While socioeconomic status (SES), time in preschool (TiP) and their interaction are related to reading ability, the results have been mixed. This study assessed whether the shared environment mediated these associations using a longitudinal behavior genetic design. Further, this study contrasted the source of variance in reading accounted for by (a) SES and TiP, against that of (b) genes, the shared environment, and the unique environment. Participants were 511 monozygotic twin pairs, and 515 dizygotic same-sex twin pairs from Australia, the United States and Scandinavia. They were assessed at preschool, kindergarten, grade 1, and grade 2. The interaction between TiP and SES did not explain variance in reading at any stage. At preschool, SES and TiP combined accounted for 9% of the total variance in reading, or 17.6% of the shared environment variance. Of that 9%, SES explained 8.1% independent of TiP. By Grade 2, SES and TiP explained 4% of the total variance, or 57% of the shared environment variance. Of that 4%, SES accounted for 3% with TiP accounting for just 1%. It was found that SES, but not TiP, had a small but significant influence on reading over time, and is a substantial mediator of the shared environment influence of reading by Grade 2.

This population-based cross-sectional study investigated the associations of sleep, nutrition and physical activity with overweight and obesity among 4108 school-aged children and adolescents (9–17 years) in Punjab, Pakistan, alongside 3371 parental responses. BMI was calculated using anthropometric measurements, and weight status was classified according to the 2007 WHO growth reference. Socio-economic status was determined through parental education, occupation and household income, while lifestyle behaviours were assessed via validated questionnaires. Multivariate logistic regression analyses were conducted, adjusting for sex, grade and socio-economic variables. The prevalence of overweight and obesity was 19·4 % and 10·7 %, respectively. Girls had a higher obesity prevalence than boys (12·3 % v. 8·9 %), whereas boys showed a higher combined prevalence of overweight and obesity. Among boys, obesity was significantly associated with urban residence (adjusted OR (aOR) 1·37; 95 % CI 1·13, 1·83), being an only child (aOR 2·74; 95 % CI 1·92, 3·92), frequent fast-food consumption (≥ 3 times/week; aOR 1·56; 95 % CI 1·23, 1·97) and lower parental education (aOR 1·22; 95 % CI 1·05, 1·41). Among girls, long weekend sleep duration increased obesity risk (aOR 1·38; 95 % CI 1·14, 1·67), while being an only child (aOR 0·36; 95 % CI 0·25, 0·52), frequent fast-food consumption (aOR 0·64; 95 % CI 0·50, 0·80) and lower parental education (aOR 0·81; 95 % CI 0·70, 0·94) were linked to lower odds. Physical activity and soft drink intake were not significant after adjustment. These findings underscore complex, gender-specific relationships between lifestyle and socio-economic factors, highlighting the need for targeted interventions promoting healthy sleep, nutrition and equity-focused strategies.

Metabolic dysfunction-associated steatotic liver disease (MASLD) was very common worldwide and was associated with metabolic syndrome, modifiable lifestyle factors and socio-economic status (SES). Although provitamin A carotenoid-rich foods have shown potential protective effects against MASLD, there was limited population-based evidence in this regard, and the mediating role of healthy lifestyle and SES in the association of carotenoids induced MASLD was still unclear. This study aimed to assess the association of provitamin A carotenoid-rich foods intake with MASLD risk and the mediating effects of healthy lifestyle and SES. Provitamin A carotenoid-rich foods intake was assessed using a 24-h recall data from the National Health and Nutrition Examination Survey. The USA Fatty Liver Index value ≥ 30 was used to define the MASLD status. SES (education/income) and healthy lifestyle (smoking/drinking/physical activity) were categorised via latent class analysis. Multivariable logistic regression and mediation analysis were used for analyses. A total of 6613 participants (mean (sd) age 50·8 (17·7) years; 53·6 % female) were included. Provitamin A carotenoid-rich foods intake was inversely associated with MASLD risk (adjusted OR, 0·684; 95 % CI: 0·532, 0·879). SES (mediation proportion, 12·92 %) and healthy lifestyle (16·84 %) exerted significant mediating effects. Subgroup analyses showed stronger associations in females (OR, 0·572; 95 % CI: 0·406, 0·805) and adults aged < 45 years (OR, 0·519; 95 % CI: 0·367, 0·734). Higher provitamin A carotenoid-rich foods intake was associated with lower MASLD risk, partially mediated by SES and healthy lifestyle. This provided a feasible dietary strategy for MASLD prevention, especially in females and younger adults.

This study examined the association between transitions in BMI growth channel (BMI-GC) and the odds of underweight and overweight in young adulthood. Data were drawn from 2759 participants in the Young Lives study (YL) and 2782 participants in the National Longitudinal Survey of Youth 1997 (NLSY97). Normal weight subsamples, consisting of 1922 participants from YL and 1477 from NLSY97, were selected for sensitivity analyses. Individual BMI-GC trajectories were estimated using linear mixed-effects models and classified into four groups: Stable, Crossing Upwards, Crossing Downwards and Fluctuating. Associations between BMI-GC groups and underweight and overweight at age 22 were assessed using logistic regression models. Compared with the Stable group, participants in the Crossing Downwards group had higher odds of being underweight in YL (OR 2·62; 95 % CI 1·95, 3·54), whereas those in the Crossing Upwards group had higher odds of overweight in YL (OR 3·96 (95 % CI 2·61, 5·99)) and in NLSY97 (OR 2·55 (95 % CI 1·95, 3·33)). In sensitivity analysis (normal weight subsamples), Crossing Downwards remained associated with underweight in YL (OR 1·75; 95 % CI 1·23, 2·48), and Crossing Upwards remained associated with overweight in both cohorts (OR 1·95; 95 % CI 1·14, 3·34 in YL and OR 1·67; 95 % CI 1·00, 2·78 in NLSY97). Crossing BMI-GC was associated with both underweight and overweight outcomes, including among participants with normal weight during childhood and adolescence. These findings highlight the importance of BMI-GC in weight assessments, offering a more nuanced understanding of growth trajectories and emphasising the need to move beyond BMI categories alone to predict long-term nutritional risks.

This study investigates the impact of socio-economic status (SES) on children’s vocabulary, focusing on the distinction between vocabulary breadth (number of words known) and vocabulary depth (quality of word knowledge). It aims to determine whether SES affects both dimensions equally and whether the relationship between SES and vocabulary depth is mediated by vocabulary breadth. Participants were 219 children schooled in France in fourth and fifth grades who had French as their dominant language. Analyses showed that SES significantly influences vocabulary breadth, as predicted by previous research. Importantly, it also impacts vocabulary depth. Mediation analysis revealed that vocabulary breadth can mediate this effect depending on the task used to measure vocabulary depth.

Vitamin D has been associated with depression, potentially via anti-inflammatory mechanisms, yet data are scarce, particularly in adolescence. We investigated (1) whether lower vitamin D status is associated with greater depression severity and (2) whether this association is statistically moderated by inflammation in patients of a child and adolescent psychiatry department. At admission, fasting morning venous blood was drawn. Serum vitamin D (25-hydroxy-cholecalciferol (25(OH)D)) and C-reactive protein (CRP) were analysed in all participants (n 465 (64·7 %♀; 11·3–18·9 years)). In a subsample (n 177), we additionally measured tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and interleukin (IL)-1β, IL-6, IL-8 and IL-10. Depression severity was assessed by the Beck Depression Inventory II (BDI-II) (n 450), the Diagnostic System for Mental Disorders in Childhood and Adolescence via self-assessment (DISYPS Self) (n 441) and parent-assessment (DISYPS Proxy) (n 422). Overall, 43·2 % (n 201) were at risk for vitamin D deficiency (< 30 nmol/l), and 73·5–83·2 % – depending on assessment tool – showed at least mild depression. Linear regression revealed an inverse association between 25(OH)D and BDI-II in both crude and CRP-adjusted full-sample models. Logistic regressions showed a robust inverse association between 25(OH)D and DISYPS Proxy, but not for DISYPS Self. Although 25(OH)D was inversely correlated with some pro-inflammatory markers, neither their inclusion in regression models nor formal mediation analyses supported inflammation as a mediator of the vitamin D–depression association. Overall, our results suggest that vitamin D relates modestly to both depression and inflammation in adolescence. However, based on the measured parameters, we cannot confirm that anti-inflammatory effects are the link between vitamin D and depression.

Dietary patterns are increasingly recognised as crucial factors influencing the progression of metabolic-associated steatotic liver disease (MASLD). This study aimed to explore the association between dietary patterns and MASLD risk among adults, using latent class analysis (LCA), to our knowledge, for the first time in this context. This cross-sectional study included 8549 adults from the general population. Dietary intake data were collected using a validated FFQ and analysed with Nutritionist IV software. A 3-step LCA was applied to determine distinct dietary patterns among participants using micro- and macronutrients. Liver fibrosis severity was evaluated using a validated non-invasive marker, FIB-4 Score. Our analysis identified three distinct dietary patterns, each significantly associated with the severity of liver fibrosis. Class 1 (high-volume, high-fibre/mineral-rich pattern) was associated with the lowest risk of liver fibrosis. Compared with Class 1, participants in Class 2 (moderate volume, low-fibre/high-Na/mineral-poor pattern) (OR = 1·24; P = 0·002) and Class 3 (restricted volume, nutrient-depleted pattern) (OR = 1·13; P = 0·027) had significantly higher odds of moderate-to-high liver fibrosis risk. Class-specific regression analysis showed that age and smoking were the most consistent predictors of fibrosis risk across all patterns. Dietary patterns rich in antioxidants, fibre and essential micronutrients appear effective in reducing the risk of liver fibrosis. Further longitudinal studies are required to confirm these findings and determine practical clinical applications.

Few studies have examined the effects of early-life nutrition interventions on adolescent physical activity (PA). We aimed to examine the long-term effects of small-quantity lipid-based nutrient supplements (SQ-LNS) on adolescent PA and sedentary behaviour (SB) and to describe current adolescent PA and SB levels in this cohort. In the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana trial, 1320 mothers were enrolled and randomly assigned to one of three conditions: (1) daily iron and folic acid during pregnancy and placebo (calcium) from birth to 6 months postpartum (IFA), (2) multiple micronutrient supplements during pregnancy to 6 months postpartum (MMN) or (3) SQ-LNS during pregnancy to 6 months postpartum (LNS). Infants from mothers in the LNS group received SQ-LNS designed for children from 6 to 18 months. We recruited 11–13-year-old adolescents of mothers enrolled in the iLiNS-DYAD-G trial for a 7-d PA and SB assessment using accelerometers (n 305) and self-reported PA and SB (n 508). We compared the LNS with non-LNS (IFA+MMN) groups using ANCOVA models for the following outcomes: mean vector magnitude counts per minute, PAQ-C score and percentage of time in SB, light PA and moderate-to-vigorous PA (MVPA). There were no significant differences between the LNS and non-LNS groups in any PA outcome in minimally or fully adjusted models. Only approximately 50 % of adolescents met the PA recommendation of 60 min/d MVPA, with males more active than females; however, there is room for improvement. SQ-LNS in early life does not appear to have a sustained impact on PA or SB.

This pilot study evaluated the effect of an online cooking intervention: Up for Cooking. Seventy-three Dutch families participated in four 1.5-hour sessions, before which they received ingredients and intervention materials. Parental questionnaires (pre-post) assessed food literacy skills (planning, selecting and making a healthy meal), knowledge and self-efficacy towards cooking and healthy eating (quantitative). Interviews assessed whether families changed their cooking behaviour at home (qualitative). A Wilcoxon Signed Rank test and inductive thematic coding were used. Thirty-nine parents completed questionnaires and eleven parents participated in interviews. Scores on food literacy items related to selecting and making a healthy meal improved significantly post-intervention. Parents’ knowledge of healthy eating and self-efficacy in cooking with their children also improved significantly. Interviews revealed an increased involvement of children in meal preparation and positive changes in family cooking behaviour. This online cooking intervention is a promising nutrition intervention, but implementation and long-term changes need further exploration.

The German Federal Constitutional Court has defined constitutional limits for exclusionary legislation in social law. In these judgments, the Federal Constitutional Court has used human dignity and social equality doctrines to address poverty and social exclusion based on a specific group status as constitutional issues. In doing that, the Federal Constitutional Court has developed practices of a social constitutionalism. While the reviewing power of apex courts for restrictions in classic civil liberties is generally accepted, it is more contested and less obvious for distributive welfare policies. That is why, the practices of social constitutionalism of the Federal Constitutional Court have been an important constitutional development in recent years. The case law shows that they strengthen the social rights protection of the most vulnerable groups in society: people in need and refugees.

Diet in the first years of life is a key determinant of lifelong disease risk and is highly affected by socio-economic status (SES). However, the specific relation between SES and food consumption in toddlers and preschoolers is poorly understood. This study assesses SES-related differences in food consumption in 1- to 5-year-olds in Germany using weighed food records (3 + 1 d) of a subsample of 887 children from the cross-sectional Children’s Nutrition Survey to Record Food Consumption (KiESEL) undertaken between 2014 and 2017. Children were categorised as having a low, medium or high SES depending on parental income, education and occupation. A two-step generalised linear model corrected for age and sex was applied to assess differences in food consumption, using bootstrapping to address unequal group sizes. Differences between SES groups were found for unfavourable foods (and the subgroups sugar-sweetened beverages and confectionary/desserts), fruit, bread/cereals and fats/oils (PBoot < 0·05). Mean daily consumption in the low-SES group as compared with the high-SES group was 84 g lower for total fruit, 22 g lower for bread/cereals and 3 g lower for fats/oils, while being 123 g higher for sugar-sweetened beverages and 158 g higher for unfavourable foods in total (based on bootstrap 95 % CI). In conclusion, this study suggests a social gradient in the diet of German toddlers and preschoolers, with lower SES linked to lower diet quality. To prevent adverse health trajectories, public health measures to improve early life nutrition should address all children, prioritising those of lower SES.

Inflammation and infections such as malaria affect concentrations of many micronutrient biomarkers and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi and examine the potential role of malarial immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell folate and vitamin B12 were estimated using multivariable linear regression. Factors related to malarial immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68 % (95 % CI 51, 86), 28 % (18, 40) and 34 % (13, 45) greater inflammation-adjusted ferritin in PSC, SAC and WRA, respectively (P < 0·001 for each). In PSC, the positive association was stronger in younger children, high altitude and children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25 % (16, 29) and + 15 % (9, 22) respectively, P < 0·001). Serum folate and erythrocyte folate were elevated in WRA with malaria (+ 18 % (3, 35) and + 11 % (1, 23), P = 0·01 and P = 0·003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations, and examining factors related to malarial immunity may be informative.

Dietary habits, particularly vegetable consumption, play a crucial role in preventing noncommunicable diseases. However, despite international guidelines advocating daily vegetable intake, adherence remains low across many populations. As a result, more focused efforts to boost vegetable consumption at the population level are essential. This study aimed to assess the impact of a health communication campaign (HCC) in City A, which combined information dissemination and incentives to promote vegetable consumption. In 2021, a new app-based vegetable quiz was introduced as part of the ongoing campaign, which had been implemented since 2017. Participants earned 10 points per correct quiz answer, which could be redeemed for product certificates, with a maximum of 30 points. To evaluate the effectiveness of the quiz, we analysed vegetable intake data from 786 quiz users. A multiple regression analysis was conducted to consider factors such as sex, age, body mass index, pre-campaign points, prior vegetable intake, and frequency of food recording during the campaign. We ensured robustness of the results by analysing data from 605 individuals whose vegetable intake had been tracked one year earlier, during a non-incentivized version of the campaign. The results demonstrated that participants who completed all three quizzes consumed 10.7% more vegetables than non-participants. Year-over-year comparisons further showed a significant increase in vegetable intake among frequent quiz participants compared to the previous year, highlighting the positive impact of gamified quizzes on vegetable consumption. These findings suggest that incentivized HCC, especially those incorporating gamification elements, can be highly effective in encouraging healthier eating habits.

Understanding adolescents’ diet and eating behaviours is crucial for informing public health strategies and policies, allowing interventions to be tailored effectively to enhance dietary patterns and improve overall health and quality of life. This study examined dietary patterns, dietary diversity, eating habits, food choice and the factors influencing these among adolescent girls in the Mion District, Ghana. A convergent parallel mixed-method design employing in-depth interviews (n = 30), two focus group discussions (n = 10) and survey data from 882 mother-daughter pairs was used. Key findings indicate that approximately 90% of girls achieved the minimum dietary diversity for women of reproductive age (MDD-W), with most consuming three meals daily. Staples were eaten daily, while fruits and unhealthy foods were less frequently eaten. Moderate/severe food insecurity was negatively associated with the MDD-W, whereas larger household size was positively correlated with the MDD-W. Older girls were less likely to eat breakfast, while household crop farm diversity increased the odds of eating supper on weekends. Moderate/severe food insecurity was inversely associated with intake of animal-sourced foods (ASFs), fruit, and unhealthy foods but positively correlated with vegetable consumption in the past month. Maternal non-literacy was linked to a lower intake of unhealthy foods, while specific ethnic backgrounds negatively influenced ASF intake. Wealthier households demonstrated higher consumption of staples. Qualitatively, health considerations, availability, taste, and cravings were major influencers of food choices. Food aversions were often tied to intolerance, fatigue from consuming the same foods repeatedly, and preferences related to taste and texture. These findings underscore the need for targeted nutritional interventions considering socio-economic and household factors to improve adolescent girls’ dietary habits and overall health.

The prevalence of poor linear growth among African children with perinatally acquired HIV remains high. There is concern that poor linear growth may to lead to later total and central fat deposition and associated non-communicable disease risks. We investigated associations between height-for-age Z score (HAZ) and total and regional fat and lean mass measured by dual-energy X-ray absorptiometry, expressed as internal population Z scores, among 839 Zimbabwean and Zambian perinatally HIV-infected male and female adolescents aged 11–19 years. Stunting (HAZ < –2) was present in 37 % of males and 23 % of females. HAZ was strongly positively associated with total, trunk, arm and leg fat mass and lean mass Z scores, in analyses controlling for pubertal stage, socio-economic status and HIV viral load. Associations of linear growth with lean mass were stronger than those with fat outcomes; associations with total and regional fat were similar, indicating no preferential central fat deposition. There was no evidence that age of starting antiretroviral therapy was associated with HAZ or body composition. Non-suppressed HIV viral load was associated with lower lean but not fat mass. The results do not support the hypothesis that poor linear growth or stunting are risk factors for later total or central fat deposition. Rather, increased linear growth primarily benefits lean mass but also promotes fat mass, both consistent with larger body size. Nutritional and/or HIV infection control programmes need to address the high prevalence of stunting among perinatally HIV-infected children in order to mitigate constraints on the accretion of lean and fat mass.

The study aimed to describe trajectories of free sugar (FS) intake, its main sources and the associations with socio-economic status (SES) in Portuguese children/adolescents evaluated at 4, 7, 10 and 13 years of age from Generation XXI birth-cohort. Dietary intake was assessed through 3-day food diaries (n 5268). Added sugar intake was estimated following a systematic methodology, and FS was based on the WHO definition. A mixed-effects model with linear and quadratic terms for time was used to estimate FS trajectories and its association with SES, adjusting for children’s sex, age, BMI and SES. The FS mean intake (g/day) was 37, 47, 51 and 48 at 4, 7, 10 and 13 years, respectively. FS intake increased 4·6 g/year (CI 95 %: 4·20, 5·04), but velocity decreased by 0·3 g/year2 until 13 years. At all ages, the main food source was sweets. Some item’s consumption declined (sweets 25–21 % and yoghurts 22–7 %) as children grew older. Inversely, soft drink intake increased (9–18 %). Boys and children from younger mothers had higher FS intake, whereas higher maternal–SES was associated with lower children’s FS intake: occupational status (β = –3·5; 95 % CI: –4·97, –1·94), years of education (β = –3·7; 95 % CI: –4·93, –2·40) and household income (β = –4·9; 95 % CI: –6·50, –3·27). The FS trajectories were similar by SES categories but different by obesity status (interaction term β = –1·04; CI 95 % (–1·50, –0·59)). An increasing FS trajectory during childhood is mainly driven by an increasing intake of soft drinks and nectars. The FS trajectory pattern did not change according to SES categories, but children’s FS intake was always higher when their mothers had a lower SES.