To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old.

Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child’s mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05.

Nationally representative survey.

Children (n 4064) under 5 years old.

There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55).

Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

The objective of the current work was to determine the association between food insecurity and frailty in older adults, within the context of a country with accelerated ageing and nutritional problems.

Cross-sectional analysis of a representative nationwide survey on health and nutrition.

Mexican nationwide survey.

A sample of 7108 adults aged 60 years or older living in communities, representative of Mexican older adults.

Multivariate regression and descriptive analyses of food insecurity and frailty were performed. From a total of 7108 adults aged 60 years or older, with a mean age of 70·7 years, most (54·7 %) were women. Food security categories were: 26·3 % had food security, 40·3 % had mild food insecurity, 20·5 % had moderate food insecurity and 12·9 % had severe food insecurity. Food insecurity categories were associated with frailty, with the severe category having the highest odds ratio of 2·41 (95 % CI 2·03, 2·86; P<0·001) after adjustment for confounding factors.

According to our results, food insecurity is associated to frailty, which in turn is a condition that renders the older adult at a higher risk of developing adverse outcomes. Targeted food programmes for older adults with a high risk of having food insecurity or of being frail may improve health in this population group.

Large portion sizes in restaurants have been identified as a public health risk. The purpose of the present study was to determine whether customers in two different food-service operator segments (non-commercial worksite cafeteria and commercial upscale restaurant) would select reduced-portion menu items and the impact of selecting reduced-portion menu items on energy and nutrient intakes and plate waste.

Consumption and plate waste data were collected for 5 weeks before and 7 weeks after introduction of five reduced-size entrées in a worksite lunch cafeteria and for 3 weeks before and 4 weeks after introduction of five reduced-size dinner entrées in a restaurant setting. Full-size entrées were available throughout the entire study periods.

A worksite cafeteria and a commercial upscale restaurant in a large US Midwestern metropolitan area.

Adult worksite employees and restaurant patrons.

Reduced-size entrées accounted for 5·3–12·8 % and 18·8–31·3 % of total entrées selected in the worksite and restaurant settings, respectively. Food waste, energy intake and intakes of total fat, saturated fat, cholesterol, Na, fibre, Ca, K and Fe were significantly lower when both full- and reduced-size entrées were served in the worksite setting and in the restaurant setting compared with when only full-size entrées were served.

A relatively small proportion of reduced-size entrées were selected but still resulted in reductions in overall energy and nutrient intakes. These outcomes could serve as the foundation for future studies to determine strategies to enhance acceptance of reduced-portion menu items in restaurant settings.

To determine and compare the effect of two interventions in reducing the plate waste of school lunches.

A between-group analysis was conducted among children from three primary schools: (i) a group receiving intervention A, designed for children and focusing on nutrition education and food waste; (ii) a group receiving intervention B, intended for teachers and focusing on the causes and consequences of food waste; and (iii) a control group with no intervention. For each child, physical weighing of individual meals and leftovers was performed on three non-consecutive weeks at baseline (T0), 1 week (T1, short term) and 3 months (T2, medium term) following the intervention. Plate waste was recorded for a total of 1742 lunches during 14 d over eight different menus.

Portuguese public primary schools in the city of Porto.

All fourth-grade children (n 212) attending the three preselected schools.

After intervention A focusing on nutrition education designed for children, a decrease in soup waste was observed compared with the control group. The effect was greater at T1 (−11·9 (se 2·8) %; P<0·001) than at T2 (−5·8 (se 4·4) %; P=0·103). The plate waste of identical main dishes decreased strongly at T1 (−33·9 (se 4·8) %; P<0·001). However, this effect was not found at T2 (−13·7 (se 3·2) %; P<0·001). After intervention B involving teachers, plate waste decreased at T2 (−5·5 (se 1·9) % for soup; −5·4 (se 2·4) % for identical main dishes).

Nutrition education designed for children was more effective in the short than the medium term. Thus, this kind of intervention was not effective in reducing food waste in the medium term. In contrast, an intervention focusing on teachers revealed better results in the medium term than in the short term.

To assess the nutritional quality of food packages offered in the Food Distribution Program on Indian Reservations (FDPIR) using the Healthy Eating Index 2010 (HEI-2010).

Data were collected from the list of the food products provided by the US Department of Agriculture’s Food and Nutrition Handbook 501 for FDPIR. Nutritional quality was measured through a cross-sectional analysis of five randomly selected food packages offered through FDPIR. HEI-2010 component and total scores were calculated for each food package. ANOVA and t tests assessed significant differences between food packages and HEI-2010 maximum scores, respectively.

This study took place in the USA.

Study units included food products offered through FDPIR.

The mean total HEI-2010 score for the combined FDPIR food packages was significantly lower than the total HEI-2010 maximum score of 100 (66·38 (sd 11·60); P<0·01). Mean scores for total fruit (3·52 (sd 0·73); P<0·05), total vegetables (2·58 (sd 0·15); P<0·001), greens and beans (0·92 (sd 1·00); P<0·001), dairy (5·12 (sd 0·63); P<0·001), total protein foods (4·14 (sd 0·56); P<0·05) and refined grains (3·04 (sd 2·90); P<0·001) were all significantly lower than the maximum values.

The FDPIR food package HEI-2010 score was notably higher than other federal food assistance and nutrition programmes. Study findings highlight opportunities for the FDPIR to modify its offerings to best support lifestyles towards prevention of diet-related chronic disease.

Food insecurity increases risk of health conditions that may decrease military readiness. The aim of the present study was to define the prevalence of food insecurity among households with young children utilizing military installation childcare facilities and to describe household characteristics associated with food insecurity among this population.

Cross-sectional survey including demographic questions and the US Department of Agriculture Food Security Survey Module six-item short form given to households (n 248) enrolled in Joint Base San Antonio Child Development Centers (JBSA-CDC) during the spring of 2015.

Department of Defense families with at least one child less than 6 years old enrolled in a JBSA-CDC.

Joint Base San Antonio, TX, USA.

Nearly one in seven families reported food insecurity. Households were more likely to be food-insecure if the head of household’s highest level of education was high school or equivalent (P=0·003) and if the head of household was unmarried/unpartnered (P=0·001). Among food-insecure households headed by military service members, all were junior enlisted or non-commissioned officers (E1–E9). Food-insecure households were less likely to live off-post in owned or rented homes compared with those who were food-secure (P=0·016). Other characteristics associated with food insecurity included at least one family member enrolled in the Exceptional Family Member Program (P=0·020) and more children in the household (P=0·029). Few families reported enrolment in government supplemental food programmes.

Food insecurity is prevalent in military families. Targeted interventions and policies can be developed using the demographic risk factors identified in the present study.

To measure the impact of a reimbursement-based consumer subsidy on vegetable expenditures, consumption and waste.

Two-arm randomized controlled trial; two-week baseline observation period, three-week intervention period. Participants’ vegetable expenditures, consumption and waste were monitored using receipts collection and through an FFQ. During the intervention period, the treatment group received reimbursement of up to 50 US dollars ($) for purchased vegetables.

Participants were solicited from Palo Alto, CA, USA using materials advertising a ‘consumer behavior study’ and a small participation incentive. To prevent selection bias, solicitation materials did not describe the specific behaviour being evaluated.

One hundred and fifty potential participants responded to the solicitations and 144 participants enrolled in the study; 138 participants completed all five weekly surveys.

Accounting for the control group (n 69) and the two-week baseline period, the intervention significantly impacted the treatment group’s (n 69) vegetable expenditures (+$8·16 (sd 2·67)/week, P<0·01), but not vegetable consumption (+1·3 (sd 1·2) servings/week, P=0·28) or waste (−0·23 (sd 1·2) servings/week, P=0·60).

The consumer subsidy significantly increased participants’ vegetable expenditures, but not consumption or waste, suggesting that this type of subsidy might not have the effects anticipated. Reimbursement-based consumer subsidies may therefore not be as useful a policy tool for impacting vegetable consumption as earlier studies have suggested. Moreover, moderation analysis revealed that the subsidy’s effect on participants’ vegetable expenditures was significant only in men. Additional research should seek to determine how far reaching gender-specific effects are in this context. Further research should also examine the effect of a similar consumer subsidy on high-risk populations and explore to what extent increases in participants’ expenditures are due to the purchase of more expensive vegetables, purchasing of vegetables during the study period that were consumed outside the study period, or a shift from restaurant vegetable consumption to grocery vegetable consumption.

American Indian children of pre-school age have disproportionally high obesity rates and consequent risk for related diseases. Healthy Children, Strong Families was a family-based randomized trial assessing the efficacy of an obesity prevention toolkit delivered by a mentor v. mailed delivery that was designed and administered using community-based participatory research approaches.

During Year 1, twelve healthy behaviour toolkit lessons were delivered by either a community-based home mentor or monthly mailings. Primary outcomes were child BMI percentile, child BMI Z-score and adult BMI. Secondary outcomes included fruit/vegetable consumption, sugar consumption, television watching, physical activity, adult health-related self-efficacy and perceived health status. During a maintenance year, home-mentored families had access to monthly support groups and all families received monthly newsletters.

Family homes in four tribal communities, Wisconsin, USA.

Adult and child (2–5-year-olds) dyads (n 150).

No significant effect of the mentored v. mailed intervention delivery was found; however, significant improvements were noted in both groups exposed to the toolkit. Obese child participants showed a reduction in BMI percentile at Year 1 that continued through Year 2 (P<0·05); no change in adult BMI was observed. Child fruit/vegetable consumption increased (P=0·006) and mean television watching decreased for children (P=0·05) and adults (P=0·002). Reported adult self-efficacy for health-related behaviour changes (P=0·006) and quality of life increased (P=0·02).

Although no effect of delivery method was demonstrated, toolkit exposure positively affected adult and child health. The intervention was well received by community partners; a more comprehensive intervention is currently underway based on these findings.

To provide an update on current practices and policy development status concerning breastfeeding in the WHO European Region.

National surveys and studies conducted by national health institutions were prioritized. Sub-national data were included where no national data or studies existed. Information on national breastfeeding policies was collected mainly from the WHO Seventh Meeting of Baby-Friendly Hospital Initiative Coordinators and European Union projects. Owing to the different data sources and methods, any comparisons between countries must be made with caution.

WHO European Member States.

Data from fifty-three WHO European Member States were investigated; however, a large proportion had not reported any data. Rates of early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding to 1 year all varied considerably within the WHO European Region. Exclusive breastfeeding rates declined considerably after 4 months, and were low in infants under 6 months and at 6 months of age. The majority of the countries with existing data reported having a national infant and young child feeding policy and the establishment of a national committee on breastfeeding or infant and young child feeding. The majority of the countries with existing data reported having baby-friendly hospitals, although the proportion of baby-friendly hospitals to the total number of national hospitals with maternity units was low in most countries.

Breastfeeding practices within the WHO European Region, especially exclusive breastfeeding rates, are far from complying with the WHO recommendations. There are marked differences between countries in breastfeeding practices, infant and young child feeding policy adoption and proportion of baby-friendly hospitals.

To examine the association of food insufficiency with dietary intake and eating and health behaviours.

A cross-sectional study.

Data were obtained from a secondary source, the Fifth Korea National Health and Nutrition Examination Survey (2010–2012).

The sample size consisted of 15 603 adults over 19 years of age (8898 households).

Significant differences in socio-economic factors were observed according to food insufficiency level (P<0·05), but BMI was similar among groups. Regarding macronutrients, lower protein intake and higher carbohydrate intake were found in the severely food-insufficient group, but we found no association with fat intake. Regarding micronutrients, Ca, Fe, vitamin A, thiamin, riboflavin niacin and vitamin C intakes were negatively associated with food insufficiency level (Ptrend<0·05). Consumption of different food groups, such as meat, fish, eggs and beans, vegetables and fruits, was significantly lower as food insufficiency level decreased after controlling for all possible variables; food group consumption also differed by sex. Overall eating and health behaviours were poorer in the mildly and severely food-insufficient groups, who received more food assistance but less nutritional education.

Our results showed that dietary intake as well as eating and health behaviours are adversely associated with food insufficiency. These findings suggest that specific strategies to help food-insufficient individuals should be developed in order to improve their dietary quality and health status.

The present study aimed to compare different indicators of obesity in the Serbian adult population.

Cross-sectional study. A stratified, two-stage, national-representative random sampling approach was used for the selection of the survey sample. Data sources were questionnaires created according to the European Health Interview Survey questionnaire. Measurements of weight, height and waist circumference (WC) were performed using standard procedures. Anthropometric measures included BMI, WC and waist-to-height ratio (WHtR).

Data for the study were obtained from the 2013 National Health Survey, performed in line with the EUROSTAT recommendations for performance of the European Health Interview Survey.

Adults aged ≥20 years.

According to BMI, out of the whole studied population (12 460 adults of both sexes) 2·4 % were underweight, 36·4 % overweight and 22·4 % obese. Using WC and WHtR as measures of adiposity showed that 22·5 % and 42·8 % of participants were overweight and 39·8 % and 25·3 % were obese, respectively. Men and women differed significantly in all variables observed. Overweight was more frequent in men and obesity in women regardless of adiposity measure used.

In spite of strong correlations between BMI, WC and WHtR, substantial discrepancies between these three measures in the assessment of overweight and obesity were found, especially in some age groups. Which of these anthropometric measures should be used, or whether two or all three of them should be applied, depends on their associations with cardiovascular or some other disease of interest.

Weight management appears to be multidimensional and complex, and registered nutritionists might work to educate, promote and provide weight-management services to communities, groups and individuals. However, nutrition education might not adequately reflect the weight-management requirements of individuals and groups. The aim of the present study was to investigate if the Association for Nutrition’s undergraduate core competency framework for accredited Nutrition degrees sufficiently reflects the weight-management needs and experiences of individuals.

A qualitative investigation, conducted within critical realist ontology, was performed to understand the weight-management experiences of dieters and compare these with the Association for Nutrition’s accreditation criteria for undergraduate Nutrition degrees.

Framework analysis was used to identify and explain participants’ experiences thematically and to compare these with the Association for Nutrition’s core competency criteria.

Participants (n 8) with weight-loss (n 4) and weight-maintenance experiences (n 4) were interviewed using semi-structured interviews to understand weight management at the agential level.

Participants described knowledge, exercise, planning, psychological constructs and behaviour-change techniques, determinants of eating and social support as features of weight management. The competency criteria provided clear guidance on all aspects discussed by the group, apart from psychological constructs and behaviour-change techniques and social support.

Accredited Nutrition courses might not fully reflect the weight-management needs and experiences of individuals. Nutritionists might require greater knowledge of psychology and behaviour change to better understand and accommodate their clients’ weight-management needs.

The effectiveness of leaf concentrate powder (LCP) as a nutritional supplement was established in trials conducted among adolescent girls and pregnant women in India. Here we evaluate LCP, compared with skimmed milk powder (SMP), as a supplement for antiretroviral-naïve children living with HIV in a sub-Saharan African country.

Randomized controlled, two-arm, 6-month trial comparing effects of isoproteic (5 g) LCP (10 g daily) and SMP (15 g daily) on HIV-1 viral load, CD4+ cell count/percentage, weight/height-for-age, general blood parameters, diarrhoea, respiratory and HIV-related opportunistic infections.

Bujumbura and Kirundo, Burundi.

Eighty-three HIV-positive, antiretroviral-naïve children aged 5–14 years: median (range) CD4+ count, 716 (361–1690) cells/mm3; log10 HIV-1 viral load, 4·39 (1·79–6·00).

LCP was equivalent to SMP in relation to HIV-specific blood parameters and did not demonstrate superiority over SMP in relation to Hb. Three children in each arm (LCP, 7·1 % (3/42); SMP, 7·3 % (3/41)) proceeded to antiretroviral therapy because their CD4+ counts fell below 350 cells/mm3. Children in the LCP group reported higher levels of appetite and overall health at 6 months. There were no differences in clinical events or any other outcome measures. LCP was less palatable than SMP to the children in this population, but there were few negative perceptions of appearance, texture and taste.

LCP appears to be equivalent to SMP as a nutritional supplement in this population, despite slightly lower palatability. In relation to viral load and CD4+ count, equivalence may indicate no effect in either group. Effectiveness relative to no supplementation remains to be determined.