Within the UK, dietary fibre intakes are well below recommended intakes and associated with increased risk of obesity. This study aimed to explore the views of parents and children on barriers and facilitators to increasing fibre intakes and improving diets, alongside investigating the appropriateness of intervention components to overcome modifiable barriers.

Qualitative study including semi-structured interviews and focus groups informed by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model.

Year 5 children (aged 9–10-years) and parents, recruited through London primary schools

A total of twenty-four participants (eleven parents and thirteen children) took part. Five key themes were identified as barriers and facilitators, namely lack of (and improving) knowledge, social factors (including parent–child conflicts, limited time for food preparation, influence of peer and family members), current eating habits, influence of the school, community and home environment in shaping eating behaviours, and the importance of choice and variety in finding foods that are healthy and tasty. Parents strongly supported school-based dietary interventions to enable consistent messaging at home and school and help support dietary behaviour change. Practical sessions (such as workshops to strengthen knowledge, taste tests and food swap ideas) were supported by parents and children.

By using a theory-driven approach to explore the barriers and facilitators to increasing fibre intake, this research identified important themes and modifiable barriers to behaviour change and identifies acceptable intervention components to overcome barriers and bring about sustained dietary behaviour change in primary school children.

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.

To prevent and reduce non-communicable diseases, the Norwegian Directorate of Health encourages Healthy Life Centres (HLCs) in all municipalities.

This study investigates whether the behaviour change interventions at HLCs positively affected participants’ diet and to evaluate predictors for healthy and unhealthy eating. Our data are part of the Norwegian Healthy Life Centre Study, a 6-month, pragmatic randomised controlled trial (RCT).

Totally, 118 participants ≥18 years old were randomised to an intervention group (n 57), or a waiting list (control group) (n 61). Eighty-six participants met at the 6 months follow-up visit. We merged the participants to one cohort for predictor analyses, using linear regressions.

The RCT of the HLCs’ interventions had no effect on healthy and unhealthy eating 6 months after baseline compared with controls. A short, additional healthy eating education programme produced a modest, statistically significant improvement in healthy eating compared with controls. This did not, however, reduce unhealthy eating. Higher income predicted unhealthier eating over time. Increasing body mass index and impaired physical functioning also led to an increase in unhealthy eating. Healthy eating at 6 months was predicted by self-rated health (SRH), vitality and life satisfaction, and hampered by musculo-skeletal challenges and impaired self-esteem (SE). SRH impacted improvement in healthy eating during the 6 months. The effect of interventions on healthier eating may be improved by an emphasis on developing positive self-concepts like better SRH, vitality, life satisfaction, and SE.

People with lactose intolerance have to limit their consumption of lactose-containing dairy products which are a main source of Ca. In particular, for low-income people it is of interest which alternative diet form rich in Ca leads to the lowest additional costs. This study aims to calculate the additional costs of lactose-reduced diets and to show which of different options represent the most cost-effective alternative within a lactose-reduced diet.

Using linear programming, food baskets with different lactose contents were calculated and were compared to a basic model, reflecting a normal diet without a limitation of lactose. By comparing the costs and the composition of the food baskets, recommendations for a lactose-reduced diet were derived.

Germany.

A consumer panel dataset representative for Germany is used for the calculations. Information on prices and nutrients is derived from the 9429 adult households without children, and information on consumed food quantities from the 3046 single households.

The minimum additional food costs depend on the severity of lactose intolerance and range from 0·2 % to 6·1 % per month. It was found that the greatest adjustments due to lactose reduction could be observed within the dairy product group. In this group, with a rising lactose limit, normal milk was increasingly replaced by lactose-free milk.

It was shown that a lactose-reduced diet is generally associated with higher food costs. When suffering from lactose intolerance, switching to lactose-free milk seems to be the most cost-effective way to cover nutrient requirements.

To examine the feasibility of taste testing and point-of-purchase prompting to promote healthier food choices at a food truck event.

A pre-/post-study was conducted where food trucks provided samples of healthy food items to patrons and implemented point-of-purchase prompting (promotional signage; verbal cues). Implementation fidelity, acceptability and initial effectiveness were assessed via observation, patron surveys and sales data. A linear mixed model with a random effect for subject (food truck) and fixed effect for time point (baseline, intervention and post-intervention) was used to assess changes in relative sales of promoted healthy items as a percentage of food items sold.

Weekly food truck event in Buffalo, New York.

Seven food trucks; 179 patrons.

Implementation fidelity data illustrated that all food trucks complied with manualised procedures. Approximately one-third of surveyed patrons accepted a healthy sample, with the majority rating the sample positively. There was no main effect of time when examining changes in relative sales of promoted healthy items across all periods (P = 0·32); however, effect sizes representing changes between individual time points are consistent with an increase from baseline to intervention (d = 0·51), which was maintained through post-intervention (d = 0·03). The change from baseline to post-intervention corresponded to a medium effect size (d = 0·55).

Findings generally support the feasibility of implementing taste testing and point-of-purchase prompting to increase the selection of healthy food items from food trucks; implications for future research in this novel setting are discussed.

A social network is a valuable resource in later life. Therefore, the current study aims to investigate whether social networks within homes and neighbourhoods are associated with older adults’ daily fruit and vegetable consumption.

Cross-sectional secondary data analysis.

USA.

A nationally representative sample of 6865 community-dwelling older adults over age 53 in the Health and Retirement Study – Health Care and Nutrition Survey.

Older adults who lived alone with no children or friends nearby had the lowest fruit and vegetable consumption. However, the daily fruit and vegetable consumption of respondents who lived alone and had children or friends nearby or those who lived with someone and had no children or friends nearby was not statistically different from those who lived with someone and had children or friends nearby. This suggests that having a social network either at home or in the neighbourhood complements the absence of living with someone or having children or friends nearby and attenuates the negative association between limited social networks and daily fruit and vegetable consumption. A greater decrease in the number of fruits and vegetables consumed was observed among men when they lived alone with no children or friends nearby.

Special attention should be given to older adults with limited social networks, especially older adults living alone with no children or friends nearby. Provision of help with grocery shopping and meal preparation as well as social support networks and more opportunities that can improve social engagement appear to be necessary.

To examine whether using grocery delivery services moderates the relationship between distance to supermarket and dietary variety among Japanese older adults.

We conducted a 1-year prospective cohort study. Distance to supermarket was measured using geographic information systems. We collected information on dietary variety score (range 0–10), regular use of grocery delivery services and socio-demographic factors using a questionnaire delivered via post.

The current study was performed in Nada Ward, Kobe City, Japan, from 2017 to 2018.

Older adults living in Nada Ward (n 778).

The linear mixed model showed that a longer distance to supermarket (per 100 m: B = –0·07, 95 % CI –0·14, –0·01, P = 0·048) significantly predicted lower dietary variety after adjusting for socio-demographic factors. Using grocery delivery services (B = 0·28, 95 % CI –0·08, 0·64, P = 0·127) did not significantly predict dietary variety, and neither did its interaction with distance to supermarket (B = –0·04, 95 % CI –0·17, 0·10, P = 0·604).

The current study found that longer distance to supermarket was associated with lower dietary variety among Japanese older adults and that the use of grocery delivery services did not moderate this association. The findings imply that the use of grocery delivery services is insufficient to reduce the negative influence of inconvenient food access on dietary variety among older adults.

To determine the awareness of cardiovascular risk factors among university students in Turkey.

Cardiovascular disease (CVD) is the leading cause of death in developed countries. The use of tobacco products and unhealthy diet are prominent habits that increase the risk of CVD.

Healthy university students (n = 2450) aged between 18 and 22 years in Istanbul filled out the questionnaire about the awareness of CVD risk factors and participated in this cross-sectional study. They were asked several questions with regard to the importance of CVD risk factors.

The leading responses for men and women were, respectively, high cholesterol (58.3; 72.3%), stress (58.8; 71.8%), hypertension (50; 64.2%), smoking (53.1; 58.7%), obesity (46.8; 64.3%), diabetes (41.7; 52.7%), inactivity (43.3; 47.8%), and CVD in family history (31.8; 44.4%). Unhealthy diet (9.7; 15.3%), exposure to second-hand cigarette smoking (24.4; 34%), and poor socioeconomic status (22.6; 22.3%) were also considered to be important. The study also revealed that men disregard the risk factors more frequently. Another comparison between body mass index groups revealed that obese subjects gave significantly lower importance to cardiovascular risk factors.

Observations indicate that awareness levels of CVD risk factors have to be improved among university students. It is emphasized that primary healthcare workers are very important in the screening of CVD risk factors in an opportunistic and systematic way and in providing consultancy on changing risky behaviors (diet, smoking, etc.). Therefore, it is of utmost importance that primary healthcare workers make interventions to reduce the risk level by determining the CVD risk.

Globally, grandparents are the main informal childcare providers with one-quarter of children aged ≤5 years regularly cared for by grandparents in Australia, the UK and USA. Research is conflicting; many studies claim grandparents provide excessive amounts of discretionary foods (e.g. high in fat/sugar/sodium) while others suggest grandparents can positively influence children’s diet behaviours. The present study aimed to explore the meaning and role of food treats among grandparents who provide regular informal care of young grandchildren.

Qualitative methodology utilising a grounded theory approach. Data were collected using semi-structured interviews and focus groups, then thematically analysed.

Participants were recruited through libraries, churches and playgroups in South Australia.

Grandparents (n 12) caring for grandchild/ren aged 1–5 years for 10 h/week or more.

Three themes emerged: (i) the functional role of treats (e.g. to reward good behaviour); (ii) grandparent role, responsibility and identity (e.g. the belief that grandparent and parent roles differ); and (iii) the rules regarding food treats (e.g. negotiating differences between own and parental rules). Grandparents favoured core-food over discretionary-food treats. They considered the risks (e.g. dental caries) and rewards (e.g. pleasure) of food treats and balanced their wishes with those of their grandchildren and parents.

Food treats play an important role in the grandparent–grandchild relationship and are used judiciously by grandparents to differentiate their identity and relationship from parents and other family members. This research offers an alternative narrative to the dominant discourse regarding grandparents spoiling grandchildren with excessive amounts of discretionary foods.

Obesity is a major challenge for people with schizophrenia.

We assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia.

In this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included.

Between 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI −1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained.

Participants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.

R.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.