In this paper, we examined whether there are inequalities in access to food retail (by type and healthiness) across local government areas (LGA) in Greater Melbourne and by LGA grouped based on their distance from the central business district and Growth Area designation. We also examined whether these inequalities persisted over time.

This is a secondary analysis of a repeated cross-sectional census of food outlets collected at four time points (2008, 2012, 2014 and 2016) across 31 LGA. Using Geographical Information Systems, we present a spatial analysis of food retail environments in Melbourne, Australia, at these four times over eight years.

Greater Melbourne, Australia.

31 LGA in Greater Melbourne.

Findings show significant inequalities in access to healthy food retail persisting over time at the LGA level. Residents in lower density urban growth areas had the least access to healthy food retail. Unhealthy food retail was comparatively more accessible, with a temporal trend indicating increased accessibility over time in urban growth areas only.

Accessibility to food outlets, particularly healthy food outlets and supermarkets, in Greater Melbourne is not equal. To identify and address health inequalities associated with rapid urban growth, further understanding of how people interact with the food environment needs to be explored.

The objective of the study was to compare the potential dietary impact of proposed and final front-of-pack labelling (FOPL) regulations (published in Canada Gazette I (CG1) and Canada Gazette II (CG2), respectively) by examining the difference in the prevalence of foods that would require a ‘High in’ front-of-pack nutrition symbol and nutrient intakes from those foods consumed by Canadian adults.

Foods in a generic food composition database (n 3676) were categorised according to the details of FOPL regulations in CGI and CGII, and the differences in the proportion of foods were compared. Using nationally representative dietary survey data, potential intakes of nutrients from foods that would display a ‘High in’ nutrition symbol according to CGI and CGII were compared.

Canada

Canadian adults (≥ 19 years; n 13 495)

Compared with CGI, less foods would display a ‘High in’ nutrition symbol (Δ = –6 %) according to CGII (saturated fat = –4 %, sugars = –1 %, sodium = –3 %). Similarly, potential intakes of nutrients-of-concern from foods that would display a ‘High in’ nutrition symbol were reduced according to CGII compared with CGI (saturated fat = –21 %, sugars = –2 %, sodium = –6 %). Potential intakes from foods that would display a ‘High in’ nutrition symbol were also reduced for energy and nutrients-to-encourage, including protein, fibre, calcium and vitamin D.

Changes to FOPL regulations may have blunted their potential to limit intakes of nutrients-of-concern; however, they likely averted potential unintended consequences on intakes of nutrients-to-encourage for Canadians (e.g. calcium and vitamin D). To ensure policy objectives are met, FOPL regulations must be monitored regularly and evaluated over time.

This systematic review and meta-analysis examined the evidence for a potential relationship between vitamin D status and vitamin D supplementation on immune function biomarkers and prevention of acute respiratory tract infections (ARTI) in dark-skinned individuals.

Six databases were searched (inception to December 2021) for randomised controlled trials (RCT) and observational studies. A narrative synthesis and random-effects meta-analysis were used to synthesise the findings.

Not applicable.

Ethnic groups other than white, with or without a white comparator.

After duplicates were removed, 2077 articles were identified for screening. A total of eighteen studies (n 36 707), including seven RCT and 11 observational studies, met the inclusion criteria, and three RCT (n 5778) provided sufficient data of high enough quality to be included in a meta-analysis. An inverse association between vitamin D status and at least one inflammatory biomarker in black adults was found in three studies, and vitamin D status was inversely associated with ARTI incidence in black and Indigenous groups in two studies. There was no significant effect of vitamin D supplementation on differences in ARTI incidence in ethnic minority groups (OR, 1·40; 95 % CI: 0·70, 2·79; P = 0·34), nor African American (OR, 1·77; 95 % CI: 0·51, 6·19; P = 0·37) or Asian/Pacific (OR, 1·08; 95 % CI: 0·77, 2·68; P = 0·66) subgroups.

There is a lack of conclusive evidence supporting an association between vitamin D status and immune function or ARTI incidence in dark-skinned individuals. Further RCT in diverse ethnic populations are urgently needed.

This study aimed to assess the effects of multi-strain probiotics on anthropometric and biochemical measures in Saudi adults with overweight or obesity.

Single-centre, double-blind, placebo-controlled, randomised clinical trial.

Occupational Health Clinics at King Saud University Medical City, Riyadh, Saudi Arabia.

Ninety-three Saudi participants with overweight or obesity were randomly assigned to receive twice-daily doses of either placebo (n 49) or 30 × 109 CFU/g of HEXBIO® containing three Lactobacillus and three Bifidobacterium species (n 44) in a double-blind manner over a 12-week period, respectively. Both groups adhered to a hypoenergetic diet. Anthropometric measurements, glycaemic indices and lipid profiles were evaluated at baseline and post-intervention.

Following the 12-week intervention, no statistically significant differences were found in all between the probiotic group and placebo group comparisons, except for fat intake, where the group*time interaction showed a significant decrease in favour of the probiotic group (P = 0·02). However, significant within-group reductions were observed in the probiotic group: body weight (–0·9 kg, P = 0·02), HC (–1·5 cm, P = 0·002), energy intake (–387·3 kcal/d, P = 0·002), fasting glucose (–0·7, P = 0·002) and LDL-cholesterol (–0·7, P = 0·02).

Consumption of multi-strain probiotic supplementation over 12 weeks significantly decreased fat intake in Saudi adults with overweight or obesity, with the probiotic group highlighting improved anthropometric and biochemical parameters. Further research is needed to evaluate the long-term clinical significance of this dietary practice and whether it has a meaningful impact on overall health beyond the placebo effect.

Maternal iodine plays a central role in fetal neurodevelopment. It is recommended that pregnant women consume sufficient levels of iodine to accommodate increased need for mother and fetus. We examined associations among prenatal dietary and supplemental iodine intake and infant temperament.

The PRogramming of Intergenerational Stress Mechanisms (PRISM) study is an ongoing longitudinal pregnancy cohort. Data from 2011 to 2020 were used for this study. Women completed the Block98 FFQ ascertaining prenatal dietary and supplemental iodine intake and the Infant Behavior Questionnaire-Revised at infant age 6 months to ascertain infant temperament (Surgency/Extraversion, Negative Affectivity and Orienting/Regulation).

USA.

Mother–child dyads (n 892).

Women were primarily Black/Hispanic Black (44 %) and non-Black Hispanic (35 %) with 46 % reporting household income < $25 000/year. Nearly half had an estimated average requirement (EAR) < 160 µg/d (49 % based on dietary intake; 43 % based on diet and supplements). Girls born to women with an EAR ≥ 160 µg/d compared to girls born to women below this level had higher unadjusted extraversion scores for dietary plus supplemental intake (β = 0·23 (0·13, 0·33)); decreased to β = 0·05 (–0·08, 0·19) after adjusting for covariates. Boys born to women with an EAR ≥ 160 µg/d (based on diet and supplements) as compared to boys born to women below this level had statistically non-significant higher unadjusted negative affective score (β = 0·06 (–0·08, 0·20)) that became significantly lower upon covariate adjustment (β = –1·66 (–1·97, –1·35)).

A significant proportion of these women reported suboptimal prenatal iodine intake. Suboptimal prenatal iodine intake may have implications for child neurodevelopment evident as early as infancy.

To determine the prevalence of overweight and obesity in patients with severe mental disorders (SMD) and the factors associated with their socio-demographic and disease characteristics in a cross-sectional population-based study.

This analysis examined the prevalence of overweight and obesity in 14 868 managed SMD patients in an urban area of Shenzhen city based on data from the health information monitoring system in 2021. Multivariate logistic regression were used to identify the factors associated with the prevalence of overweight and obesity in patients with SMD.

China.

14 868 patients with SMD.

The prevalence of overweight and obesity in patients with SMD in this study was 32·6 % and 16·1 %, respectively. In multivariate analysis, married status, Shenzhen household registration, management durations of 5–10 years and >10 years, participation in family physician services, taking clozapine or aripiprazole, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of overweight and obesity. Compared to their respective reference categories, living with parents, spouse and children, taking risperidone, aripiprazole, amisulpride and perphenazine, FPG > 6·1 mmol/l, hypertension, TC ≥ 5·2 mmol/l, TG ≥ 1·7 mmol/l, and more frequent follow-ups in the past year were associated with higher odds of obesity.

We observed a high prevalence of overweight and obesity in patients with SMD in this study. The findings highlight the need for integrated management of overweight and obesity risk factors among patients with SMD.

The aim of this study was to investigate factors associated with reported need of weight loss support among adults with overweight or obesity in the general population.

A cross-sectional population study based on a survey questionnaire sent to a random population sample. Multivariate odds ratios for reported need of weight loss support were calculated for socio-economic, lifestyle and health indicators, in total and by gender and age group.

Five counties in Sweden in 2022.

The study includes 10 069 persons with overweight or obesity (BMI ≥ 25 kg/m2) aged 30–69 years. BMI was based on self-reported weight and height.

In total, about 20 % reported needing weight loss support. The factors most strongly associated with reported need of weight loss support were obesity and female gender. Lack of social support, economic difficulties, physical inactivity, poor self-rated health, musculoskeletal pain and depression were also associated with reported need of weight loss support, whereas diabetes and hypertension were not. Some differences in these associations were observed between age groups.

Reported need of weight loss support is more common among women than among men and associated with obesity, lack of social support, economic difficulties, physical inactivity, poor self-rated health, musculoskeletal pain and depression in both genders. These factors are important for planning preventive and weight-control measures among adults with overweight or obesity.

To assess the potential contribution of large-scale food fortification (LSFF) towards meeting dietary micronutrient requirements in Tanzania.

We used household food consumption data from the National Panel Survey 2014–15 to estimate fortifiable food vehicle coverage and consumption (standardised using the adult female equivalent approach) and the prevalence at risk of inadequate apparent intake of five micronutrients included in Tanzania’s fortification legislation. We modelled four LSFF scenarios: no fortification, status quo (i.e. compliance with current fortification contents) and full fortification with and without maize flour fortification.

Tanzania.

A nationally representative sample of 3290 Tanzanian households.

The coverage of edible oils and maize and wheat flours (including products of wheat flour and oil such as bread and cakes) was high, with 91 percent, 88 percent and 53 percent of households consuming these commodities, respectively. We estimated that vitamin A-fortified oil could reduce the prevalence of inadequate apparent intake of vitamin A (retinol activity equivalent) from 92 percent without LSFF to 80 percent with LSFF at current fortification levels. Low industry LSFF compliance of flour fortification limits the contribution of other micronutrients, but a hypothetical full fortification scenario shows that LSFF of cereal flours could substantially reduce the prevalence at risk of inadequate intakes of iron, zinc, folate and vitamin B12.

The current Tanzania LSFF programme likely contributes to reducing vitamin A inadequacy. Policies that support increased compliance could improve the supply of multiple nutrients, but the prominence of small-scale maize mills restricts this theoretical benefit.

While many Asian countries undergo dietary transitions, little is known about Japan’s dietary pattern changes and their impact on nutritional intake. We aimed to examine 17-year trends in dietary patterns and nutrient intakes in Japan.

Principal component analysis was used to derive dietary patterns. The nutrient intake of subjects with principal component scores in the highest quartiles of each dietary pattern was assessed using the NRF9·3, which is a scale that evaluates the entire diet in terms of nutrient density.

Japan.

We used data from the National Survey 2003–2019 (67 066 women, 55 133 men).

Two common dietary patterns were identified in both sexes: the ‘Japanese style’ and the ‘bread and dairy’ pattern. Additionally, two other patterns: ‘meat and oil’ and ‘noodles’, were pronounced in men. Over the 17 years, the scores of the ‘Japanese style’ pattern decreased while the ‘meat and oil’ and the ‘bread and dairy’ patterns increased. The nutrition assessment result showed that the highest quartiles of the ‘Japanese style’ pattern had higher NRF scores (women: 716·0, men: 670·5) (P < 0·001), whereas those of the ‘bread and dairy’ pattern had a lower score (636·9 in women, 661·2 in men) (P < 0·001).

Trend analysis in this study suggests the ongoing Westernisation of diet in Japan. A decreasing trend of the dietary pattern with the most preferable nutrient profile (i.e. the ‘Japanese style’) might indicate a potential decrease in beneficial nutrient intake and, thus, a deterioration of the nutritional status of the Japanese population.

To evaluate the effectiveness of a radio campaign involving serial 10-minute drama episodes, 10-minute on air discussion of each episode by trained community health workers and 30-minute phone-ins from listeners in improving mothers’ nutrition- and health-related attitudes (HNRAs) and children’s minimum acceptable diet (MAD).

A two-arm quasi-experimental trial with a pre-post design was used to quantify the effect of a radio campaign on nutrition before and immediately after the 6-month intervention. Difference-in-difference (DID) analysis was performed to assess the intervention’s effect.

Saboba district (intervention) and Central Gonja (comparison district) of northern region of Ghana.

At baseline, a total of 598 mothers with children aged 6–22 months were randomly selected from the intervention (n 298) and control (n 300) districts. At endline (6 months post-intervention), 252 mother–child dyads in the intervention district and 275 mother–child dyads in the control district were followed up.

The radio campaign was significantly and positively associated with a change in health- and nutrition-related attitudes (HNRA) over time, with DID in mean attitudes significantly improving more over time in the intervention district than the control (DID = 1·398, P < 0·001). Also, the prevalence of MAD over time in the intervention district was significantly higher than the control district (DID = 16·1 percentage points, P = 0·02) in the presence of food insecurity.

The study indicates that a radio campaign on nutrition is associated with improved mothers’ HNRA and children’s MAD. Communication interventions on child nutrition targeting low-resource settings should consider this innovative approach.

(1) To develop a new regression equation for estimating fat mass percentage (%FM) from anthropometric measurements in a heterogeneous Caucasian population and (2) to compare it with the Durnin and Womersley equation, which is one of the most used anthropometric equations for FM assessment.

Body mass, stature and four skinfolds (biceps, triceps, subscapular and supracrestal) were assessed by an accredited anthropometrist, according to the International Society for Advancement in Kinanthropometry. Participants completed a dual-energy X-ray absorptiometry (DXA) whole-body scan to determine their %FM. A new anthropometric equation to estimate %FM was developed using multiple forward regression analyses with DXA as the reference method. Tests for the accuracy of the different equations included mean differences, coefficient of determination, SE of the estimate (SEE), concordance correlation coefficient (CCC) and Bland–Altman plots.

Spain.

Two hundred and eighteen healthy Caucasian participants aged 18–65 years participated in this cross-sectional study.

Our proposed equation explained 89·9 % of the variance in the DXA-derived %FM, with a low random error (SEE = 3·00 %), a very strong agreement (CCC = 0·93), no fixed or proportional bias and a relatively low individual variability (5·84 %). However, the Durnin and Womersley equations obtained a fixed bias of –3·65 % when compared with DXA and a greater individual variability (6·74 %).

The proposed equation can accurately estimate %FM in a heterogeneous Caucasian population with a wide age range (18–65 years). Additionally, the Durnin and Womersley equation was inadequate when applied to our participants.

This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study according to ethnicity and socio-economic status (SES).

Cross-sectional analysis of baseline nutrient intakes in the African-PREDICT study.

North West Province, South Africa

Black and white adults (n 1153), aged 20–30 years, were classified into three SES groups. Dietary data were collected using three multiple-pass 24-h dietary recalls.

Among all participants, over 70 % failed to meet the estimated energy requirements and the estimated average requirements (EAR) for seventeen of the nineteen reported micronutrients. Across SES groups, more than 50 % of participants consistently did not meet the EAR for Ca, Mg, folate, pantothenic acid and biotin, as well as vitamins A, C, D and E. Participants’ distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in Mg, potassium, Ca, phosphorus and fibre. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, Zn and Fe nutrient pattern.

The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of CVD and hypertension.

This study aimed to measure urinary sodium and potassium as a measure of sodium and potassium intake concerning the knowledge, attitude and practice towards sodium intake among a group of healthy residents in the UAE.

A cross-sectional study on a sample of healthy adults in the UAE. In addition to the knowledge, attitude and practice questionnaire, sodium and potassium excretions and food records were taken.

The UAE.

A sample of 190 healthy individuals aged between 20 and 60 years.

The mean (± sd) age of the sample was 38·6 (± 12·5) years, and 50·5 % were females. The mean urinary sodium and potassium intake were 2816·2 ± 675·7 mg/d and 2533·3 ± 615 mg/d, respectively. The means were significantly different compared with the WHO recommendation of sodium and potassium (P < 0·001). About 65 % of the participants exceeded the WHO recommendations for salt intake, and participants’ knowledge classification for health-related issues was fair, while food-related knowledge was poor (P = 0·001). A two-stage stepwise multiple regression analysis revealed that knowledge, attitude and practice scores were negatively associated with urinary sodium excretion (r = –0·174; P = 0·017) and those older participants and females had lower urinary sodium excretion (P < 0·001).

These findings may suggest an increase in the risk of hypertension in the UAE population. Moreover, these findings emphasise the need to establish education and public awareness programmes focusing on identifying the sodium contents of foods and establishing national regulations regarding food reformulation, particularly for staple foods such as bread.

Evaluate knowledge and beliefs about dietary nitrate among United Kingdom (UK)-based adults.

An online questionnaire was administered to evaluate knowledge and beliefs about dietary nitrate. Overall knowledge of dietary nitrate was quantified using a twenty-one-point Nitrate Knowledge Index. Responses were compared between socio-demographic groups.

UK.

A nationally representative sample of 300 adults.

Only 19 % of participants had heard of dietary nitrate prior to completing the questionnaire. Most participants (∼70 %) were unsure about the effects of dietary nitrate on health parameters (e.g. blood pressure, cognitive function and cancer risk) or exercise performance. Most participants were unsure of the average population intake (78 %) and acceptable daily intake (83 %) of nitrate. Knowledge of dietary sources of nitrate was generally low, with only ∼30 % of participants correctly identifying foods with higher or lower nitrate contents. Almost none of the participants had deliberately purchased, or avoided purchasing, a food based around its nitrate content. Nitrate Knowledge Index scores were generally low (median (interquartile range (IQR)): 5 (8)), but were significantly higher in individuals who were currently employed v. unemployed (median (IQR): 5 (7) v. 4 (7); P < 0·001), in those with previous nutrition education v. no nutrition education (median (IQR): 6 (7) v. 4 (8); P = 0·012) and in individuals who had heard of nitrate prior to completing the questionnaire v. those who had not (median (IQR): 9 (8) v. 4 (7); P < 0·001).

This study demonstrates low knowledge around dietary nitrate in UK-based adults. Greater education around dietary nitrate may be valuable to help individuals make more informed decisions about their consumption of this compound.

This study aimed to assess the association between emotional attitudes towards diabetes, eating behaviour styles and glycaemic control in outpatients with type 2 diabetes.

Observational study.

Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil.

Ninety-one outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behaviour styles and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages and glycated Hb (HbA1c) values. Patients were categorised based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests.

At baseline, no differences were observed in the proportion of patients with good glycaemic control, eating behaviour styles and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycaemic control compared with the reference group (OR = 3·47; 95 % CI = 1·12, 10·75), after adjusting for diabetes duration, sex and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution.

Patients with a positive attitude towards diabetes showed a greater reduction in HbA1c levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.

To evaluate the application of front-of-package (FOP) labelling regulations to menu labelling in the Canadian restaurant sector by assessing the proportion of menu items that would be required to display the ‘high-in’ FOP symbol if the policy were extended to the restaurant sector.

Nutrition information of 18 760 menu items was collected from 141 chain restaurants in Canada. Menu items were evaluated using the mandatory FOP labelling regulations promulgated in Canada Gazette II by Health Canada in July of 2022.

Chain restaurants with ≥20 establishments in Canada.

Canadian chain restaurant menu items including beverages, desserts, entrées, sides and starters.

Overall, 77 % of menu items in the Canadian restaurant sector would display a ‘high-in’ FOP symbol. Among these menu items, 43 % would display ‘high-in’ one nutrient, 54 % would display ‘high-in’ two and 3 % would display ‘high-in’ all three nutrients-of-concern. By nutrient, 52 % were ‘high-in’ sodium, and 24 and 47 % were ‘high-in’ total sugars and saturated fat, respectively.

Given the poor nutritional quality of restaurant foods, the current regulations, if applied to restaurant foods, would result in most menu items displaying a FOP symbol. Therefore, expanding the Canadian FOP labelling regulations to the restaurant sector can be key to ensuring a healthy food environment for Canadians. Furthermore, menu labelling along with other multi-faceted approaches such as reformulation targets are necessary to improve the dietary intake of Canadians from restaurant foods.

Provide an in-depth examination of consumers’ food safety beliefs and practices to draw implications for interventions to improve nutrition and food safety in Ethiopia.

Adapted Focused Ethnographic Study approach using in-person semi-structured interviews and free-listing exercises, in two iterative phases.

A traditional food market in Hawassa, a mid-sized city.

Forty-six market shoppers, selected randomly in line with quotas for age and gender.

Consumers did not clearly differentiate between quality and safety, seeing them through connected concepts such as ‘freshness’. While most respondents had some understanding of the causes of unsafe food, they did not generally worry about becoming ill themselves and felt food safety risks were easily mitigated through in-home behaviours. Thus, food safety practices were not a main motivator of market or vendor choice. There was no evidence that food safety concerns led consumers to prefer packaged, processed food or to avoid consuming fresh foods.

The study offers novel depth and detail on a topic of strong policy relevance. While building on an encouraging base of understanding of food safety, there remains considerable scope for increasing knowledge, particularly with regard to the need to procure safe food as opposed to expecting household-level practices to mitigate all safety risks. Motivating customers to give food safety factors more consideration when making food purchasing decisions, such as by leveraging emotion-based communication from trusted messengers to elevate the issue’s salience in their minds, may contribute to improvements in food safety in low-income countries such as Ethiopia.

To assess the availability and marketing of ultra-processed foods (UPF) in modern retail food outlets (supermarkets and minimarts) in Kenya and associated factors.

This cross-sectional study was conducted in Kenya from August 2021 to October 2021. Variables included the geographic location and the socio-economic status (SES) levels, the food items displayed for sale and advertised in the stores, and locations in the stores such as the entrance.

Three counties in Kenya (Nairobi – urban, Mombasa – coastal tourist and Baringo – rural). Each county was stratified into high and low SES using national poverty indices.

Food outlets that offered a self-service, had at least one checkout and had a minimum of two stocked aisles were assessed.

Of 115 outlets assessed, UPF occupied 33 % of the cumulative shelf space. UPF were the most advertised foods (60 %) and constituted 40 % of foods available for sale. The most commonly used promotional characters were cartoon characters (18 %). UPF were significantly more available for sale in Mombasa (urban) compared to Baringo (rural) (adjusted prevalence rate ratios (APRR): 1·13, 95 % CI 1·00, 1·26, P = 0·005). UPF advertisements were significantly higher in Mombasa ((APRR): 2·18: 1·26, 3·79, P = 0·005) compared to Baringo and Nairobi counties. There was a significantly higher rate of advertisement of UPF in larger outlets ((APRR): 1·68: 1·06, 2·67 P = 0·001) compared to smaller outlets.

The high marketing and availability of UPF in modern retail outlets in Kenya calls for policies regulating unhealthy food advertisements in different settings in the country.