To describe the development and validation of the Nova Food-Frequency Questionnaire (NovaFFQ) for Brazilian adults.

The NovaFFQ is a self-administered, semi-quantitative questionnaire. The food list includes the most consumed foods and drinks based on 2017-2018 National Food Intake Survey data. We identified and differentiated foods that could be classified into multiple Nova groups. We assessed reproducibility and criterion validity using the percent energy contribution of each Nova group. Reproducibility was assessed by comparing NovaFFQ estimates on two occasions. Criterion validity was assessed by comparing the first NovaFFQ estimate against the mean of two Nova24h recalls. We estimated the intraclass correlation coefficients for both analyses and assessed the agreement of classification into quintiles using the prevalence-and-bias-adjusted kappa coefficients for criterion validity analysis.

Nationwide Brazilian study, the NutriNet-Brasil cohort.

There were 243 participants in the reproducibility analysis and 377 in the criterion validity analysis.

Strong reproducibility was observed, with an intraclass correlation coefficient of 0.91 for all the Nova groups. Criterion validity showed a moderate intraclass correlation coefficient, ranging from 0.61 for processed and ultra-processed foods to 0.65 for unprocessed and minimally processed foods. Substantial agreement in ranking individuals across quintiles was found, as indicated by the prevalence-and-bias-adjusted kappa (PABAKs= 0.74, 0.72, 0.70 and 0.73 for unprocessed and minimally processed foods, culinary ingredients, and processed and ultra-processed foods, respectively).

The NovaFFQ is a valid instrument for assessing food consumption by processing level, especially for discriminating individuals according to the magnitude of consumption in all Nova groups.

The study examined the impact of the Diabetes Prevention and Management program on dietary tracking, changes in dietary behavior, glycosylated hemoglobin (HbA1c) and weight loss over six months among rural adults with type 2 diabetes and prediabetes. The program was a health coach (HC)-led, community-based lifestyle intervention.

The study used an explanatory sequential quantitative and qualitative design to gain insight on participant’s dietary behavior and macronutrient consumption as well as experience with food tracking. Five of the 22 educational sessions focused on dietary education. Participants were taught strategies for healthy eating and dietary modification. Trained HCs delivered the sessions and provided weekly feedback to food journals.

Obese adults with type 2 diabetes or prediabetes (n=94) participated in the program and fifty-six (66%) completed dietary tracking (optional) for six months. Twenty-two participated in three focus groups.

Fifty-nine percent consistently completed food journals. At 6 months, average diet self-efficacy and dietary intake improved, and average weight loss was 4.58 ± 9.14lbs. Factors associated with weight loss included attendance, consistent dietary tracking, higher HbA1c, diabetes status, and calorie intake (Adjusted R2 = 43.5%; F=.003). Focus group participants reported the program improved eating habits. Consistency of dietary tracking was cumbersome yet was beneficial for making better choices and key to being honest.

Participants who consistently tracked their diet improved dietary self-efficacy and intake over six months. This model has the potential to be reproduced in other rural regions of the United States.

There have been unsafe levels of unpaired fructose in the high fructose corn syrup (HFCS) in U.S. beverages, and research/case study evidence shows their intake is associated with greater asthma prevalence/risk/incidence, a debilitating disease, likely due to fructose-malabsorption, gut fructosylation, and gut dysbiosis mechanisms. The “unexplained” asthma epidemic has disproportionately affected children and Black individuals, groups with higher fructose-malabsorption prevalence than others, and research to assess disproportionately higher asthma risk/incidence among Black individuals in association with HFCS sweetened beverage intake is lacking.

Demographic, lifestyle, dietary data collected at enrollment/(1985-86), and incident asthma through exam 5/(1995-96), were used in Cox proportional hazards models to assess HFCS intake associations (hazard-ratios) with asthma risk/incidence.

CARDIA-Study participants from Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA.

1998 Black and 2104 White young adults.

HFCS sweetened beverage intake >once/wk was significantly associated with higher asthma risk relative to ≤ once/wk, (P-trend=0.04), among Black participants only; risk was 2.8 times higher among 2-4 times/wk consumers (HR=2.8, 95% CI 1.1-7.3, P=0.04), and 3.5 times higher when consumed multiple times/d, independent of sucrose intake/obesity/dietary quality/smoking/in-home smoke-exposure (HR=3.5, 95% CI 1.3-9.9, P=0.02). Intake of orange juice, with nominal unpaired fructose, was not associated with asthma in either group, nor was intake of sucrose, a disaccharide (paired) of fructose/glucose.

Ubiquitous HFCS in the U.S. food supply, with HFCS that contains high/unsafe unpaired fructose, a.k.a. excess-free-fructose, and the fructose/gut/lung/axis are overlooked risk factors in the “unexplained” U.S. asthma epidemic that disproportionately affects Black individuals.

To simulate the impact of a price subsidy (price reduction) on purchases of healthy foods with suboptimal consumption.

We used data from the 2018 Mexican National Household Income and Expenditure Survey, a cross sectional study. We estimated own and cross price elasticities of the demand for food groups using a Linear Approximation of an Almost Ideal Demand System. Using the estimated elasticities, we derived changes in purchases associated with a 10, 20 and 30% price reduction in healthy food groups with suboptimal consumption. We also estimated prices reductions for these food group that would meet the recommendations of the Healthy Reference Diet (EAT-HRD) proposed by the EAT-Lancet commission.

Mexico (country).

A nationally representative sample of urban and rural households.

Price reductions were associated with increases in quantity purchased between 9.4 to 28.3% for vegetables, 7.9 to 23.8% for fruits, 0.8 to 2.5% for legumes and 6.0 to 18.0% for fish. Higher reductions in prices would be needed to achieve the EAT-Lancet Commission’s recommendations for food groups with suboptimal consumption in Mexico: a 39.7% reduction in prices for fruits, 20.0% for vegetables and 118.7% for legumes.

Our study shows that reductions in prices can lead to increases in purchases of healthier food options. More research is needed to assess the most cost-effective strategy to deliver subsidies using either conditional cash transfers, vouchers or food baskets provided to families or direct subsidies to producers.

Australian children fall short of national dietary guidelines with only 63% consuming adequate fruit and 10% enough vegetables. Before school care operates as part of Out of School Hours Care (OSHC) services and provides opportunities to address poor dietary habits in children. The aim of this study was to describe the food and beverages provided in before school care and to explore how service-level factors influence food provision.

A cross-sectional study was conducted in OSHC services. Services had their before school care visited twice between March and June 2021. Direct observation was used to capture food and beverage provision, and child and staff behaviour during breakfast. Interviews with staff collected information on service characteristics. Foods were categorised using the Australian Dietary Guidelines, and frequencies calculated. Fishers Exact Test was used to compare food provision with service characteristics.

The before school care of OSHC services in New South Wales, Australia.

25 OSHC services.

Fruit was provided on 22% (n=11) of days and vegetables on 12% (n=6). Services with nutrition policies containing specific language on food provision (i.e. measurable) were more likely to provide fruit compared to those with policies using non-specific language (p = 0.027). Services that reported receiving training in healthy eating provided more vegetables than those who had not received training (p = 0.037).

Before school care can be supported to improve food provision through staff professional development and advocating regulatory bodies for increased specificity requirements in the nutrition policies of service providers.

To examine the potential indirect effect of meal frequency on mortality via obesity indices.

prospective cohort study

Korean Genome and Epidemiology Study

This cohort study involved 148,438 South Korean adults aged 40 years and older.

Meal frequency at the baseline survey was assessed using a validated food frequency questionnaire. Outcomes included all-cause mortality, cancer mortality, and cardiovascular disease (CVD) mortality. Cox proportional hazards regression models were employed to examine the relationship between meal frequency and the risk of mortality. Mediation analyses were performed with changes in obesity indices (body mass index and waist circumference (WC)) as mediators. In comparison to the three-times group, the once-per-day and four-times-per-day groups had a higher risk for all-cause mortality. The irregular frequency group had a higher risk for CVD mortality. Both once-per-day and four-times-per-day groups exhibited higher risks for cancer mortality. The effect of meal frequency on all-cause mortality was partially mediated by WC. For specific-cause mortality, similar mediation effects were found.

The data suggests that three meals per day have a lower mortality and longer life expectancy compared to other meal frequencies. Increased waist circumference partially mediates this effect. These findings support the implementation of a strategy that addresses meal frequency and weight reduction together.

Weight misperception has been reported as a common problem in high-income countries, but there is a paucity of high quality empirical evidence in low- and middle-income countries, especially among children and adolescents. This study estimates the prevalence of weight misperception and investigates changes over time among children and adolescents in China, as well as identify factors which may affect this weight misperception.

The China Health and Nutrition Survey (CHNS), which is a repeated, representative cross-sectional study employing multistage random cluster processes.

A Chinese national survey across 15 provinces and municipal cities.

Data from with children and adolescents aged 6-16 years from six consecutive waves of between 2000 and 2015 were included.

The final sample totaled 7,110 children and adolescents. The overall prevalence of weight misperception was largely stable between 2000 and 2015 (range: 34.1% to 37.3%). Sex and age group were associated with weight misperception, with boys and younger participants more likely to misperceive their weight status. In addition, dieting and being physically active or inactive was associated with increased rates of weight misperception.

Weight misperception is common among youth in China, and unequally shared with several subpopulations at increased risk. Researchers and health promotors are called to recognize weight misperception when addressing overweight and obesity countermeasures, and more tailored public health initiatives are warranted to more effectively reach those with weight misperceptions.

To understand healthcare staff perspectives of their hospital food environment, and the impact of these perceptions on their food choice, health and wellbeing.

A narrative systematic review.

Publications were eligible for inclusion if participants were hospital-based staff, all job roles were eligible, including both clinical and non-clinical staff. Both public and private hospitals in the United Kingdom, United States of America or Australia were included.

Clinical and non-clinical staff employed in hospitals.

A systematic search was carried out across four databases: OVID Medline, CINAHL, PsycInfo and Scopus. Grey literature screening was completed via Google and Google Scholar. Eleven studies were included and were predominantly from the UK. Setting sizes varied or were unknown and participant numbers varied (n=16 to n=1158) or were unknown. Most participants were nurses. Methods included reports, surveys, focus groups, and interviews. The main themes identified were accessibility to food, diversity of food choices, free foods used to boost staff morale and job role influencing engagement with the food environment. Staff reported issues around canteen opening hours, limited healthy food options, and free food on wards causing extra calories to be consumed. Irregular breaks and staffing shortages affected hospital staff’s ability to engage with the wider food environment resulting in reliance on convenience foods and snacks.

The current hospital food environment does not facilitate healthy dietary practices and is perceived by staff as a barrier to healthy eating. The hospital food environment requires adaptation to reflect a 24-hour workplace.

The aim of this study was to assess the association between fish intake, n-3 polyunsaturated fatty acids (PUFA), n-6 PUFA and risk of disabling dementia.

Prospective cohort

Municipalities within the Japan Public Health Center-based Prospective Study

43,651 participants: (20,002 men and 23,649 women)

Exposure intake of fish, n-3 and n-6 PUFA intake were evaluated in 1995-1997. We defined disabling dementia cases as participants who were certified to receive disability care under the long-term-care insurance program (2006-2016) in participating municipalities with a grade of activities of daily living related to dementia ≥IIa on the dementia rating scale (range 0-IV and M). Cox proportional hazard models were applied to obtain hazard ratios (HR) and 95% confidence intervals (CI) according to quartiles of exposures of interest. In the main analysis, we adjusted for age and area, smoking, body mass index, alcohol, and metabolic equivalent tasks. During 410,350 person years of follow-up with an average follow-up of 9.4 years, 5,278 cases of disabling dementia were diagnosed. Fish intake and most PUFAs were not associated with the risk of disabling dementia in men. In women, n-6 PUFA showed a significant decreasing trend in risk the highest HR (95% CI) compared with the lowest was 0.90 (0.81-0.99) (p for trend=0.024) and alpha-linolenic acid (ALA) was 0.91 (0.82 to 1.00) (p for trend=0.043).

Our findings suggest no association with fish in general and only n-6 PUFA and ALA may be associated with a decreased risk of disabling dementia especially in women.

To evaluate the prevalence of advertisements of ultra-processed products outside food outlets in Montevideo (Uruguay) and to explore the patterns of these advertisements across areas with different socio-economic status.

Cross-sectional field survey of advertisements of ultra-processed products outside food outlets. The percentage of outlets featuring any type of advertisement of ultra-processed products on the exterior part of the outlets was calculated, at the aggregate level and separately by type of outlet and type of product. Comparisons were made considering the socio-economic status of the tract where outlets were located.

106 census tracts in Montevideo, differing in geographical location and socio-economic status.

Outlets selling foods and beverages, located within the selected census tracts.

30.7% of the 1,217 food outlets identified in the field survey featured some type of exterior advertisement of ultra-processed products. Sweetened beverages (specifically soda) was the most frequently advertised ultra-processed product category, followed by ice-cream. After adjusting for the type of outlet, medium SES tracts exhibited the highest prevalence of ultra-processed product advertisements outside food outlets (36.0%). Differences in the prevalence of advertisements of specific categories with SES were also found, which may reflect variations in the types and characteristics of food outlets.

Results from the present work suggest frequent exterior advertisements of ultra-processed products and highlight the need to develop effective policies to reduce their use as part of a comprehensive set of strategies to discourage consumption of ultra-processed products.

Fish is high in nutrients that provide a range of health benefits, but people in Great Britain only consume around half the amount that is recommended. This study analysed the demand for fish, for consumption at home, across different household groups in Great Britain.

Using a Rotterdam demand model, price and income elasticities were estimated for eleven fish groups across seven household groups. To investigate changes in fish demand, we decomposed growth in fish demand into income, relative price, and change in taste and seasonality.

The data used for our analysis was drawn from the Kantar Worldpanel dataset for Great Britain for the period from 2013 to 2021.

12,492 households in Great Britain.

Families with children consistently allocated a lower share of their grocery spending on fish and prefer to purchase ready-to-use and convenient fish products, compared to households without children. Purchases of chilled fresh/smoked oily fish, canned oily fish, and frozen processed fish led spending across demographic groups, whilst purchases of canned oily fish showed minimal growth. The demand for most fish products across household groups was price inelastic, indicating that the percentage change in quantity of fish demanded increased or fell by less than the percentage change in price.

Income and taste were identified as significant determinants of demand changes across all household groups, while price only played a prominent role in demand changes for certain fish groups. Thus, increasing fish consumption, especially in lower-income groups, who do not usually consume much fish, may require a different intervention than simply making fish more affordable.

This study investigates and measures whether the association of childhood stunting with household socioeconomic position (SEP) differs in Sri Lanka compared to other South Asian countries.

Secondary analysis of data of children from the latest available DHS data (survey years, 2016-2018). The exposures (SEP) were maternal education and wealth. The outcome was stunting. Binary logistic regression models incorporated SEP, Country, and SEP-by-Country interaction terms.

A nationally representative sample of children from Bangladesh, India, Nepal, Pakistan and Sri Lanka.

Mothers/caregivers of children under 36 months (133,491).

The prevalence of stunting in Sri Lanka of 19% was much lower than that observed for all the other low to low-middle income South Asian countries (37% in Bangladesh, 36% in India, 31% in Nepal, 30% in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared to other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared to Bangladesh. For example, in Sri Lanka, the poorest group had 2.75 (2.06, 3.67) times higher odds of stunting compared to the richest group, but in Bangladesh, this estimate was 4.20 (3.24, 5.44); the difference between these two estimates being 0.65 (0.44, 0.96) on the odds ratio scale.

The lower prevalence of stunting in Sri Lanka is unlikely to be due to less inequality. It is more likely that the lower prevalence of stunting in Sri Lanka is related to there being fewer mothers belonging to the lowest SEP groups.

This study aims to identify fathers’ profiles integrating food parenting practices (FPP) and physical activity parenting practices (PAPP).

We analyzed cross-sectional data. The fathers completed the reduced FPP and PAPP item banks and sociodemographic and family dynamics (co-parenting and household responsibility) questionnaires. We identified fathers’ profiles via latent profile analysis. We explored the influence of social determinants, child characteristics, and family dynamics on fathers’ profiles using multinomial logistic regression.

Online survey in the US.

Fathers of 5-11-year-old children.

We analyzed data from 606 fathers (age=38±8.0; Hispanic=37.5%). Most fathers self-identified as White (57.9%) or Black (17.7%); overweight (41.1%) or obese (34.8%); attended college (70%); earned >$47,000 (62.7%); worked 40 hrs/week (63.4%); and were biological fathers (90.1%). Most children (boys=55.5%) were 5-8 years old (65.2%). We identified five fathers’ profiles combining FPP and PAPP: 1) Engaged Supporter Father (n=94 [15.5%]); 2) Leveled Father (n=160 [26.4%]); 3) Autonomy-Focused Father (n=117 [19.3%]); 4) Uninvolved Father (n=113 [18.6%]); 5) Control-Focused Father (n=122 [20.1%]). We observed significant associations with race, ethnicity, child characteristics, co-parenting, and household responsibility, but not with education level, annual income, or employment status. We observed significant pairwise differences between profiles in co-parenting and household responsibility, with the Engaged Supporter Father presenting higher scores in both measures.

Understanding how fathers’ FPP and PAPP interact can enhance assessments for a comprehensive understanding of fathers’ influences on children’s health. Recognizing the characteristics and differences among fathers’ profiles may enable tailored interventions, potentially improving children’s health trajectories.

To investigate whether the introduction of healthy vending machines on a university campus could increase the proportion of healthy food and beverage purchases.

Four new healthy vending machines offering a wider range of healthier food and beverages were installed alongside existing machines. These new machines used traffic light colours to indicate nutritional value. A year after their installation, a traffic light text guide and colourful wrap were added to the new machines. Chi-square tests were used to assess significant differences in the sales of green (healthy), amber, or red (unhealthy) items from healthy and existing vending machines across the three years (2021 – 2023).

The study was conducted on a university campus where the new healthy vending machines were installed.

Participants of this study were the consumers who purchased items from the vending machines on the university campus.

The results indicated a shift towards healthier purchases following the introduction of the healthy vending machines. The addition of the traffic light text guide and colourful wrap further reduced unhealthy purchases, although this change was small. Sales from the existing vending machines did not meaningfully decrease, and any reductions were more than replaced by sales from the new healthy vending machines.

The study concluded that by providing healthier options and guiding consumers towards these options, the vending machine program offers a promising pathway towards promoting healthier food and beverage choices from vending machines on university campuses.

To investigate the intake of iodine in mother-infant pairs.

An exploratory, cross-sectional study. Iodine intake was estimated using Nutritics nutritional analysis software, following 24-hour dietary recall. Iodine-rich foods were grouped and compared between those women who met the UK RNI for iodine (140 µg/day) and those who did not.

Online and telephone questionnaires.

Self-selecting caregivers of infants aged 6-12 months.

Ninety-one mother-infant pairs with a mean (SD) age of 33.2 (4.1) years and 8.4 (1.3) months, respectively, were included. Most mothers were exclusively breast feeding (54.9%). The estimated maternal median iodine intake from food and supplements (median 140.3 µg/day, just meeting the UK RNI for women of reproductive age, but not the WHO or BDA recommendations for lactating women (250 µg/day and 200 µg/day, respectively). Forty-six (50.5%) of mothers met the UK RNI. Estimated intakes of fish, eggs, cow’s milk, and yoghurt/cream/dairy desserts were significantly greater, whilst intakes of plant-based milk alternative drinks were significantly less in mothers who met the RNI for iodine (P<0.05) compared with those who did not. Infant iodine intake from food was positively correlated with maternal; total iodine intake, iodine intake from all food, and iodine intake from dairy foods (Spearman’s rho=0.243, 0.238, 0.264 respectively; P<0.05).

Women in the UK may not consume enough iodine to meet the demands of lactation. Guidance on iodine-containing foods, focussed on intake before and during pregnancy and lactation, and mandatory fortification of plant-based milk-alternatives could all serve to avoid deficiency.

To explore the impact of online food shopping in France on the selection of products purchased and its potential impact on shoppers' dietary balance.

A qualitative study involving in-depth semi-structured individual interviews. The interviews were recorded, transcribed verbatim, and analysed through a reflexive thematic analysis approach.

France

Thirty-four male and female respondents aged between 21 and 61 years old, residing in various regions of France, including urban, suburban, and rural areas, with diverse profiles in terms of gender, age, location, and number of children under 18.

Five key themes were identified as influencing decision-making with regard to the products purchased, namely ‘less choice, especially for fresh produce’, ‘sense of security in buying the same products’, ‘convenience of online shopping through time-saving and product recommendation lists’, ‘avoiding unplanned purchases’, and ‘less fresh produce purchased, sometimes replaced by more processed items’. In turn, all of these factors potentially have an impact on the diet of online shoppers.

With grocery e-commerce penetration expected to double in the next five years, the study underscores the consequences of online shopping on consumers' dietary balance. The findings have practical implications for online food retailers, inciting them to develop solutions that would encourage e-grocery shoppers to buy more fresh produce and to sample a more varied diet. Additionally, they highlight the importance of monitoring the influence of technology on the consumer buying process, particularly with regard to food.

Public health approaches for addressing diet-related health in the United States (US) include nutrition incentive (NI) and produce prescription (PPR) projects. These projects, funded through the US Department of Agriculture Gus Schumacher Nutrition Incentive Program (GusNIP), aim to support intake of fruits and vegetables through healthy food incentives. Measuring GusNIP impact is vital to assessing the ability of incentives to improve public health nutrition outcomes across populations. Shared measures used across GusNIP projects assess fruit and vegetable intake, food security, demographics, among other variables, through a participant survey. This study explored challenges and opportunities to support evaluation across GusNIP.

This qualitative study used a sociodemographic survey, semi-structured interviews, and focus groups. Descriptive statistics were used to summarize survey data and applied thematic analysis was used to identify patterns in interview and focus group data.

Data collection occurred in the United States virtually using Qualtrics and Zoom, fall 2021 to fall 2022.

18 GusNIP PPR and NI data collectors, 24 external evaluators, and 11 GusNIP Training, Technical Assistance, Evaluation, and Information Center’s (NTAE) staff participated.

Opportunities to improve evaluation among GusNIP’s participants include tailoring surveys to specific subpopulations, translations, culturally appropriate food examples, avoiding stigmatizing language, using mixed methods, and intentional strategies to enhance representation.

To increase applicability, evaluation tools must reflect the experiences across populations. This study provides insights that can guide future NI and PPR evaluations, helping to more effectively measure and understand outcomes of all communities.