To determine the reliability of streamlined data-gathering techniques for examining the price and affordability of a healthy (recommended) and unhealthy (current) diet. We additionally estimated the price and affordability of diets across socio-economic areas and quantified the influence of different pricing scenarios.

Following the Healthy Diets Australian Standardised Affordability and Pricing (ASAP) protocol, we compared a cross-sectional sample of food and beverage pricing data collected using online data and phone calls (lower-resource streamlined techniques) with data collected in-store from the same retailers.

Food and beverage prices were collected from major supermarkets, fast food and alcohol retailers in eight conveniently sampled areas in Victoria, Australia (n 72 stores), stratified by area-level deprivation and remoteness.

This study did not involve human participants.

The biweekly price of a healthy diet was on average 21 % cheaper ($596) than an unhealthy diet ($721) for a four-person family using the streamlined techniques, which was comparable with estimates using in-store data (healthy: $594, unhealthy: $731). The diet price differential did not vary considerably across geographical areas (range: 18–23 %). Both diets were estimated to be unaffordable for families living on indicative low disposable household incomes and below the poverty line. The inclusion of generic brands notably reduced the prices of healthy and unhealthy diets (≥20 %), rendering both affordable against indicative low disposable household incomes. Inclusion of discounted prices marginally reduced diet prices (3 %).

Streamlined data-gathering techniques are a reliable method for regular, flexible and widespread monitoring of the price and affordability of population diets in areas where supermarkets have an online presence.

Consumption of trans-fatty acids (TFA) is a well-established risk factor for CVD morbidity and mortality. Our objective was to investigate TFA levels in Slovenian food supply.

Cross-sectional study.

Selected foods (n 282) were purchased in Slovenia (2016), and the TFA content was determined. The sample included pre-packed foods with/without declared partially hydrogenated vegetable oils (PHO), as well as non-pre-packed foods. A sales-weighting approach was used to ponder different market shares of the products.

While the majority of the investigated samples had low levels of TFA, up to 6·8 g of TFA per 100 g of food was observed in certain foods. Within pre-packed foods (n 207), the highest proportion of samples with high TFA levels was found among cookies with labelled PHO: 69 % (n 18) would exceed European Union regulatory TFA limit (2 g industrial TFA per 100 g of fats), which will be implemented in April 2021. Among the investigated non-pre-packed foods (n 75), only croissants contained notable TFA levels (mean 0·90 (sd 0·97); maximum 3·3 g/100 g), with about half of the samples exceeding 2 g TFA per 100 g of fats.

In 2016, some foods in Slovenian food supply still contained notable amounts of TFA. Foods with listed PHO as an ingredient were usually higher in TFA as compared with foods not labelled to contain PHO. Biscuits were identified as the most concerning category of pre-packed foods, while croissants contained highest levels of TFA within non-pre-packed foods.

To understand how dietary intake data collected via a brief ecological momentary assessment (EMA) measure compares to that of data collected via interviewer-administered 24-h dietary recalls, and explore differences in level of concordance between these two assessment types by individual- and meal-level characteristics.

Parents completed three 24-h dietary recalls and 8 d of brief EMA surveys on behalf of their child; in total, there were 185 d where dietary intake data from both EMA and 24-h recall were available. The EMA measure asked parents to indicate whether (yes/no) their child had consumed any of the nine total food items (e.g. fruit, vegetable, etc.) at eating occasions where both the child and parent were present.

Twenty-four-hour dietary recalls were completed in person in the study participant’s home; participants completed EMA surveys using a study provided in iPad or their personal cell phone.

A diverse, population-based sample of parent–child dyads (n 150).

Among meals reported in both the EMA and dietary recalls, concordance of reporting of specific types of food ranged from moderate agreement for meat (kappa = 0·55); fair agreement for sweets (kappa = 0·38), beans/nuts (kappa = 0·37), dairy (kappa = 0·31), fruit (kappa = 0·31) and vegetables (kappa = 0·27); and little to no agreement for refined grains, whole grains and sweetened beverages (73 % overall agreement; kappa = 0·14). Concordance of reporting was highest for breakfast and snacks, as compared with other eating occasions. Higher concordance was observed between the two measures if the meal occurred at home.

Data suggest that among meals reported in both the EMA and dietary recalls, concordance in reporting was reasonably good for some types of food but only fair or poor for others.

To assess the relative validity of a FFQ developed for the Pelotas Birth Cohort Studies.

Participants completed a ninety-two-food-item FFQ and then answered two 24-h recalls (24HR), one in-person interview and a second one by telephone, administered 14–28 d apart. Median and relative differences of energy, fifteen nutrients and eleven food groups were estimated based on the FFQ and the average of two 24HR. Nutrients were log-transformed and energy-adjusted using residual method. Validity was assessed by crude, energy-adjusted and de-attenuated Pearson and Lin’s concordance correlation coefficients. Agreement of quartiles and weighted κ were performed. Differences in energy and nutrient estimations between methods were plotted in Bland–Altman graphs.

Pelotas, southern Brazil.

Two hundred fifty-four participants randomly selected from the 1993 Pelotas Birth Cohort during the 22-year follow-up (2015).

The FFQ overestimated energy and most nutrients and food groups compared with the two 24HR. Energy-adjusted and de-attenuated Pearson correlation coefficients ranged from 0·21 to 0·66. The highest energy-adjusted and de-attenuated concordance correlation coefficients were observed for Ca (0·48), niacin (0·32), Na (0·29), vitamin C (0·28) and riboflavin (0·25). The percentage of nutrients classified into the same and opposite quartiles ranged from 36·5 to 60·3 %, and from 4·8 to 19·1 %, respectively. Weighted κ was moderate for Ca (0·51), beans and legumes (0·50) and milk and dairies (0·49).

The FFQ provides a reasonable dietary intake assessment for habitual food consumption. However, the relative validity was weak for specific nutrients and food groups.

The current study was conducted to assess the nutritional status and associated risk factors among foreign students residing at King Saud University for different periods and to explore its correlations.

A cross-sectional study was conducted during the spring semester of 2018. A total of 400 male students aged 18–35 years had participated in the current study after signing a written consent form according to Helsinki Declaration.

A structural questionnaire was used to collect data on daily food intake and habits and socio-economic characteristics. Nutrients of food intake were assessed using the Esha programme and compared with that of dietary requirement intake (DRI). A body composition analyser was used to measure body fat (BF), visceral fat (VF) and BMI. Spearman correlation coefficients and simple regression analysis were performed to determine associations between variables.

Foreign students residing for different periods (<6 months: 200 students and >6 months: 200 students) were used as subjects.

The students who stayed <6 months consumed lower level of some nutrients than that of the DRI compared with those stayed >6 months. Overweight and obesity were more common among students who stayed >6 months with high values of BF and VF. Several risk factors were positively or negatively correlated with the students’ nutrition proxies.

Most of the students who stayed >6 months are suffered from overweight. Some independent variables were found to be significantly correlated with the students’ nutrition proxies either positively or negatively.

Stunting (height-for-age < −2 sd) is one of the forms of undernutrition and is frequent among children of low- and middle-income countries. But stunting perse is not a synonym of undernutrition. We investigated association between body height and indicators of energetic undernutrition at three critical thresholds for thinness used in public health: (1) BMI SDS < −2; (2) mid-upper arm circumference divided by height (MUAC (mm) × 10/height (cm) < 1·36) and (3) mean skinfold thickness (SF) < 7 mm and to question the reliability of thresholds as indicators of undernutrition.

Cross-sectional study; breakpoint analysis.

Rural and urban regions of Indonesia and Guatemala – different socio-economic status (SES).

1716 Indonesian children (6·0–13·2 years) and 3838 Guatemalan children (4·0–18·9 years) with up to 50 % stunted children.

When separating the regression of BMI, MUAC or SF, on height into distinguishable segments (breakpoint analysis), we failed to detect relevant associations between height, and BMI, MUAC or SF, even in the thinnest and shortest children. For BMI and SF, the breakpoint analysis either failed to reach statistical significance or distinguished at breakpoints above critical thresholds. For MUAC, the breakpoint analysis yielded negative associations between MUAC/h and height in thin individuals. Only in high SES Guatemalan children, SF and height appeared mildly associated with R2 = 0·017.

Currently used lower thresholds of height-for-age (stunting) do not show relevant associations with anthropometric indicators of energetic undernutrition. We recommend using the catch-up growth spurt during early re-feeding instead as immediate and sensitive indicator of past undernourishment. We discuss the primacy of education and social-economic-political-emotional circumstances as responsible factors for stunting.

To examine the impact of front-of-package (FOP) labels on perceived healthfulness, purchasing intentions and understanding of common FOP systems.

A parallel, open-label design randomised participants to different FOP labelling conditions: ‘high in’ warning labels (WL), multiple traffic light labelling (TLL), health star ratings (HSR) (all displayed per serving) or control with no interpretive FOP labelling. Participants completed a brief educational session via a smartphone application and two experimental tasks. In Task 1, participants viewed healthy or unhealthy versions of four products and rated healthiness and purchasing intention on a seven-point Likert-type scale. In Task 2, participants ranked three sets of five products from healthiest to least healthy.

Online commercial panel.

Canadian residents ≥ 18 years who were involved in household grocery shopping, owned a smartphone and met minimum screen requirements.

Data from 1997 participants (n 500/condition) were analysed. Task 1: across most product categories, the TLL and HSR increased perceived healthiness of healthier products. All FOP systems decreased perceived healthiness of less healthy products. Similar, albeit dampened, effects were seen regarding purchasing intentions. Task 2: participants performed best in the HSR, followed by the TLL, WL and control conditions. Lower health literacy was associated with higher perceived healthiness and purchasing intentions and poorer ranking task performance across all conditions.

All FOP labelling systems, after a brief educational session, improved task performance across a wide spectrum of foods. This effect differed depending on the nutritional quality of the products and the information communicated on labels.

Trial Registration: NCT03290118.

To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems.

A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits.

Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools.

University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents).

Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report ‘To manage or treat a medical condition’ as motivation and almost seven times more likely to report ‘To align with my ethical beliefs’ as motivation compared with non-adherents. However, these participants were 94 % less likely to report ‘To maintain and/or improve my health’ as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet.

Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.

To relate empirically derived dietary patterns identified using the Treelet Transform (TT) to risk of stroke.

A prospective cohort study using the Danish Diet, Cancer and Health cohort. Dietary information was obtained in 1993–1997 using a validated semi-quantitative FFQ. Incident stroke diagnoses, obtained from the Danish National Patient Register, were verified by record review. Dietary patterns were generated using TT, and participants were categorised into quintiles based on their adherence to each pattern. Sex-specific Cox proportional hazard models estimated associations between dietary patterns and stroke.

Denmark.

55 061 men and women aged 50–64 years at the time of enrolment.

Three dietary patterns explaining 15·4 % of the total variance were identified: a Prudent pattern, a Western pattern and a Wine & Snacks pattern. During a follow-up time of 10 years, 1513 cases occurred. Comparing the highest to lowest quintiles of intake, adherence to a Prudent pattern was inversely associated with stroke (HRmen 0·74, 95 % CI 0·60, 0·91; HRwomen 0·82, 95 % CI 0·62, 1·08), while adherence to a Western pattern was associated with greater risk (HRmen 1·61, 95 % CI 1·23, 2·10; HRwomen 2·01, 95 % CI 1·48, 2·72). No association was found for a Wine & Snacks pattern for women, but a weak inverse association was found for men (HR 0·81, 95 % CI 0·67, 0·99).

The results of this study are broadly in line with current recommendations for a healthy diet to prevent stroke.

To investigate the association between body image disorders and the lifestyle and body composition of female adolescents.

Cross-sectional study.

The Body Shape Questionnaire (BSQ) and Silhouette Scale and Sociocultural Attitudes Towards Appearance Questionnaire-3 were used to evaluate the participants’ body image. Body composition was evaluated by a Dual-Energy X-ray Absorptiometry equipment, and lifestyles were identified by latent class analysis (LCA) using the poLCA package for R.

Female adolescents aged 14–19 years old, in the city of Viçosa-MG, Brazil.

In total, 405 girls participated in the study. Almost half of the participants were dissatisfied with their current physical appearance (51·4 %), presented body perception distortions (52·9 %). 47·3 % of the adolescents were dissatisfied with their body according to the BSQ, and another 8 % severely so. Subjects with an ‘Inactive and Sedentary’ latent lifestyle were 1·71 times as likely to feel dissatisfied as those with active and sedentary or inactive and non-sedentary lifestyles (95 % CI 1·08, 2·90, P = 0·047). Body image disorders showed an association with decreased amounts of moderate and vigorous physical activity, high screen time, increased alcohol consumption and excess body fat.

Particular patterns of lifestyle and body composition seem to be associated in female adolescents with dissatisfaction with, distortion of and excessive concern about appearance. Specifically, physical inactivity, sedentary behaviour, alcohol consumption and high body fat percentage may be strongly linked to body image disorders.

To assess the association between short maternal height and four types of mother–child nutritional status groupings within Mexican households.

We classified mother–child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother–child nutrition status using multinomial logistic regression, controlling for socio-economic covariates.

Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey.

Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother–child dyads.

We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively.

Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.

This study assesses the association between living in a food desert and cardiovascular health risk among young adults in the USA, as well as evaluates whether personal and area socioeconomic status moderates this relationship.

A cross-sectional analysis was performed using data from Wave I (1993–1994) and Wave IV (2008) from the National Longitudinal Study of Adolescent to Adult Health. Ordinary least squares regression models assessing the association between living in a food desert and cardiovascular health were performed. Mediation and moderation analyses assessed the degree to which this association was conditioned by area and personal socioeconomic status.

Sample of respondents living in urban census tracts in the USA in 2008.

Young adults (n 8896) aged 24–34 years.

Net of covariates living in a food desert had a statistically significant association with cardiovascular health risk (range 0–14) (β = 0·048, P < 0·01). This association was partially mediated by area and personal socioeconomic status. Further analyses demonstrate that the adverse association between living in a food desert and cardiovascular health is concentrated among low socioeconomic status respondents.

The findings from this study suggest a complex interplay between food deserts and economic conditions for the cardiovascular health of young adults. Developing interventions that aim to improve health behaviour among lower-income populations may yield benefits for preventing the development of cardiovascular health problems.

Environmental interventions are more effective at changing nutrition behaviour than educational campaigns alone. As part of their health promotion efforts, the University of British Columbia (UBC) developed the Healthy Beverage Initiative (HBI) to ultimately reduce the consumption of sugar-sweetened beverages (SSB) on campus. We describe the development, implementation, preliminary evaluation and future of the HBI.

Naturalistic observation of environmental changes to induce behaviour change.

Large urban research university campus.

University community members and campus visitors.

Three main activities have been implemented since the initiation of the UBC HBI: renegotiation of the cold beverage agreement, a media campaign to promote tap water consumption and the removal of SSB from select retail locations on campus (residence dining hall). No significant loss of revenue was observed following the removal of SSB from a residence dining hall compared with similar locations. Compensatory purchasing behaviour of SSB was not observed at the closest retail locations where they were still available. After the removal of SSB, ~75% of survey respondents were not aware that the beverages had been removed.

The implementation of the HBI has met little resistance from the UBC community. The removal of SSB from residence dining locations did not result in any significant revenue loss or compensatory purchasing behaviour. This suggests that environmental intervention initiatives appear to be a viable option that may reduce SSB consumption on post-secondary campuses.

To evaluate the inclusion and exclusion of nutritional content in guidance materials related to nutritional care for hospitalised Ebola Virus Disease (EVD) patients of any age with the aim to provide recommendations for future revised nutritional care guidelines in Ebola Treatment Units (ETU).

Qualitative and quantitative analyses of ETU protocols and other guidance materials were conducted. Materials were obtained from practitioners, their organisations and governments active in EVD outbreaks since 2014.

Guinea, Liberia, Sierra Leone and Democratic Republic of Congo.

Guidance materials showed a wide variety of topics. Most contained information on different feeding phases during illness, the use of specialised products, what and how to feed children aged 0–23 months, and meal and snack frequency for different age groups. Most materials lacked guidance on how to assess or accommodate patients’ dietary preferences, how to obtain feedback on nutritional care from patients or how to assess whether patients need feeding support. These aspects are particularly relevant to prevent deterioration of the patients’ nutritional status. There was limited guidance on operational aspects of food preparation and provision.

Since 2014, numerous materials have been developed by organisations and governments on nutritional support in ETU. Although every EVD outbreak response must be contextualised because of the complexity of EVD and its case management, it is important to resolve technical differences and to provide comprehensive and more practical guidance. The findings of this study may inform future revised guidelines from normative UN organisations and governments of countries affected by EVD.

We examined the measurement and mediating role of social support in dietary intake among participants in Texercise Select, an intervention for improving lifestyle behaviours.

Quasi-experimental study. Participants reported their dietary intake, level of social support measured by the new Social Support for Healthy Eating scale, sociodemographics and disease profile. We conducted exploratory factor analysis for scale evaluation and structural equation modelling for mediation analysis to test if changes in dietary-specific social support mediate the relationship between the intervention and changes in dietary intake.

Texas.

Community-dwelling middle-aged and older adults completed a self-reported survey at baseline and 3-month follow-up (intervention group n 211, comparison group n 175).

The majority of the sample was aged ≥70 years (mean 74·30, sd 8·54), female (82·1 %) and had at least two chronic conditions (63·5 %). The acceptable levels of reliability and validity of the dietary-specific social support scale were confirmed. Compared with the comparison group, the intervention group reported improved intake of fruit/vegetables and water, and improved dietary-specific social support. Improved dietary-specific social support mediated the association between intervention and change in fruit/vegetable intake, controlling for sociodemographics, number of chronic conditions and geographic residence. About 12 % of intervention effect was mediated by social support.

The current study confirms positive intervention effects on healthy eating, and highlights social support relating to dietary behaviours that may be helpful for healthy eating. Future research should investigate additional social support for developing healthy eating behavioural skills.

The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children.

Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews.

Poor rural communities in Mexico; 48 intervention and 29 control.

Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention).

The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers’ knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose–response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant.

Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.

This study aimed to determine the knowledge, perceptions and practices of dietitians in South Africa regarding the Regulations Relating to Foodstuffs for Infants and Young Children (R991).

A mixed methods, cross-sectional design was used.

Quantitative data were collected using an online survey (n 282) and qualitative data by means of two focus group discussions (n 12).

Participants were dietitians registered with the Health Professions Council of South Africa.

Dietitians’ average knowledge score was 64·8 % ± 12·5. Those working in infant and young child feeding had a 5 % higher knowledge score (95 % CI 1·4, 8·6, P = 0·01). Perceptions towards the Regulations were generally positive, and the majority of practices were compliant. Positive perceptions seemed to correlate with compliant practices. The most frequently selected enabler to the implementation of the Regulations was ‘Increase in other initiatives which support, protect and promote breastfeeding’, and the most frequently selected barrier was ‘Lack of awareness of the Regulation among health care providers’. The major themes from the focus group discussions comprised: less knowledge among dietitians and mothers about products controlled under the Regulations, non-compliance of other health care providers, the dietitians’ role in support and enforcement, the discrepancy between practice in private and public sectors and a lack of enforcement.

South Africa has taken a bold step in legislating the International Code of Marketing of Breast-milk Substitutes and should upscale programmes to ensure consistent monitoring and enforcing of the Regulations.