To review and synthesize studies on household food security in South Africa.

Systematic mapping review of metrics (methodological review).

Electronic databases, including EBSCOHost, Scopus and Web of Science, were searched for studies and reports on household food security in South Africa, reporting household food security published between 1999 and 2021. Searching, selecting and reporting were performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement.

South African households

Forty-eight articles reporting on six national surveys (one repeated annually since 2002) and forty sub-national studies meeting the inclusion criteria were selected. Various metrics, with different recall periods and ways of categorizing food security levels, were identified. Surveys that used similar metrics showed that the percentage of South African households that have experienced food insecurity and hunger has decreased over the review period yet remains concerning. However, the multitude of metrics used to assess the different components and levels of food security limits the comparability of the results to evaluate the scope and scale of the problem.

There is growing support for developing multi-variable approaches for food security research in sub-Saharan Africa. Future research should focus on finding the most appropriate combination of complementary metrics that would allow comparable data while holistically capturing food security and providing insight into the causes and consequences.

To describe environmentally sustainable (ES) and healthy food provision practices in childcare services in Victoria, Australia.

Cross-sectional study.

Childcare services providing food onsite.

Staff completed an online survey that explored ES food provision practices including purchasing seasonal/local food, food waste awareness/management, and food cost/child/d. A purposively sampled subgroup conducted weighed audits to determine compliance with guidelines and total waste, serving waste (prepared, not served) and plate waste.

Survey results found 8 % of services (n 129) had previously conducted food waste audits. Service audits (n 12) found 27 % total food waste (range: 9 % - 64 %). Statistically significant differences in plate waste were found between services who had previously conducted food waste audits (7 %) and those who had not (17 %) (P = 0·04). The most common ES practice was ‘providing seasonal food’; the least common was ‘maintaining a compost system’ and ‘less packaged foods’. Most services (95 %) purchased foods from supermarkets with 23 % purchasing from farmers’ markets. This was statistically lower for regional/rural services (8 %), compared to metropolitan services (27 %) (P = 0·04). Twenty-seven per cent of services spent AUD2·50 or less per child per day on food. Only one audited service provided a menu compliant with childcare food provision guidelines.

Childcare settings procure and provide large volumes of food; however, food waste awareness appears limited, and environmentally sustainable food procurement practices may be less affordable and difficult to achieve. Understanding the impact of food waste awareness on food waste practices and food costs across time merits further research.

To determine if customer purchases at small food stores are associated with healthfulness of the diet as approximated by skin carotenoids.

This is a cross-sectional survey of customers in small food stores regarding demographics and food purchases. Food and beverage purchases were classified as ‘healthy’ or ‘non-healthy’ and ‘carotenoid’ v. ‘non-carotenoid’ using a systematic classification scheme. Fruit and vegetable intake was objectively assessed using a non-invasive device to measure skin carotenoids. Associations between variables of interest were examined using Pearson’s correlation coefficients, t tests and multiple linear regression analyses.

Twenty-two small food retail stores in rural (n 7 stores) and urban (n 15) areas of North Carolina.

Customers of small food stores

Of study participants (n 1086), 55·1 % were male, 60·0 % were African American/Black and 4·2 % were Hispanic, with a mean age of 43·5 years. Overall, 36 % purchased at least one healthy item, and 7·6 % of participants purchased a carotenoid-containing food/beverage. Healthy foods and beverages purchased included produce, lean meats, 100 % juices, plain popcorn, plain nuts, milk and yogurt. Unhealthy items included non-100 % juices, crackers, chips, candy, cakes and donuts. Purchase of a healthy or carotenoid-containing item was positively associated with skin carotenoid scores (P = 0·002 and 0·006, respectively).

A relatively small proportion of customers purchased any healthy or carotenoid-containing foods and beverages, and those who did purchase healthy options had higher skin carotenoid scores. Future research should confirm these findings in different populations.

The aim of this study is to assess the validity and reliability of the Adult Eating Behaviour Questionnaire (AEBQ-TR) for adults.

Hunot et al. (2016) developed the original questionnaire, which was modified and translated into Turkish. On data collected from adults, construct validity was assessed using exploratory factor analysis and confirmatory factor analysis. Pearson’s and Cronbach’s correlation coefficients were used to evaluate reliability and validity (P < 0·05).

This research was carried out in Ankara, Turkey.

A total of 311 adults from Ankara (148 men and 163 women) took part in the study. Seventy-two of these adults take the retest.

In the present study, 311 adults with a mean age of 29·3 ± 11·3 years participated. Factor loadings ranged from 0·404 to 0·907. In general, food approach and food avoidance scales showed a positive correlation within themselves. According to the results of confirmatory factor analysis and goodness-of-fit indicators, the seven-factor model showed a better model fit in the Turkish data (chi-square/degrees of freedom = 2·137, root mean error of approximation: 0·061, comparative fit index: 0·884, and normed fit index: 0·850). Higher BMI was associated with higher Emotional Over-eating, higher Enjoyment of the Food, lower Food Satiety and lower Emotional Under-eating.

The Turkish AEBQ is a valid and reliable tool for 20- to 65-year adults to determine appetitive properties related to the aetiology of weight change and especially obesity risk. Besides, AEBQ testing is required for validation in early and late adulthood.

To conduct a comprehensive systematic review and meta-analysis of the available literature on the anthropometric nutritional status of South African infants and children, 0–18 years old and to report on trends of changes in nutritional status over the period 1997–2022.

Systematic review and meta-analysis.

Review of the available literature on the anthropometric nutritional status of South African infants and children, 0–18 years old, over the period 1997–2022.

South African infants and children, 0–18 years old.

Only quantitative data from ninety-five publications that described the nutritional status in terms of anthropometry were included. Most recent studies applied the WHO 2006 and 2007 definitions for malnutrition among children 0–5 years old and 5–19 years old, respectively. Meta-analysis of all prevalence data shows the highest stunting prevalence of 25·1 % among infants and preschool children, compared to 11·3 % among primary school-age children and 9·6 % among adolescents. Furthermore, the overweight and obesity prevalence was similar among children younger than 6 years and adolescents (19 %), compared to 12·5 % among primary school-age children. In national surveys, adolescent overweight prevalence increased from 16·9 % in 2002 to 23·1 % in 2011. Meta-regression analysis shows a decrease in stunting among children 6–18 years old and an increase in combined overweight and obesity in the 10–19 years age group.

The double burden of malnutrition remains evident in South Africa with stunting and overweight/obesity the most prevalent forms of malnutrition among children.

To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES).

A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years.

All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017.

N/A.

Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients.

The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

Ultra-processed foods (UPF), including those containing food additive emulsifiers, have received research attention due to evidence implicating them in the pathogenesis of certain diseases. The aims of this research were to develop a large-scale, brand-level database of UPF in the UK food supply and to characterise the occurrence and co-occurrence of food additive emulsifiers.

A database was compiled sampling all products from the food categories contributing to energy intake from UPF in the UK from the National Diet and Nutrition Survey (2008–2014). Every food in these categories were identified from online supermarket provision from the ‘big four’ supermarkets that dominate the market share in the UK, comprising Tesco, Sainsbury’s, Asda and Morrisons.

Major supermarkets in the UK.

A total of 32 719 food products in the UK supermarket food supply were returned in searches. Of these, 12 844 products were eligible and manually reviewed for the presence of emulsifiers. Emulsifiers were present in 6642 (51·7 %) food products. Emulsifiers were contained in 95·0 % of ‘Pastries, buns and cakes’, 81·9 % of ‘Milk-based drinks’, 81·0 % of ‘Industrial desserts’ and 77·5 % of ‘Confectionary’. Fifty-one per cent of all emulsifier-containing foods contained multiple emulsifiers. Across emulsifier-containing foods, there were a median of two emulsifiers (IQR 2) per product. The five most common emulsifiers were lecithin (23·4 % of all products), mono- and diglycerides of fatty acids (14·5 %), diphosphates (11·6 %), and xanthan gum and pectin (8·0 %).

Findings from this study are the first to demonstrate the widespread occurrence and co-occurrence of emulsifiers in UPF in the UK food supply.

Night shift workers are at a 20 to 40 % increased risk of metabolic diseases, which may be associated with their disrupted eating patterns. This qualitative study explores factors that influence night shift workers’ eating habits, within and outside of the workplace, to identify target areas for health promotion strategies.

Eligible participants resided in Australia, working at least three overnight shifts per month.

The photovoice method was used, whereby participants were asked to take photos that represent their typical eating habits. These photos were incorporated as prompts in a semi-structured interview, which explored factors influencing eating habits on night shifts and days-off and perceptions and enablers to healthy eating.

Ten participants completed the study. Thematic analysis generated four main themes, which were mapped onto the Social Ecological Model (SE Model). Aligned with the SE Model, our results show night shift workers’ eating habits are influenced by intrapersonal, interpersonal and (work) organisational levels. Participants reported that at work, appropriate food preparation facilities are required to enable healthy food choices. Poor shift work rostering leads to prolonged fatigue on days-off, limiting their ability and motivation to engage in healthy eating. Consequently, night shift workers seem to require additional supports from their social networks and enhanced food literacy skills, in order to adopt/ maintain healthy eating behaviours.

Night shift work creates individual and environmental barriers to healthy eating, which are present during and outside of work. Health promotion strategies for this population should include multiple approaches to address these barriers.

The goal of this study is to evaluate university students’ perceptions of tap water safety and water filter use and determine how these perceptions and behaviours affect water and sugar-sweetened beverage intake.

Cross-sectional; online survey conducted in Fall 2021.

A large, public Midwestern university in the USA.

Seven-hundred ninety-three university students.

Students who experienced food insecurity, were on a Pell grant, were first-generation college students or were racial/ethnic minorities were less likely to trust tap water safety. Tap water filtration behaviour also varied by age and race/ethnicity. Students who did not agree with the statement ‘my local tap water is safe to drink’ had lower odds of consuming ≥ 3 cups of total water per day (OR = 0·45, 95 % CI: 0·32, 0·62), lower odds of consuming tap water ≥ 3 times/d (OR = 0·46, 95 % CI: 0·34, 0·64), higher odds of drinking bottled water ≥ 1 time per day (OR = 1·80, 95 % CI: 1·22, 2·66) and higher odds of drinking SSB ≥ 1 time per day (OR = 1·47, 95 % CI: 1·01, 2·14) than those who agreed. Students who always or sometimes filtered their tap water had lower odds of consuming ≥ 3 cups of total water per day (OR = 0·59, 95 % CI: 0·39, 0·90) than students who never filtered their tap water.

Tap water perceptions and behaviours affect tap and bottled water and SSB intake among university students. Tap water perceptions and behaviours in this demographic provide important context for university programming promoting healthy beverage initiatives.

The goal of the present study was to evaluate the association between depression and ultra-processed food (UPF) consumption as risk factors for developing type 2 diabetes (T2D).

A prospective community study.

Baseline data (2009–2010) from CARTaGENE community health study from Quebec, Canada, were used. Food and drink consumption was assessed using the Canadian-Diet History Questionnaire II and grouped according to their degree of processing by the NOVA classification, and participants were categorised into tertiles of UPF (g/d). Depression was defined using either a validated cut-off score on the Patient Health Questionnaire-9 or antidepressant use. The outcome was the incidence of T2D, examined in 3880 participants by linking survey data with administrative health insurance data. Cox regression models estimated the associations between UPF, depression and incident T2D.

40–69-year-old individuals at baseline.

In total, 263 (6·8 %) individuals developed T2D. Participants with high depressive symptoms and high UPF consumption showed the highest risk for T2D (adjusted hazard ratios (aHR) = 1·58, 95 % CI (0·98, 2·68)), compared to those with low depressive symptoms and low UPF consumption. The risk for T2D was similar when high depressive symptoms and antidepressant use were combined with high UPF (aHR 1·62, 95 % CI (1·02, 2·57)).

This study shows that co-occurring depression and high UPF consumption were associated with a higher risk for T2D. Early management and monitoring of both risk factors might be essential for diabetes prevention.

To assess the association between the consumption of ultra-processed foods (UPF) and diet quality among preschool children and women of reproductive age from Argentina.

Cross-sectional and nationally representative survey. The food items were classified according to the NOVA system. Consumption of fruits, vegetables, legumes, nuts, seeds and wholegrains was estimated, and the energy and nutrients related to non-communicable disease (NCD) intake. Linear regression was used to assess the associations.

Argentina.

Children aged 2–5 years (n 7022), female adolescent aged 10–19 years (n 2165) and women aged 20–49 years (n 4414).

UPF represented more than a quarter of total energy intake, 27 % in children, 31 % in female adolescents and 26 % in women. Across all age groups, the major contributors to UPF consumption were cookies and pastries (about 6·0–7·0 %), soft drinks (about 2·7–3·7 %), candies (about 1·8–4·6 %), and juices (about 1·3–1·7 %). The consumption of fresh vegetables, fresh fruits and legumes was negatively associated with UPF consumption. A significant positive association was found between the dietary share of UPF and the dietary content of NCD-promoting nutrients such as free sugars and total saturated and trans-fats. In contrast, a significant negative association was found with the content of NCD-protective such as fibre and protein.

UPF were associated with lower consumption of healthy foods and higher intake of nutrients related to NCD in children and women of reproductive age in Argentina. It is necessary to design food policies that simultaneously reduce the consumption of UPF while promoting the intake of fresh and whole foods to improve the dietary quality.

The consumption of various foods is internationally recommended in healthy diet although the association between dietary variety and incident dementia is unknown. We aimed to examine the association between dietary variety and the incidence of disabling dementia in older Japanese adults.

We conducted a prospective cohort study. Dietary variety was assessed based on the Dietary Variety Score (DVS). DVS was assessed by counting the number of ten food components (meat, fish/shellfish, eggs, milk, soyabean products, green/yellow vegetables, potatoes, fruit, seaweed and fats/oils) that were consumed almost daily using a FFQ. Participants were categorised into low (0–2 points), middle (3–4 points) and high (5–10 points) groups based on the DVS. Data on newly diagnosed disabling dementia were retrieved from the public long-term care insurance database. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95 % CI.

Yabu cohort study, Japan.

A total of 4972 community-dwelling adults aged 65 years or older.

During the median follow-up of 6·8 years, 884 participants were newly diagnosed with disabling dementia. After adjusting for confounders, the multivariable-adjusted HR for incident disabling dementia was 0·82 (95 % CI, 0·69, 0·97) for participants in the highest DVS category compared with those in the lowest DVS category (Pfor trend = 0·019).

A higher dietary variety is associated with a reduced risk of disabling dementia in older Japanese adults. These results have potential implications for the development of effective public nutritional approaches to prevent dementia in older adults.

This study aims to explore the association between coffee consumption and the prevalence of hearing loss in American adults based on a national population-based survey.

Cross-sectional analysis of reported audiometric status and coffee intake from the 2003–2006 National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression, forest plots and restricted cubic spline (RCS) analyses were used to explore the associations and dose–response relationships between coffee consumption frequency and hearing loss.

The USA.

This study included 1894 individuals aged ≥ 20 from the 2003–2006 NHANES.

In this study, the prevalence of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) among the participants was 35·90 % and 51·54 %, respectively. Compared with those who no consumed coffee, non-Hispanic White who consumed ≥ 4 cups/d had higher prevalence of SFHL (OR: 1·87; 95 % CI: 1·003. 3·47). And a positive trend of coffee consumption frequency with the prevalence of HFHL was found (Ptrend = 0·001). This association of HFHL was similar for participants aged 20–64 (Ptrend = 0·001), non-Hispanic White (Ptrend = 0·002), non-noise exposure participants (Ptrend = 0·03) and noise-exposed participants (Ptrend = 0·003). The forest plots analysis found that the association between 1 cup-increment of daily coffee consumption and the prevalence of HFHL was statistically significant in males. RCS model supported a positive linear association of coffee consumption with SFHL (P for overall association = 0·02, P for nonlinearity = 0·48) and a positive non-linear association of coffee consumption with HFHL (P for overall association = 0·001, P for nonlinearity = 0·001).

Our findings suggested that coffee consumption was associated with higher prevalence of hearing loss. Further cohort studies in larger population are needed to investigate these findings.

To assess the associations between adherence to the Swedish dietary guidelines and all-cause mortality (i.e. assessing the index’ ability to predict health outcomes), as well as levels of dietary greenhouse gas emissions (GHGEs).

A longitudinal study 1990–2016 within the population-based cohort Västerbotten Intervention Programme. Dietary data were based on FFQs. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15), based on the 2015 Swedish dietary guidelines. Dietary GHGEs were estimated from life cycle assessment data including emissions from farm to industry gate. Hazard ratios (HR) and 95 % CI of all-cause mortality were evaluated with Cox proportional hazards regression, and differences in median GHGEs were tested between quintiles of SHEIA15 score using the Kruskal–Wallis one-way ANOVA test.

Northern Sweden.

In total, 49 124 women and 47 651 men, aged 35–65 years.

Median follow-up times were 16·0 years for women and 14·7 years for men, during which time 3074 women and 4212 men died. A consistent trend of lower all-cause mortality HR for both sexes with higher SHEIA15 scores was demonstrated. For women, the all-cause mortality HR was 0·81 ((95 % CI 0·71, 0·92); P = 0·001) and for men 0·90 ((95 % CI 0·81, 0·996); P = 0·041) between the quintile with the highest SHEIA15 score compared with the quintile with the lowest SHEIA15 score. A consistent trend of lower estimated dietary GHGEs among both sexes with higher SHEIA15 scores was also found.

Adherence to Swedish dietary guidelines, estimated by SHEIA15, seems to promote longevity and reduce dietary climate impact.

Low childhood socio-economic status (SES) and adverse childhood experiences (ACE) are associated with poor health outcomes in adulthood. Determining how ACE may be linked to food insecurity among young people from socio-economically diverse households can inform health-protective strategies. This study examined if ACE are associated with food insecurity during the transition to adulthood and investigated prevalence differences across SES strata.

Participants were recruited from twenty secondary schools in Minneapolis-St. Paul, Minnesota.

The analytic sample (n 1518) completed classroom surveys in 2009–2010 (mean age = 14·5 years) and follow-up surveys in 2017–2018 (mean age = 22·0 years).

Past-year food insecurity was reported at both time points, and ACE were reported at follow-up. Logistic regression models were used to estimate emerging adult food insecurity prevalence by ACE exposure; models were stratified by childhood SES (low, middle and high).

The adjusted prevalence of food insecurity was 45·3 % among emerging adults who reported three or more ACE compared with 23·6 % among those with one or two ACE and 15·5 % among those with no ACE (P < 0·001). All forms of ACE were related to an elevated prevalence of food insecurity in emerging adulthood. ACE–food insecurity associations were strongest for emerging adults from lower and middle SES households. Among emerging adults from low SES households, childhood experiences of emotional abuse and substance use by a household member were associated with the largest prevalence differences in food insecurity.

Findings suggest a need for trauma-informed services within food assistance programs to better serve individuals with a history of ACE.

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.

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 evaluate snacking and diet quality among US adolescents.

Cross-sectional analysis examined snack frequency (snacks/day), size (kcal/snack) and energy density (kcal/g/snack) as predictors of diet quality using the mean of two 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI-2015, 0–100), a mean adequacy ratio (MAR, 0–100) for under-consumed nutrients (potassium, fibre, Ca, vitamin D) and mean percentage of recommended limits for over-consumed nutrients (added sugar, saturated fat, Na). Linear regression models examined total snacks, food only snacks and beverage only snacks, as predictors of diet quality adjusting for demographic characteristics and estimated energy reporting accuracy.

2007–2018 National Health and Nutrition Examination Survey.

Adolescents 12–19 years (n 4985).

Snack frequency was associated with higher HEI-2015 (β = 0·7 (0·3), P < 0·05) but also with higher intake of over-consumed nutrients (β = 3·0 (0·8), P ≤ 0·001). Snack size was associated with lower HEI (β = –0·005 (0·001), P ≤ 0·001) and MAR (β = –0·005 (0·002), P < 0·05) and higher intake of over-consumed nutrients (β = 0·03 (0·005), P ≤ 0·001). Associations differed for food only and beverage only snacks. Food only snack frequency was associated with higher HEI-2015 (β = 1·7 (0·03), P ≤ 0·001), while food only snack size (β = –0·006 (0·0009), P ≤ 0·001) and food only snack energy density (β = –1·1 (0·2), P ≤ 0·001) were associated with lower HEI-2015. Conversely, beverage only snack frequency (β = 4·4 (2·1) P < 0·05) and beverage only snack size (β = 0·03 (0·01), P ≤ 0·001) were associated with higher intake of over-consumed nutrients.

Smaller, frequent, less energy-dense food only snacks are associated with higher diet quality in adolescents; beverages consumed as snacks are associated with greater intake of over-consumed nutrients.

To understand early-life growth in the Middle East and North Africa (MENA) region, and how it has changed over time, we estimated the prevalence of wasting and overweight at ages under 5 years.

Cross-sectional data from twenty-nine Demographic and Health Surveys with direct anthropometric data and parent-reported demographic information were examined. The study utilised the WHO Child Growth Standards to classify overweight (weight-for-height z-score ≥ 2 sd above the median), wasting (weight-for-height z-score ≤ 2 sd below the median) and unhealthy weight defined as either wasting or overweight.

Nationally representative for nine of the MENA countries (Armenia, Azerbaijan, Egypt, Jordan, Mauritania, Morocco, Tunisia, Turkey and Yemen).

Children under age 5 from nine MENA countries between 1987 and 2016 (n 155 961).

Across the region, at the most recent time point, between 7·3 and 23·6 % of children experienced unhealthy weight (Jordan – 7·3 %, Egypt –23·6 %); 1·7 and 16·6 % had wasting (Turkey, Yemen) and 2·0 and 15·0 % had overweight (Yemen, Egypt). Overweight was more common than wasting in all countries except Yemen and Mauritania. Between 1987 and 2016, the prevalence of unhealthy weight in the region increased (10·0–18·4 %) due to increases in both wasting and overweight. Boys had a higher prevalence of unhealthy weight than girls.

Undernutrition continues to be a problem in some countries in the MENA region, and overnutrition is emerging as a health concern in many countries in the region. Countries in the region must advance programmes that reduce undernutrition while not overlooking or inadvertently promoting overnutrition.