It is unknown whether the nutritional quality of children’s menus varies depending on the cuisine type. This study aimed to investigate differences in the nutritional quality of children’s menus by cuisine type in restaurants located in Perth, Western Australia (WA).

Cross-sectional study

Perth, WA.

Children’s menus (n 139) from the five most prevalent restaurant cuisine types in Perth (i.e. Chinese, Modern Australian, Italian, Indian and Japanese) were assessed using the Children’s Menu Assessment Tool (CMAT; range -5–21 with lower scores denoting lower nutritional quality) and the Food Traffic Light system, evaluated against Healthy Options WA Food and Nutrition Policy recommendations. Non-parametric ANOVA was used to test for a significant difference in total CMAT scores among cuisine types.

Total CMAT scores were low for all cuisine types (range -2–5), with a significant difference between cuisine types (Kruskal–Wallis H = 58·8, P < 0·001). The highest total CMAT score by cuisine type was Modern Australian (mean = 2·27, sd = 1·41) followed by Italian (mean = 2·02, sd = 1·02), Japanese (mean = 1·80, sd = 2·39), Indian (mean = 0·30, sd = 0·97) and Chinese (mean = 0·07, sd = 0·83). When using the Food Traffic Light for assessment, Japanese cuisine had the highest percentage of green food items (44 %), followed by Italian (42 %), Modern Australian (38 %), Indian (17 %) and Chinese (14 %).

Overall, the nutritional quality of children’s menus was poor regardless of cuisine type. However, children’s menus from Japanese, Italian and Modern Australian restaurants scored better in terms of nutritional quality than children’s menus from Chinese and Indian restaurants.

Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention.

We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens.

Communities.

Practice-based researcher experience and perspectives.

Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded.

We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.

Efficacy studies show early nutrition interventions improving infant nutrition status, but understanding caregiver acceptability is required for implementation of such interventions. This systematic review examines caregivers’ perceptions of nutrition interventions in young children.

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and PsychINFO from date of online journal inception through December 2020. Interventions included oral (powder/liquid/tablet) and/or intravenous supplementation, food fortification and nutrition counselling. Inclusion criteria included primary research, data presented on caregiver perception and studies published in English. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Studies underwent narrative synthesis using inductive thematic analysis.

No restriction.

Caregivers of children under 24 months of age.

Of 11 798 records identified, thirty-seven publications were included. Interventions included oral supplementation, food fortification and nutrition counselling. Caregivers included mothers (83 %), fathers, grandparents and aunts. Perceptions were gathered through individual interviews, focus group discussions, questionnaires, surveys and ratings. Totally, 89 % of studies noted high acceptability (n 33 most notably increased appetite (n 17). In total, 57 % of studies (n 21) cited low acceptability, commonly from side effects (n 13) such as gastrointestinal issues, appetite loss and stained teeth.

Positive perceptions and enthusiasm for interventions were frequently reported. Key to implementation was the increased appetite noted by caregivers. A substantial proportion of studies reported negative perceptions, mainly due to side effects. In future interventions, mitigation and education around common side effects are crucial for acceptability. Understanding both positive and negative caregiver perceptions is important for informing future nutrition interventions and strengthening sustainability and implementation.

We examined the association between food insecurity and positive childhood experiences (PCE).

Outcome measure was number of PCE and seven PCE constructs. Food insecurity was assessed with a three-category measure that ascertained whether the respondent could afford and choose to eat nutritious food. We then used bivariate and multivariable Poisson and logistic regressions to analyse the relationship between food insecurity and the outcome measures. The analyses were further stratified by age (≤ 5, 6–11 and 12–17 years).

The National Survey of Children’s Health (NSCH) from 2017 to 2020, a nationally representative sample of children and adolescents in the USA.

Parents/caregivers who reported on their children’s experiences of PCE and food insecurity from the 2017–2020 NSCH (n 114 709).

Descriptively, 22·13 % of respondents reported mild food insecurity, while 3·45 % of respondents reported moderate to severe food insecurity. On multivariable Poisson regression analyses, there was a lower rate of PCE among children who experienced mild (incidence rate ratio (IRR) = 0·93; 95 % CI 0·92, 0·94) or moderate/severe food insecurity (IRR = 0·84; 95 % CI 0·83, 0·86) compared with those who were food secure. We found an inverse relationship between food insecurity and rate of PCE across all age categories.

Our study finding lends evidence to support that interventions, public health programmes, as well as public health policies that reduce food insecurity among children and adolescents may be associated with an increase in PCE. Longitudinal and intervention research are needed to examine the mechanistic relationship between food insecurity and PCE across the life course.

Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity.

Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey.

Washington State, USA.

Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more.

The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not.

Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity.

To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference.

Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet.

Five regions are included in the urban and rural areas of Ethiopia.

Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019.

Women’s mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet’s cost.

The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.

To describe and compare the references cited in popular books about diet and health between the USA and Japan.

Books were selected based on their best-seller rankings in the diet and health category of online bookstores. We identified references throughout all pages of the books and examined the number of references, reference format (identifiable or not) and presence of specific types of references, such as systematic reviews of human research. We compared the characteristics of references between the two countries and examined related factors to citation.

Cross-sectional study.

Books (n 100 in each country).

Among 100 books from each country, sixty-five US and sixty-six Japanese books had references. Forty-five US books cited more than 100 references, against only five Japanese books. The number of books that cited systematic reviews of human research differed between the USA (n 49) and Japan (n 9). Additionally, the number of books that provided identifiable information for all references was significantly higher in the USA (n 63) than in Japan (n 42). Books whose first authors have licences of medical doctors were more likely to cite references than those without in both countries.

Two-thirds of books about diet and health cited references in both the USA and Japan, but Japanese books cited fewer references and were less likely to cite systematic reviews and provide identifiable references than US books. Further research into the scientific reliability of information in books about diet and health is warranted.

The aim of this project is to review the products and recipes contained within popular subscription meal kits to determine if they are suitable for wider use among people who are food insecure.

Across the 6-week period, weekly meal kits from both HelloFresh and Markey Spoon were purchased, resulting in thirty-six individual meals that were prepared and assessed. Meals were assessed based on the content included in the meal kit compared with the recipe card and the nutrition panel, the costs of the individual foods if purchased at one of two major supermarkets and the ease of preparation.

Australia.

Households were comprised of two, 2-person households who were provided with 2 meals each week, and two, single-person households who were provided with one meal each week.

The findings of this research suggest that while the meal kits are convenient and, in general, the recipes are easy to follow, and the meals would be made again, the high levels of salt and fat may preclude these kits from regular inclusion in a healthy diet. The meal kits were also found to be more costly than the same ingredients if purchased from a major supermarket. However, the convenience of having most of the foods needed to prepare a full meal with little to no wastage may counterbalance this cost.

Meal kits may be a useful component of a healthy diet, that can increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation.

To explore on-package formula messaging with reference to legislation and government-issued guidance in Great Britain (GB).

Formula products were identified, pictures of all sides of packs collated and on-package text and images were coded. Compliance with both GB legislation and guidance issued by the Department of Health and Social Care (DHSC) was assessed.

All formula packs that were available for sale over the counter in GB between April and October 2020.

Formula packs (n 71) including infant formula, follow-on formula, growing-up formula and specialist formula were identified, coded and analysed.

In total, 41 % of formula packs included nutrition claims, and 18 % included health claims that may be considered non-permitted, according to DHSC guidance. Additionally, 72 % of products showed images considered ‘non-permitted’. Breast Milk Substitute (BMS) legislation states infant and follow-on formula packs should be clearly distinguishable but does not provide criteria to assess similarity. Based on DHSC guidance, 72 % of infant and follow-on formula packs were categorised as showing a high degree of similarity. Marketing practices not covered by current legislation were widespread, such as 94 % of infant formula packs including advertisements for follow-on or growing-up formula.

Text and images considered non-permitted according to DHSC guidance for implementing BMS legislation were widespread on formula products available in GB. As terms such as ‘similarity’ are not defined in BMS legislation, it was unclear if breaches had occurred. Findings support the WHO call for loopholes in domestic legislation to be closed as a matter of urgency.

Food systems are a major contributor to climate change, producing one-third of global greenhouse gas emissions. However, public knowledge of food systems’ contributions to climate change is low. One reason for low public awareness may be limited media coverage of the issue. To investigate this, we conducted a media analysis examining coverage of food systems and their contribution to climate change in Australian newspapers.

We analysed climate change articles from twelve Australian newspapers between 2011 and 2021, sourced from Factiva. We explored the volume and frequency of climate change articles that mentioned food systems and their contributions to climate change, as well as the level of focus on food systems.

Australia.

N/A.

Of the 2892 articles included, only 5 % mentioned the contributions of food systems to climate change, with the majority highlighting food production as the main contributor, followed by food consumption. Conversely, 8 % mentioned the impact of climate change on food systems.

Though newspaper coverage of food systems’ effects on climate change is increasing, coverage of the issue remains limited. As newspapers play a key role in increasing public and political awareness of matters, the findings provide valuable insights for advocates wishing to increase engagement on the issue. Increased media coverage may raise public awareness and encourage action by policymakers. Collaboration between public health and environmental stakeholders to increase public knowledge of the relationship between food systems and climate change is recommended.

In 2015, the Victorian Salt Reduction Partnership launched a 4-year multifaceted salt reduction intervention designed to reduce salt intake by 1 g/d in children and adults living in Victoria, Australia. Child-relevant intervention strategies included a consumer awareness campaign targeting parents and food industry engagement seeking to reduce salt levels in processed foods. This study aimed to assess trends in salt intake, dietary sources of salt and discretionary salt use in primary schoolchildren pre- and post-delivery of the intervention.

Repeated cross-sectional surveys were completed at baseline (2010–2013) and follow-up (2018–2019). Salt intake was measured via 24-h urinary Na excretion, discretionary salt use behaviours by self-report and sources of salt by 24-h dietary recall. Data were analysed with multivariable-adjusted regression models.

Victoria, Australia.

Children aged 4–12 years

Complete 24-h urine samples were collected from 666 children at baseline and 161 at follow-up. Mean salt intake remained unchanged from baseline (6·0; se 0·1 g/d) to follow-up (6·1; 0·4 g/d) (P = 0·36), and there were no clear differences in the food sources of salt and at both time points approximately 70 % of children exceeded Na intake recommendations. At follow-up, 14 % more parents (P = 0·001) reported adding salt during cooking, but child use of table salt and inclusion of a saltshaker on the table remained unchanged.

These findings show no beneficial effect of the Victorian Salt Reduction Partnership intervention on children’s salt intake. More intensive, sustained and coordinated efforts between state and federal stakeholders are required.

To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain.

The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including ‘yes/no’ questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m2) increase of ≥5 % was coded as BMI gain.

Brazil.

9551 participants from the NutriNet-Brasil cohort.

Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (–0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score.

The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems.

To pilot a global policy scan assessing how governments worldwide regulate weight-loss supplements (WLS).

Experts on WLS policies from thirty countries that varied by World Bank income classification, with five from each of the six WHO regions, completed an online survey on WLS regulation in their country. The survey covered six domains: legal frameworks; pre-market requirements; claims, labelling, and advertisements; product availability; adverse events reporting; and monitoring and enforcement. Percentages were calculated for presence or absence of a type of regulation.

Experts were recruited through websites of regulatory bodies and professional LinkedIn networks and scientific article searches on Google Scholar.

Thirty experts, one from each country (i.e. researchers, regulators, other experts in food and drug regulation).

WLS regulations varied widely across countries, and a number of gaps were identified. One country (Nigeria) has a minimum legal age to purchase WLS. Thirteen countries reported independently evaluating the safety of a new WLS product sample. Two countries have limitations on where WLS can be sold. In eleven countries, reports on adverse events related to WLS are publicly available. In eighteen countries, safety of new WLS is to be established through scientific criteria. Penalties for WLS non-compliance with pre-market regulations exist in twelve countries and labelling requirements in sixteen countries.

Results of this pilot study document wide variability in national WLS regulations globally, exposing many gaps in important components of consumer protection regulatory frameworks for WLS, which likely put consumer health at risk.

To evaluate nutrition literacy status and its association with adherence to the Mediterranean diet (MD), anthropometric parameters and lifestyle behaviours among early adolescents.

This is a cross-sectional study. Nutrition literacy was evaluated using the ‘Adolescent Nutrition Literacy Scale’. Dietary intake was assessed by 24-h food recall. The ‘Mediterranean Diet Quality Index’ was used to evaluate adolescents’ adherence to the MD. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Body weight, height, waist, hip and neck circumference were measured.

Four secondary schools in İzmir, Türkiye

The study included 1074 secondary school students.

Adolescents’ nutrition literacy was at a moderate level. Nutrition literacy scores were significantly lower in those who skip main meals. Adolescents with high nutrition literacy had higher intakes of fibre, protein, protein, Ca, K, Mg, P, vitamin C, folate and Fe intake than those with low and moderate nutrition literacy (P < 0·05). According to IPAQ, active adolescents had higher nutrition literacy scores than inactive adolescents. There was no significant difference in BMI and anthropometric measurements of the adolescents according to their nutrition literacy level. Linear regression analysis showed that each unit increase in nutrition literacy increased adherence to the MD by 0·286 points (β = 0·286) and decreased total screen time by 0·182 points (β = –0·182).

These findings showed that nutrition literacy among early adolescents was not optimal, and a higher nutrition literacy score was significantly associated with higher MD adherence, and healthy eating habits and lifestyle behaviours.

Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction.

Randomised controlled trial.

Web-based intervention for young adults living in Australia.

18–24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire.

Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme.

Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods.

To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention.

Pilot randomised controlled trial.

Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials.

Parents and their 2–5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups.

Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (−1·35, −0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (−1·52, −0·19)), using food as a reward (PE = -0·54, 95 % CI (−1·35, −0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)).

Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

This study aimed to (1) evaluate the prevalence and predictors of perceived depression, anxiety, stress (DAS) levels and emotional eating behaviours and (2) determine the correlations between DAS levels and emotional eating behaviours during the pandemic.

An online cross-sectional study included questions about demographic and anthropometric characteristics, dietary habits, Emotional Appetite Questionnaire (EMAQ) and Depression Anxiety Stress Scales. The snowball sampling method was used.

Türkiye.

The study population was 2002 adults aged ≥18 years.

The mean age was 27·1 ± 9·52 years (72·1 % females and 27·9 % males). The prevalence of moderate to severe DAS was reported as 27·8 %, 30·5 % and 30·7 %, respectively. Skipping meals (OR = 1·32, 95 % CI (1·14, 1·49)) was associated with depression. Weight gain (OR = 1·43, 95 % CI (1·19, 1·66); OR = 1·30, 95 % CI (1·14, 1·49); OR = 1·39, 95 % CI (1·14, 1·64)), weight loss (OR = 1·45, 95 % CI (1·20, 1·70); OR = 1·37, 95 % CI (1·11, 1·62); OR = 1·46, 95 % CI (1·20, 1·72)), exercising at least 150 min/week (OR = 0·64, 95 % CI (0·46, 0·83); OR = 0·73, 95 % CI (0·55, 0·92); OR = 0·83, 95 % CI (0·63, 1·02)), and maintaining an adequate and balanced diet (OR = 0·52, 95 % CI (0·33, 0·71); OR = 0·53, 95 % CI (0·34, 0·73); OR = 0·63, 95 % CI (-0·15, 0·35)) were associated with DAS, respectively. BMI (r = 0·169, P < 0·001), weight (r = 0·152, P < 0·001), number of snacks (r = 0·102, P = 0·011), depression (r = 0·060, P = 0·007), anxiety (r = 0·061, P = 0·006) and stress (r = 0·073, P = 0·001) levels were positively correlated with EMAQ-negative scores.

Approximately one out of every three participants reported moderate to severe DAS levels. Emotional eating was significantly correlated with perceived DAS. The predictors obtained in the study suggest that a healthy diet and lifestyle behaviours are part of psychological well-being and emotional eating.