To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples.

A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics.

Iranian adults recruited in 2014–2015.

Healthy volunteer adults aged ≥18 years.

With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (−469 to −708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (–151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50).

In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.

To assess trends in consumption of soda, sweetened fruit drinks/sports drinks and any sugar-sweetened beverage (SSB) from 2013 to 2016 among all children in California aged 2–5 and 6–11 years and by racial-ethnic group.

Serial cross-sectional study using the California Health Interview Survey (CHIS).

CHIS is a telephone survey of households in California designed to assess population-level estimates of key health behaviours. Previous research using CHIS documented a decrease in SSB consumption among children in California from 2003 to 2009 coinciding with state-level policy efforts targeting child SSB consumption.

Parents of children in California aged 2–11 years (n 4901 in 2013–2014; n 3606 in 2015–2016) were surveyed about the child’s consumption of soda and sweetened fruit drinks/sports drinks on the day prior.

Among 2–5-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB remained stable. Sweetened fruit drink/sports drink consumption was higher than soda consumption in this age group. Latino 2–5- year-olds were more likely to consume any SSB in both 2013–2014 and 2015–2016 compared with Whites. Among 6–11-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB also remained stable over time. Latino and African-American 6–11-year-olds were more likely to consume an SSB in 2013–2014 compared with White children.

SSB consumption among children in California was unchanged from 2013 to 2016 and racial-ethnic disparities were evident. Increased policy efforts are needed to further reduce SSB consumption, particularly among children of Latino and African-American backgrounds.

To measure change in price of food groups over time (1995–2030) in Brazil, considering the Brazilian Dietary Guidelines’ recommendations.

Data from the Household Budget Survey (2008–2009 HBS) and the National System of Consumer Price Indexes (NSCPI) were used to create a data set containing monthly prices for the foods and beverages most consumed in the country (n 102), from January 1995 to December 2017. Data on price of foods and beverages from 2008–2009 HBS (referring to January 2009) were used to calculate real price over time using the monthly variation in prices from NSCPI. All prices were deflated to December 2017. Foods and beverages were classified following the Brazilian Dietary Guidelines’ recommendations. The monthly price for each food group and subgroup was used to analyse changes in prices from 1995 to 2017 and to forecast prices up to 2030 using fractional polynomial models.

Brazil.

National estimates of foods and beverages purchased for Brazil.

In 1995, ultra-processed foods were the most expensive group (R$ 6·51/kg), followed by processed foods (R$ 6·44/kg), then unprocessed or minimally processed foods and culinary ingredients (R$ 3·45/kg). Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Forecasts indicate that unhealthy foods will become cheaper than healthy foods in 2026.

Food prices in Brazil have changed unfavourably considering the Brazilian Dietary Guidelines’ recommendations. This may imply a decrease in the quality of the population’s diet.

To (i) describe the adaptation of the Short Food Survey (SFS) for assessing the dietary intake of children (2–5 years) during attendance at Early Childhood Education and Care (SFS-ECEC); (ii) determine the acceptability and feasibility of the SFS-ECEC; and (iii) compare the SFS-ECEC to direct observations for assessing dietary intake of children in care.

The adapted forty-seven-item SFS-ECEC was completed by childcare educators to capture individual child’s usual intake over the past month. Acceptability and feasibility were assessed via educator self-report and completion rates. Mean servings of food groups consumed in accordance with dietary guidelines reported in the SFS-ECEC were compared to those obtained by a single-day direct observation via visual estimation conducted by trained personnel. Mean differences, intra-class correlations, Bland–Altman plots, percentage agreement and Cohen’s κ were examined.

Early Childhood Education and Care, NSW, Australia.

Educators and children.

213 (98·61 %) SFS-ECECs were returned. Acceptability was high with 86·54 % of educators reporting the tool as easy to understand. Mean differences in servings of food groups between the SFS-ECEC and direct observation were statistically significantly different for five out of six foods and ranged 0·08–1·07, with intra-class correlations ranging 0·00–0·21. Agreement between the methods in the classification of children meeting or not meeting dietary guidelines ranged 42·78–93·01 %, with Cohen’s κ ranging −0·03 to 0·14.

The SFS-ECEC is acceptable and feasible for completion by childcare educators. While tool refinement and further validation is warranted, small mean differences suggest the tool may be useful in estimating group-level intakes.

To recognize the causality of environmental factors (i.e. temperature, humidity and sun exposure) on nutritional variables, specifically body water balance and water-seeking behaviour.

Author perspective.

Global.

Not applicable.

A free-standing code supplement is provided to facilitate investigators in accessing meteorological data for incorporation into analyses related to nutrition and hydration.

Analytical models related to human hydration should account for the environment de rigueur.

The aim of the current study is to develop a valid and reliable instrument with psychometric qualities to measure effect of social media usage on eating behaviour in university students.

A thirty-eight-item draft scale developed by the researchers. After content validity, twenty-two items are remained and was used to collect the data. In the analysis of the data, confirmatory factor analyses were performed to test construct validity. For the reliability of the scale, Cronbach alpha coefficient was calculated for the whole of the scale.

The participants attended from various departments of different universities in Ankara.

The scale was administered to the study group consisting of 247 university students.

Four items that had total correlation value less than 0·40 were removed from scale. The reliability coefficient of the whole eighteen-item scale was found to be 0·928.

It has been shown that the scale developed as a result of the validity and reliability analyses performed for the scale is a valid and reliable measurement tool and can be used in studies.

To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.

Cross-sectional telephone surveys using a validated 24 h dietary assessment.

Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.

Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.

Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.

The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.

Cross-sectional study.

Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011–2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.

Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.

A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.

Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.

To assess the frequency, healthfulness and promotional techniques of television food advertising to children and adolescents in the Russian Federation.

A cross-sectional study was conducted to monitor food and beverage television advertising. For the five most popular TV channels among children and adolescents, TV broadcasts were recorded for two weekdays and two weekends (320 h) during March–May 2017. Recordings were screened for advertisements. Food advertisements were categorised by food categories and as either ‘permitted’ or ‘not permitted’ for advertising to children in accordance with World Health Organization Regional Office for Europe Nutrient Profile Model (NPM), and promotional techniques in advertisements were recorded.

Overall, 11 678 advertisements were coded. Across all channels, food and drink (19·2 %) were the most frequently advertised product type. The most common food categories advertised were beverages (except juices, milk drinks and energy drinks) (24·1 %); yoghurts and other dairy foods (15 %); and chocolate and confectionery (12·3 %). A majority (64·2 %) of food and drink products advertised should not be permitted for advertising to children according to the NPM. The most frequently used persuasive appeals in the food advertisements were low price (15·4 %), product novelty (11·8 %) and enjoyment (10·0 %).

Children and adolescents in the Russian Federation are likely exposed to a substantial number of unhealthy food advertisements. There is a need to consider policies to restrict children’s exposure to unhealthy food advertising on television in the Russian Federation.

To explore the extent to which micronutrient deficiencies (MND) affect children’s health-related quality of life (HRQoL), using vitamin D deficiency (VDD) as a case study.

Proxy valuation study to estimate the impact of VDD on the HRQoL of younger (0–4 years) and older (>4 years) children. We used the Child Health Utility 9 Dimension (CHU9D) questionnaire to estimate HRQoL for children within six VDD-related health states: ‘hypocalcaemic cardiomyopathy’, ‘hypocalcaemic seizures’, ‘active rickets’, ‘bone deformities’, ‘pain and muscle weakness’ and ‘subclinical VDD’.

Sampling was not restricted to any particular setting and worldwide experts were recruited.

Respondents were paediatric bone experts recruited through network sampling.

Thirty-eight experts completed the survey. The health state with the largest detrimental impact (mean score (se)) on children’s HRQoL was hypocalcaemic cardiomyopathy (0·47 (0·02)), followed by hypocalcaemic seizures (0·50 (0·02)) and active rickets (0·62 (0·02) in young children; 0·57 (0·02) in older children). Asymptomatic VDD had a modest but noticeable negative impact on HRQoL, attributed mostly to tiredness in both age groups and pain in the older paediatric population.

Elicitation of HRQoL from clinical experts suggests a negative impact of VDD on HRQoL, even if there is no recognizable clinical manifestation. HRQoL data from populations of patients with MND will inform public health policy decisions. In some settings, routine collection of HRQoL data alongside national nutrition surveys may help capture the full burden of MND and prioritize resources towards effective prevention.

The relationship between nutrition and behavioural health (BH) outcomes has been established in the literature. However, the relationship between nutrition and anxiety is unclear. Furthermore, the relationship between nutrition and BH outcomes has not been examined in a US Army Soldier population. This study sought to understand the relationship between Soldiers’ nutritional intake and anxiety as well as depression.

This cross-sectional study utilised multivariable logistic regression analyses to examine the relationship between nutritional intake and BH outcomes.

The study utilised data collected in 2018 during a BH epidemiological consultation conducted at one Army installation.

Participants were 7043 US Army Soldiers at one Army installation.

Of the Soldiers completing the survey, 12 % (n 812) screened positive for anxiety and 11 % (n 774) for depression. The adjusted odds of anxiety were significantly higher among Soldiers who reported low fruit intake compared with Soldiers who reported high fruit intake (adjusted OR (AOR) 1·36; 95 % CI 1·04, 1·79). The adjusted odds of depression were higher for Soldiers who reported low fruit intake (AOR 1·35; 95 % CI 1·01, 1·79) and/or low green vegetable intake (AOR 1·37; 95 % CI 1·02, 1·83). Lastly, the adjusted odds of depression were lower for Soldiers who reported low sugary drink intake (AOR 0·62; 95 % CI 0·48, 0·81).

This study is the first to examine the important connection between nutritional intake and anxiety and depression at a US military installation. The information learned from this study has implications for enhancing Soldiers’ nutritional knowledge and BH, ultimately improving Soldiers’ health and medical readiness.

To evaluate the effects of gestational weight gain (GWG) in the first trimester (GWG-F) and the rate of gestational weight gain in the second trimester (RGWG-S) on gestational diabetes mellitus (GDM), exploring the optimal GWG ranges for the avoidance of GDM in Chinese women.

A population-based prospective study was conducted. Gestational weight was measured regularly in every antenatal visit and assessed by the Institute of Medicine (IOM) criteria (2009). GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24–28 weeks of gestation. Multivariable logistic regression was performed to assess the effects of GWG-F and RGWG-S on GDM, stratified by pre-pregnancy BMI. In each BMI category, the GWG values corresponding to the lowest prevalence of GDM were defined as the optimal GWG range.

Southwest China.

Pregnant women (n 1910) in 2017.

After adjusting for confounders, GWG-F above IOM recommendations increased the risk of GDM (OR; 95 % CI) among underweight (2·500; 1·106, 5·655), normal-weight (1·396; 1·023, 1·906) and overweight/obese women (3·017; 1·118, 8·138) compared with women within IOM recommendations. No significant difference was observed between RGWG-S and GDM (P > 0·05) after adjusting for GWG-F based on the previous model. The optimal GWG-F ranges for the avoidance of GDM were 0·8–1·2, 0·8–1·2 and 0·35–0·70 kg for underweight, normal-weight and overweight/obese women, respectively.

Excessive GWG in the first trimester, rather than the second trimester, is associated with increased risk of GDM regardless of pre-pregnancy BMI. Obstetricians should provide more pre-emptive guidance in achieving adequate GWG-F.

The aim of the current study is to analyse the trends, determinants of prelacteal feeding (PLF) and its relations with the mode of delivery among infants <24 months over the years 2003–2018.

We pooled data from Turkey Demographic and Health Surveys (TDHS). The key outcome variable was PLF. Factors associated with PLF were analysed by using complex sample multiple logistic regression analysis, separately and merged database.

TDHS in 2003, 2008, 2013 and 2018.

Mother–infant dyads (n 4942).

PLF rates fluctuated between 29·3 and 41·4 %. The most common types of PLF were infant formula (61·1 %) followed by sugar/glucose water (24·9 %) and plain water (9·3 %). PLF rate was 1·51 times higher (95 % CI 1·28, 1·78) in cases delivered by caesarean section as compared with those delivered by vaginal route. According to the initiation time of breast-feeding after delivery, the most significant absolute change in PLF rate was observed within 1 h (10·9 % increase). Delayed initiation of breast-feeding was associated with significantly higher odds of PLF compared with the first hour (1 to < 2 h: adjusted OR (AOR) 1·29, 95 % CI 1·04, 1·61; 2–23 h: AOR 1·73, 95 % CI 1·42, 2·11; ≥24 h: AOR 11·37, 95 % CI 8·81, 14·69).

To eliminate suboptimal breast-feeding practices, counselling on breast-feeding and delivery type during antenatal visits, postnatal breast-feeding support and social support should be provided to all mothers and families.

To assess the prevalence of five forms of malnutrition (wasting/underweight, overweight, obesity, stunting/short stature and anaemia) by socio-economic wealth (SEW) and educational level (EL) among children, adolescents and women of reproductive age in Argentina.

Analysis from a cross-sectional survey. Anthropometric indicators and prevalence of anaemia were estimated. SEW was classified according to the proportion of contributors in the household, employment status, EL and medical coverage. EL was categorized by years of formal education.

National Health and Nutrition Survey, 2005.

Children (n 27 015) <5 years, adolescent girls (n 1729) 11–19 years, women (n 4401) 20–49 years.

In Argentina, 26 % of households lived with unsatisfied basic needs and 23 % received at least one form of food assistance. Any form of malnutrition affected 23 % of children, 36 % of girls and 56 % of women. Children were especially affected by anaemia, overweight/obesity and stunting (15·2, 9·9, 7·4 %, respectively). Girls were affected by overweight/obesity, anaemia and stunting (22·5, 15·2, 6·2 %). Women were strongly affected by overweight/obesity, anaemia and stunting (43·8, 19·8, 10·5 %). Stunting or short stature was higher in low-SEW settings, doubling in prevalence between low and high levels, increasing four times among women in reproductive age (P < 0·05). Excess weight among children was higher in high-SEW settings, in women the tendency was inverse. Anaemia showed different tendency according to SEW.

In 2005, Argentina had high rates of excess weight and anaemia, moderate prevalence of stunting and low frequency of wasting/underweight. All forms of malnutrition showed a strong relationship with socio-economic and educational inequality.

The monitoring of the populations’ iodine status is an essential part of successful programmes of iodine deficiency elimination. The current study aimed at the evaluation of current iodine nutrition in school children, pregnant and lactating women as a marker of the effectiveness and sustainability of mandatory iodine prophylaxis in Poland.

The following iodine nutrition indicators were used: urinary iodine concentration (UIC) (all participants) and serum thyroglobulin (pregnant and lactating women).

The study was conducted in 2017 within the National Health Programme in five regions of Poland.

The research included 300 pregnant women, 100 lactating women and 1000 school children (aged 6–12 years).

In pregnant women, median UIC was 111·6 µg/l; there was no significant difference in median UIC according to the region of residence. In 8 % of pregnant women, thyroglobulin level was >40 ng/ml (median thyroglobulin 13·3 ng/ml). In lactating women, median UIC was 68·0 µg/l. A significant inter-regional difference was noted (P = 0·0143). In 18 % of breastfeeding women, thyroglobulin level was >40 ng/ml (median thyroglobulin 18·5 ng/ml). According to the WHO criteria, the investigated sample of pregnant and lactating women was iodine-deficient. Median UIC in school children was 119·8 µg/l (with significant inter-regional variation; P = 0·0000), which is consistent with iodine sufficiency. Ninety-four children (9·4 %) had UIC < 50 µg/l.

Mandatory iodisation of household salt in Poland has led to a sustainable optimisation of iodine status in the general population. However, it has failed to assure adequate iodine nutrition during pregnancy and lactation.

To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts.

Cross-sectional.

Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017.

Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score.

Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE.

The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

We assessed the validity of a recently developed dish composition database (DCD) against urinary biomarkers compared with a standard food composition database (FCD).

Intakes of protein, Na and K were estimated by 2 × 24 h urine collections and by 4 d dietary record data based on the DCD (including 128 dishes) or FCD (including 1878 foods).

Japan.

A total of 161 men and 163 women aged 20–69 years.

Compared with the 24 h urine-based estimates, the median intakes estimated using the DCD and FCD differed significantly for protein and Na in men and for Na and K in women. Deattenuated Spearman correlation coefficients using 24 h urine-based estimates for the intakes of protein, Na and K were lower in the DCD (respectively: 0·26, 0·15 and 0·44 in men; 0·22, 0·27 and 0·22 in women) than those in the FCD (respectively: 0·43, 0·40 and 0·59 in men; 0·33, 0·45 and 0·42 in women). When data on dish portion size reported by participants were used for estimation instead of standard portion-size data based on the DCD, the accuracy of the estimated median intakes did not change notably, whereas the deattenuated correlation coefficients improved (for protein, Na and K respectively: 0·32, 0·31 and 0·56 in men; 0·31, 0·41 and 0·39 in women).

The DCD supported by individual-level information on dish portion size showed fair to moderate validity in ranking individuals according to their intakes of protein, Na and K, similar to the FCD.

The present study provides ranges for the magnitude of bias caused by measurement error in stunting rates, a widely used a proxy for long-term nutritional status.

Stunting, which is determined by the number of cases that fall below −2 sd from the mean height-for-age in the population, mechanically increases with higher variance. This variance stems from both natural heterogeneity in the population and measurement error. To isolate the effect of measurement error, we model the true distributions which could give rise to the observed distributions after subtracting a simulated measurement error.

We analyse information from three rounds of the Demographic and Health Survey (DHS) in Egypt (2005, 2008 and 2014). Egypt ranks high among developing countries with low-quality anthropometric data collected in the DHS, currently the main source of anthropometry in the country.

The study relies on re-analysis of existing DHS data, which record height, weight and age data for children under 5 years old.

Under the most conservative assumptions about measurement error, the stunting rate falls by 4 percentage points for the most recent DHS round, while assuming higher levels of measurement error reduces the stunting rate more dramatically.

Researchers should be aware of and adjust for data quality concerns in calculating stunting rates for cross-survey comparisons or in communicating to policy makers.

This study investigated the consumption behaviours of healthcare professionals in relation to red meat and processed red meat products.

This study included a questionnaire conducted through face-to-face interviews with 149 health professionals. The purpose of the questionnaire was to determine the extent to which health professionals agreed with the WHO classification of red meat and processed red meat on their list of carcinogenic products.

This research was carried out in İzmir, which is Turkey’s third largest city. The survey was conducted in 2016 by holding face to face interviews with forty-three specialist doctors, sixteen doctors, twelve dentists, sixty-four nurses and fourteen pharmacists.

Nationally representative sample of healthcare professionals in Turkey.

People educated in healthcare are especially cautious about the consumption of processed red meat products. The results of the research revealed the importance of processing and cooking patterns in red meat consumption preferences.

The consequences of the research, in terms of breaking down prejudices and overcoming the anxieties of those with health concerns who do not consume red meat, are important. In fact, the results show that healthcare professionals consume red meat, but they are more careful in their consumption of processed red meat products. This result is in line with the WHO report.

To assess the presence of nutrition declarations and nutritional quality in pre-packaged food products sold in Guatemala.

We photographed nutrition labels of pre-packaged foods. We extracted information about declaration of energy, total/saturated/trans-fats, total/added sugars and Na content (critical nutrients). We classified all products according to their degree of processing (NOVA classification) and nutritional quality (PAHO and WHO-Europe nutrient profile models).

Pre-packaged foods for sale in seven supermarkets in Guatemala City.

This study did not involve human subjects.

We assessed 3459 pre-packaged foods, including 80 % ultra-processed, 7 % processed and 13 % unprocessed/minimally processed foods or culinary ingredients. Nutritional information was available in 3021 products (87·3 %). Energy content was declared in 87·0 %; total fats in 86·1 %; saturated fats in 81·5 %; trans-fats in 48·9 %; total sugars in 70·3 %; added sugars in 0·5 % and Na/salt in 85·5 % of products. Insufficient nutrient information made impossible to assess nutritional quality in 36·6 and 17·1 % of products with the PAHO and WHO-Europe models, respectively. Using PAHO and WHO nutrient profiles, we found that 66·2 and 50 % of food products did not meet the model’s nutritional criteria.

A high proportion of pre-packaged foods with nutritional information available in Guatemalan supermarkets do not meet the nutritional criteria recommended by WHO and PAHO. Furthermore, a high proportion of products did not declare critical nutrients and many did not even provide any nutritional information. National regulations should consider making critical nutrient declarations (including trans-fats and sugars) mandatory for all products.