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

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

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

Twenty-five OSHC services.

Fruit was provided on 22 % (n 11) of days and vegetables on 12 % (n 6). Services with nutrition policies containing specific language on food provision (i.e. measurable) were more likely to provide fruit compared with those with policies using non-specific language (P= 0·027). Services that reported receiving training in healthy eating provided more vegetables than those who had not received training (P= 0·037).

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

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

Prospective cohort study

Korean Genome and Epidemiology Study.

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

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

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

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

Prospective cohort.

Municipalities within the Japan Public Health Centre-based Prospective Study.

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

Exposure intake of fish, n-3 and n-6 PUFA was evaluated in 1995–1997. We defined disabling dementia cases as participants who were certified to receive disability care under the long-term-care insurance programme (2006–2016) in participating municipalities with a grade of activities of daily living related to dementia ≥ IIa on the dementia rating scale (range 0–IV and M). Cox proportional hazard models were applied to obtain hazard ratios (HR) and 95 % CI according to quartiles of exposures of interest. In the main analysis, we adjusted for age and area, smoking, BMI, alcohol and metabolic equivalent tasks. During 410 350 person-years of follow-up with an average follow-up of 9·4 years, 5278 cases of disabling dementia were diagnosed. Fish intake and most PUFA were not associated with the risk of disabling dementia in men. In women, n-6 PUFA showed a significant decreasing trend in risk the highest HR (95 % CI) compared with the lowest was 0·90 (0·81, 0·99) (P for trend = 0·024) and alpha-linolenic acid (ALA) was 0·91 (0·82, 1·00) (P for trend = 0·043).

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

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

A narrative systematic review.

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

Clinical and non-clinical staff employed in hospitals.

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

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

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

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

106 census tracts in Montevideo, differing in geographical location and SES.

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

30·7 % of the 1217 food outlets identified in the field survey featured some type of exterior advertisement of ultra-processed products. Sweetened beverages (specifically soda) were the most frequently advertised ultra-processed product category, followed by ice cream. After adjusting for the type of outlet, medium SES tracts exhibited the highest prevalence of ultra-processed product advertisements outside food outlets (36·0 %). Differences in the prevalence of advertisements of specific categories with SES were also found, which may reflect variations in the types and characteristics of food outlets.

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

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

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

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

12 492 households in Great Britain.

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

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

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

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

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

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

The prevalence of stunting in Sri Lanka of 19 % was much lower than that observed for all the other low- to low–middle income South Asian countries (37 % in Bangladesh, 36 % in India, 31 % in Nepal and 30 % in Pakistan). The association of SEP with odds of stunting was similar in Sri Lanka compared with other South Asian countries. The only exception was weaker associations of wealth with stunting in Sri Lanka compared with Bangladesh. For example, in Sri Lanka, the poorest group had 2·75 (2·06, 3·67) times higher odds of stunting compared with the richest group, but in Bangladesh, this estimate was 4·20 (3·24, 5·44); the difference between these two estimates being 0·65 (0·44, 0·96) on the OR scale.

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

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

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

Online and telephone questionnaires.

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

Ninety-one mother–infant pairs with a mean (sd) age of 33·2 (4·1) years and 8·4 (1·3) months, respectively, were included. Most mothers were exclusively breast-feeding (54·9 %). The estimated maternal median iodine intake from food and supplements (median 140·3 µg/d, just meeting the UK RNI for women of reproductive age, but not the World Health Organisation (WHO) or British Dietetic Association (BDA) recommendations for lactating women (250 µg/d and 200 µg/d, respectively). Forty-six (50·5 %) of mothers met the UK RNI. Estimated intakes of fish, eggs, cow’s milk and yoghurt/cream/dairy desserts were significantly greater, whilst intakes of plant-based milk alternative drinks were significantly less in mothers who met the RNI for iodine (P < 0·05) compared with those who did not. Infant iodine intake from food was positively correlated with maternal; total iodine intake, iodine intake from all food and iodine intake from dairy foods (Spearman’s rho = 0·243, 0·238, 0·264, respectively; P < 0·05).

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

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

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

France

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

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

With grocery e-commerce penetration expected to double in the next 5 years, the study underscores the consequences of online shopping on consumers’ dietary balance. The findings have practical implications for online food retailers, inciting them to develop solutions that would encourage e-grocery shoppers to buy more fresh produce and sample a more varied diet. Additionally, they highlight the importance of monitoring the influence of technology on the consumer buying process, particularly with regard to food.

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

Four new healthy vending machines offering a wider range of healthier food and beverages were installed alongside existing machines. These new machines used traffic light colours to indicate nutritional value. A year after their installation, a traffic light text guide and colourful wrap were added to the new machines. χ2 tests were used to assess significant differences in the sales of green (healthy), amber or red (unhealthy) items from healthy and existing vending machines across the 3 years (2021–2023).

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

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

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

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