glucose (0·04 mmol/l; 95 % CI: 0·02, 0·05) and lipids in Ulaanbaatar (P < 0·05). In Almaty, nutrition knowledge (measured using an objective 20-point scale) declined despite improvements in diet quality (measured by Prime Diet Quality Score). The influence of food availability, price and taste on food choice increased in Almaty (P < 0·05). Upon multivariable adjustment, nutrition knowledge was positively associated with diet quality in Almaty and adherence to ‘acculturated’ diet patterns in both cities (P < 0·05). Different trends in smoking, sleep quality and generalised anxiety were observed between cities.

Findings indicate heterogeneous shifts in nutrition, lifestyles and drivers of food choice among urban migrants in Central Asia and provide an evidence base for focused research and advocacy to promote healthy diets and enable nutrition-sensitive food environments.

The Baby-Friendly Hospital Initiative (BFHI) designation is known to increase breast-feeding rates in the USA. However, less is known about barriers and facilitators to breast-feeding support practices in BFHI hospitals and how they differ from non-BFHI hospitals. We examined what barriers and facilitators are perceived to affect breast-feeding practices among BFHI and non-BFHI hospital administrators and further explored factors that presented challenges to the adoption and continuation of breast-feeding support practices.

Cross-sectional study was conducted. We measured whether hospitals were implementing 12 breast-feeding support practices and identified barriers and facilitators to the practices. The survey questionnaire included both structured and open-ended questions.

This study included hospital administrators from both BFHI and non-BFHI hospitals from all regions of the USA to help elucidate potential differences.

A stratified random sample of 50 % of BFHI and 50 % of non-BFHI hospitals was obtained. The final sample size included 113 BFHI and 177 non-BFHI hospital administrators.

Low interest among mothers was reported as the most significant barrier to providing breast-feeding support among all administrators. Non-BFHI hospital administrators were more likely to report cost, nursing staff and physician resistance and hospital infrastructure as barriers to initiating practices. In-person training was cited as the most important facilitator among both groups.

Strengthening prenatal education for mothers and trainings for administrative and nursing staff and physicians is warranted in BFHI and non-BFHI hospitals. Staff management and hospital infrastructure need to be improved particularly in non-BFHI hospitals to provide adequate breast-feeding support for mothers.

To characterise food group consumption, assess the contribution of food groups to energy and micronutrient intake, and estimate usual nutrient intake among adults in rural Sri Lanka.

A baseline survey (December 2020–February 2021) was conducted as part of an agriculture-based, nutrition-sensitive resilience program evaluation. Dietary intake was assessed using telephone-based 24-h recalls (n 1283), with repeat recalls from 769 participants. Mean daily intake of food groups and their contribution to energy and nutrient intakes were calculated. The National Cancer Institute method was used to estimate usual intakes and the prevalence of adequate micronutrient intake (PAI). Differences by sex, district, and wealth were assessed using t tests and ANOVA.

Forty-five rural villages throughout Sri Lanka.

Men and women from households in the program evaluation study area.

On average, grains and coconut milk provided 56 % and 12 % of energy, respectively. Rice, fish, dairy, and pulses were the primary sources of micronutrients. Participants consumed 118 ± 117 g of vegetables and 71 ± 243 g of fruit per day. PAI was < 25 % for calcium, zinc, niacin, folate, and vitamins B6, B12, and C, reflecting low consumption of animal-source foods (80 g/day), whole grains, fruit, and vegetables (F&V). Significant differences in food group consumption by socio-demographic subgroup were observed among districts and wealth quintiles.

We observed high consumption of rice and coconut milk and low prevalence of micronutrient adequacy. We recommend increasing animal-source food, whole grain, and F&V consumption to close nutrient gaps, as well as research to identify effective solutions to increase micronutrient intake.

To investigate the relationship between US containment measures during the COVID-19 pandemic and household food insecurity.

To investigate these relationships, we developed a framework linking COVID-19-related containment policies with different domains of food security and then used multilevel random effects models to examine associations between state-level containment policies and household food security. Our framework depicts theorised linkages between stringency policies and five domains of food security (availability, physical access, economic access, acceptability in meeting preferences and agency, which includes both self-efficacy and infrastructure). We used US national data from a representative survey data from the National Food Access and COVID research Team that was fielded in July–August 2020 and April 2021. Containment policy measures came from the Oxford Stringency Index and included policies such as stay-at-home orders, closing of public transit and workplace closures.

The USA.

3071 adult individuals from the National Food Access and COVID research Team survey.

We found no significant associations between state-level containment policies and overall food insecurity at the state level or any of the individual domains of food insecurity.

This research suggests that while food insecurity across all domains was a significant problem during the studied phases of the pandemic, it was not associated with these containment measures. Therefore, impacts may have been successfully mitigated, likely through a suite of policies aimed at maintaining food security, including the declaration of food workers as essential and the expansion of federal nutrition programmes.

To explore mothers’ and early childhood (EC) educators’ experiences of breast-feeding/breast milk provision and breast-feeding support in child care centres (CCC) in the USA.

We conducted one-time, semi-structured phone interviews with mothers and EC educators to examine perceptions of support, accommodations and barriers to breast-feeding in CCC. We administered a background survey to assess participant characteristics and quantify perceived degree of breast-feeding support in the workplace (mothers) and CCC (mothers and EC educators).

US-based CCC

Fifty working mothers using CCC for their infants and twenty-two EC educators

Interview themes and background surveys reflected neutral feelings towards breast-feeding support received (mothers) and provided (EC educators) in CCC. Maternal expectations for breast-feeding support in CCC were generally low; workplace and social support for breast-feeding were perceived as the most important factors impacting breast-feeding. EC educators’ capacity to offer breast-feeding support was constrained by CCC infant feeding regulations, inadequate breast-feeding training and time limitations. Tensions arose when mothers attempted to manage low milk supply at the CCC level by requesting EC educators to individualise feeding or milk storage practices for their infant.

Breast-feeding efforts of working mothers are undermined in multiple settings, including the workplace and CCC. Improving breast-feeding outcomes for this population requires structural/policy changes that: (1) maximise opportunities for continued, direct breast-feeding and maternal/infant proximity and (2) enforce evidence-based CCC feeding protocols and standards and EC educator lactation training.

This study aimed to examine the association between ultra-processed food intake and dyslipidaemia risk and whether this association varied by the polygenic score for dyslipidaemia in the adult Korean population.

Prospective cohort study.

Ultra-processed foods were identified under the NOVA classification. Participants were categorised into < 5, 5 to < 10, 10 to < 15, 15 to < 20 and ≥ 20 %E/d of ultra-processed food intake. The polygenic scores for dyslipidaemia were calculated from 53 950 SNPs. ORs and 95 % CIs were estimated using multivariate logistic regression models.

20 044 Korean adults aged ≥ 40 years in the Health Examinees (HEXA) study, the Cardiovascular Disease Association Study (CAVAS) and the Korea Association Resource (KARE) study.

During median follow-ups of 4·09, 8·67 and 15·67 years in the HEXA, CAVAS and KARE studies, respectively, there were a total of 7331, 786 and 1732 incident dyslipidaemia events. Ultra-processed food intake was not significantly associated with dyslipidaemia risk. Compared with < 5 %E/d, the pooled OR (95 % CI) of ≥ 20 %E/d of ultra-processed food intake for dyslipidaemia incidence was 1·01 (0·90, 1·13; P for trend = 0·83). There was no interaction by dyslipidaemia-related genetic variations; ORs (95 % CIs) were 1·04 (0·89, 1·22; P for trend = 0·91) and 0·98 (0·84, 1·15; P for trend = 0·72) for individuals with high- and low-polygenic scores, respectively (P for interaction = 0·90).

No significant association was observed between ultra-processed food intake and the overall risk of dyslipidaemia, nor in subgroups of polygenic scores for dyslipidaemia among Korean adults with low ultra-processed food intake.