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This study aims to assess the therapeutic effects of probiotic oral therapy in paediatric patients with anorexia nervosa (AN) and to investigate its impact on intestinal flora composition, brain–gut peptide levels and overall clinical outcomes. A retrospective study was conducted involving 100 children diagnosed with AN at Xingtang County People’s Hospital between January 2023 and June 2024. Patients were divided into two groups: a control group (n 50) receiving zinc gluconate oral solution alone and an observation group (n 50) receiving zinc gluconate plus probiotics. Outcome measures included intestinal flora analysis, brain–gut peptide levels (somatostatin (SS) and nitric oxide (NO)), clinical efficacy, serum trace element levels (Ca, Zn and Fe) and prognosis, including recurrence rates 6 months post-treatment. Baseline characteristics were similar between the two groups (P > 0·05). After treatment, the observation group showed significantly higher levels of Bifidobacterium and Lactobacillus and lower levels of Enterobacter compared with the control group (P < 0·05). Additionally, the observation group had lower levels of SS and NO (P < 0·05), indicating improved brain–gut communication. Clinical efficacy was significantly higher in the observation group (P < 0·05), with improved serum trace element levels (P < 0·05 for Ca, Zn and Fe). Furthermore, the recurrence rate 6 months post-treatment was significantly lower in the observation group compared with the control group (P < 0·05). Probiotic supplementation in children with AN effectively modulates intestinal flora, improves brain–gut peptide levels and enhances clinical outcomes.
The current review will examine the field of food intake biomarkers and the potential use of such biomarkers. Biomarkers of food intake have the potential to be objective measures of intake thus addressing some of the limitations associated with self-reported dietary assessment methods. They are typically food-derived biomarkers present in biological samples and distinct from endogenous metabolites. To date, metabolomic profiling has been successful in identifying several putative food intake biomarkers. With respect to food intake biomarkers, there has been a proliferation of publications in this field. However, caution is needed when interpreting these as food intake biomarkers. Many have not been validated thus hampering their use. While much of the focus to date is on discovery of food intake biomarkers there are excellent examples of how to utilise these biomarkers in nutrition research. Applications include but are not limited to: (1) measurement of adherence to diets in intervention studies (2) objectively predicting intake with no reliance on self-reported data and (3) calibrating self-reported data in large epidemiological studies. Examples of these applications will be covered in this review. While significant progress is achieved to date in the food intake biomarkers field there are a number of key challenges that remain. Examples include lack of databases focused on food-derived metabolites thus hindering the discovery of new biomarkers and the need for new statistical approaches to deal with multiple biomarkers for single foods. Addressing these and other key challenges will be key to development of future opportunities.
As obesity rates rise globally, addressing modifiable lifestyle factors, such as sleep, presents an opportunity for public health interventions. This review explores the growing evidence linking sleep duration, quality and timing with weight management and dietary behaviours throughout the life course. Observational studies associate short or irregular sleep with increased obesity risk, poor diet quality and metabolic disturbances. Plausible mechanisms include decreased physical activity, heightened hedonic and/or emotional eating, dysregulated appetite signals and circadian misalignment of metabolism, which contribute to a positive energy balance. Unravelling the bidirectional relationship between sleep and weight is challenging; poor sleep exacerbates weight gain, while obesity-related comorbidities such as obstructive sleep apnoea further impair sleep. Despite promising evidence from sleep-restriction studies showing increased energy intake, long-term randomised controlled trials (RCTs) examining interventions designed to improve sleep with weight management as an outcome are lacking. A handful of short-term interventions suggest benefits in reducing energy intake or improving dietary quality, but their effects on weight loss remain inconclusive. This review calls for robust, well-powered RCTs that integrate sleep, diet and physical activity interventions to evaluate the potential of sleep as a core component of obesity prevention and treatment strategies. Currently, there is insufficient evidence to support sleep-focused interventions as a mandatory element in clinical weight-management programmes.
This study aimed to investigate the association between family characteristics and adherence to the EAT-Lancet dietary recommendations in 7-year-old children. This is a prospective birth cohort study with 2125 children from Generation XXI (Porto, Portugal), who provided 3-day food diaries at age 7, used to assess habitual food consumption. At the age of 4, maternal diet was assessed using a Food Frequency Questionnaire, and a diet quality score was calculated (higher scores indicating a better maternal diet), and parental–child feeding practices were assessed with the Child Feeding Questionnaire. Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH) at the age of 7 years, previously adapted to paediatric age. Hierarchical linear regression models (consecutive addition of blocks of variables based on a theoretical framework) were employed to evaluate the associations between family characteristics and adherence to the WISH at age 7 (β regression coefficients and the respective 95 % confidence intervals (95 % CI)). Higher maternal age and education at child’s birth were associated with increased adherence to the WISH at age 7 (β = 0·018, 95 % CI 0·005, 0·031; β = 0·038, 95 % CI 0·024, 0·053, respectively). A better maternal diet quality and using more restrictive practices on child’s diet, at 4 years old, were both associated with higher scoring in the WISH at 7 years old (β = 0·033, 95 % CI 0·018, 0·049; β = 0·067, 95 % CI 0·009, 0·125, respectively). Early maternal sociodemographic and diet quality play a significant role in influencing the adherence to a healthy and environmentally sustainable dietary pattern at school-age.
By involving stakeholders to identify issues, co-design facilitates the creation of solutions aligned with the community’s unique needs and values. However, genuine co-design with consumers across all stages of nutrition intervention research remains uncommon. The aim of this review was to examine notable examples of interventions to improve diets in rural settings that have been co-designed by rural communities. Six studies were identified reporting on community-based and digital interventions to improve diets in rural settings that have been co-designed by rural communities. The level of co-design used varied, with two interventions describing co-design workshops and focus groups over a period of between 6 and 11 months, and others not reporting details on the co-design process. Collectively, most interventions demonstrated positive impacts on dietary markers, including an increase in purchase of fruit and vegetable, an increase in percentage energy from nutrient dense foods and a decrease in intake of high fat meats. While these interventions show promise for improving diets in these under-served communities, it is widely recognised that there is a lack of dietary interventions genuinely co-designed with and for rural communities. Future research should build on these studies to co-design dietary interventions that integrate the benefits of both community-based and digital interventions.
The Mediterranean diet (MD) is a dietary pattern associated with several health benefits, including reduction of risk for various cancers. We conducted a study to investigate associations between adherence to the MD and colorectal cancer (CRC) subtype risk among Moroccan adults.
Design:
A matched case–control study.
Setting:
The five major university hospitals in Morocco.
Participants:
A total of 3032 subjects (1516 CRC patients and 1516 controls) matched on age, sex and centre were recruited between September 2009 and February 2017 at five major hospitals in Morocco. Diet was assessed using a validated FFQ. Adherence to the MD was assessed through a score, ranging from 0 (no adherence) to 10 (maximal adherence) and divided into three categories (low, middle and high). Conditional logistic regression was performed to calculate multivariable OR and 95 % CI with low adherence (score 0–3) as referent, adjusting for potential confounding factors.
Results:
Close adherence to the MD (score 6–9) was associated with reduced risk of CRC (ORa = 0.74, 95 % CI 0.63, 0.86), rectal cancer (ORa = 0.73, 95 % CI 0.58, 0.90) and colon cancer (ORa = 0.74, 95 % CI 0.60, 0.92).
Conclusion:
Our study, conducted in a southern Mediterranean population, adds to the evidence suggesting a protective effect of MD against CRC risk.
This paper explores the characteristics of Ghanaian households’ consumption of obesogenic versus protective foods, including their retail, distribution, and origin.
Design:
A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers.
Setting:
Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide.
Participants:
612 households, 209 retailers and 185 wholesalers/distributors.
Results:
About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported.
Conclusion:
Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment.
While malnutrition (including both undernutrition and overweight/obesity and related non-communicable diseases) remains a persistent challenge in countries around the world, it is far from alone as a threat to human development and wellbeing – and is increasingly viewed as intersecting with climate change and environmental degradation. At the crossroads of these issues, animal-source foods (ASFs, including meat, fish, seafood, dairy and eggs) have attracted considerable attention in recent years, both for their role in diets and for their environmental impacts. Heated debate has focused on the potential benefits of reducing consumption of ASFs as well as the potential nutritional risks associated with this. ASF production also plays an important role in livelihoods, particularly in low- and middle-income countries. ASFs are also central to many food cultures and traditions, highly valued by many consumers. As the issues associated with ASFs are intertwined, they must be considered jointly and with nuance. Given wide global ranges in ASF consumption, environmental footprints and malnutrition rates and types, considering equity (in terms of ASF consumption and production) is also critical. This review examines these complex issues, discussing ASFs from the perspectives of nutrition and health, environmental impacts, livelihoods and society, and equity. It also examines potential future options for reducing environmental impacts of ASFs.
The vitamin K (VK) levels vary greatly among different populations and in different regions. Currently, there is a lack of reference intervals for VK levels in healthy individuals, The aim of this study is to establish and validate the reference intervals of serum vitamin K1 (VK1) and vitamin K2 (VK2, specifically including menaquinone-4 (MK4) and menaquinone-7 (MK7)) levels in some healthy populations in Beijing. Serum VK1, MK4, and MK7 were firstly measured by high-performance liquid chromatography and mass spectrometry in 434 subjects. The reference intervals for three indicators were established by calculating the data of 2.5 and 97.5 percentiles. Finally, preliminary clinical validation was conducted on 60 apparent healthy individuals undergoing physical examination. In the young, middle-aged, and elderly groups, the reference intervals of VK1 were 0.180 ng/mL ∼ 1.494 ng/mL, 0.247 ng/mL ∼ 1.446 ng/mL, and 0.167 ng/mL ∼ 1.445 ng/mL, respectively. The reference intervals of MK4 were 0.009 ng/mL ∼ 0.115 ng/mL, 0.002 ng/mL ∼ 0.103 ng/mL, and 0.003 ng/mL ∼ 0.106 ng/mL, respectively. The reference intervals of MK7 were 0.169 ng/mL ∼ 0.881 ng/mL, 0.238 ng/mL ∼ 0.936 ng/mL, and 0.213 ng/mL ∼ 1.012 ng/mL, respectively. The reference intervals had been validated by the samples of healthy individuals for physical examination. In conclusion, the reference intervals of VK established in this study with different age groups have certain clinical applicability, providing data support for further multicentre studies.
The ripening-dependent changes in antioxidant activities and phytochemical content of mango (Mangifera indica L.) cultivar Safaid Chonsa at various ripening stages were evaluated. The ripening time period was divided into five stages (RSI-RSV) and the pulp was subjected to proximate analysis, antioxidant potential, and UHPLC/MS-based non-targeted metabolite fingerprinting. Proximate analyses depicted variations in moisture, dry matter, fat, protein, carbohydrate, and energy parameters. Maximum DPPH activity (51%) was observed at stages III, IV, and V while FRSP increased 31% at RS V as compared to stage I. Total antioxidant capacity and total reducing power potential were maximum (295.7 and 345.71 µg AAE/mg extract, respectively at stage V. Total phenolic content increased from 3.57 µg GAE/mg extract to 5.72 µg GAE/mg extract from stage I to RSIII while 19% increase in total flavonoid content was observed at stage V as compared to stage I. UHPLC/MS analysis showed presence of Aconitic acid, methylisocitric acid, 4-O-methyl gallate, beta-glucogallin, xanthenes, sakebiose, Isobergaptene, Fructoselysine 6-phosphate, Citbismine C, and many others at different ripening stages of chonsa mango extracts. The results conclude that during the mango ripening stages, changes in phytochemical composition have positive correlation with antioxidantive potential. These phytochemicals have nutritional and nutraceutical effects on human health therefore ripening stage should be considered for consumption of mango.
The aim of this study was to examine the relationship between nutrition knowledge and nutritional adequacy among Japanese university students. This cross-sectional study was conducted in 2018 at a university located in Hyogo Prefecture, Kobe, Japan, and 801 students from various academic disciplines were enrolled. Eligible participants were students aged more than 18 years, encompassing all years of study. Nutrition knowledge data were obtained using a nutrition knowledge questionnaire (NKQ) for Japanese adults. Participants were classified into three nutrition knowledge groups according to their total NKQ scores [mean ± standard deviation; all (64.7 ± 15.4%), low (48.1 ± 13.8%), medium (68.3 ± 2.8%), and high (78.5 ± 4.2%)]. Participants reported their dietary habits in the preceding month using a brief self-administered diet history questionnaire. Differences in nutritional adequacy among groups were determined using logistic regression and covariance analyses, adjusted for potential confounding factors. The adequacy of each nutrient was quantified as the proportion of participants with nutrient intake that fell outside the reference range. Although the intakes of only a few nutrients and foods were associated with nutrition knowledge, the total number of nutrients below the estimated average requirement was lower in the high nutrition knowledge group (3.1 ± 2.7) than in the low nutrition knowledge group (3.6 ± 2.9) (P = 0.046). In conclusion, the nutrition knowledge level of Japanese university students is associated with nutritional adequacy but may partially affect eating habits. Future longitudinal studies must clarify the causal and dose-response relationships between nutrition knowledge and dietary habits.
The European Food Safety Authority (EFSA) provides independent scientific advice to EU risk managers on a wide range of food safety issues and communicates on existing and emerging risks in the food chain. This advice helps to protect consumers, animals and the environment. Data are essential to EFSA’s scientific assessments. EFSA collects data from various sources including scientific literature, biological and chemical monitoring programmes, as well as food consumption and composition databases. EFSA also assesses data from authorisation dossiers for regulated products submitted by the industry. To continue delivering the highest value for society, EFSA keeps abreast of new scientific, technological and societal developments. EFSA also engages in partnerships as an essential means to address the growing complexity in science and society and to better connect and integrate knowledge, data and expertise across sectors. This paper provides insights into EFSA’s data-related activities and future perspectives in the following key areas of EFSA’s 2027 strategy: one substance-one assessment, combined exposure to multiple chemicals, environmental risk assessment, new approach methodologies, antimicrobial resistance and risk–benefit assessment. EFSA’s initiatives to integrate societal insights in its risk communication are also described.
To evaluate the association between dietary fibre intake and obesity in Japanese outpatients with type 2 diabetes, as well as the demographic and dietary factors influencing this association.
Design:
Cross-sectional study with nationwide registry data on Japanese type 2 diabetes outpatients (2014–2019). Diet was self-reported via a FFQ. Obesity was defined as BMI ≥ 25 kg/m2.
Setting:
Clinics throughout Japan.
Participants:
1565 Japanese outpatients with type 2 diabetes (63·1 % men; age range 30–89 years).
Results:
Multivariate analysis revealed that a higher dietary fibre intake was associated with a lower risk of obesity in all participants (95 % CI = 0·439, 0·795, P trend = 0·002). Stratified analysis showed a significant inverse association between fibre intake and obesity in men and the older age groups (59–89 years), but not in women or the younger age group (30–58 years). In men, higher fibre intake was associated with healthier lifestyle behaviours, including increased physical activity (P < 0·001) and non-smoking (P < 0·001), with stronger associations compared with women. Vegetables, fruits and soyabeans/soya products were strongly correlated with fibre, while grains had a weak correlation. Folate was the micronutrient most strongly correlated with fibre.
Conclusion:
Higher fibre intake was associated with lower obesity risk, particularly in men and older age groups. These findings emphasise the need for targeted public health initiatives promoting the intake of diverse fibre-rich foods to effectively manage obesity. Further research is needed to understand sex- and age-specific factors in the fibre–obesity relationship in diverse populations.
Poor diets and food insecurity during adolescence can have long-lasting effects, and Métis youth may be at higher risk. This study, as part of the Food and Nutrition Security for Manitoba Youth study, examines dietary intakes, food behaviours and health indicators of Métis compared with non-Métis youth.
Design:
This observational cross-sectional study involved a cohort of adolescents who completed a self-administered web-based survey on demographics, dietary intake (24-h recall), food behaviours, food security and select health indicators.
Setting:
Manitoba, Canada
Participants:
Participants included 1587 Manitoba grade nine students, with 135 (8·5 %) self-identifying as Métis, a distinct Indigenous nation living in Canada.
Results:
Median intake of sugar was significantly higher in Métis (89·2 g) compared with non-Métis (76·3 g) participants. Percent energy intake of saturated fat was also significantly higher in Métis (12·4 %) than non-Métis (11·6 %) participants. Median intakes of grain products and meat and alternatives servings were significantly lower among Métis than non-Métis (6·0 v. 7·0 and 1·8 v. 2·0, respectively) participants. Intake of other foods was significantly higher in Métis (4·0) than non-Métis (3·0). Significantly more Métis participants were food insecure (33·1 %) compared with non-Métis participants (19·1 %). Significantly more Métis participants ate family dinners and breakfast less often than non-Métis participants and had lower self-reported health. Significantly more Métis participants had a BMI classified as obese compared with non-Métis participants (12·6 % v. 7·1 %).
Conclusions:
The dietary intakes observed in this study, both among Métis and non-Métis youth, are concerning. Many have dietary patterns that put them at risk for developing health issues in the future.
To understand caregivers’ perceptions about their children’s mealtime social experiences at school and how they believe these social experiences impact their children’s consumption of meals at school (both meals brought from home and school meals).
Design:
Qualitative data were originally collected as part of a larger mixed methods study using an embedded-QUAN dominant research design.
Setting:
Semi-structured interviews were conducted with United States (U.S.) caregivers over ZoomTM in English and Spanish during the 2021–2022 school year. The interview guide contained 14 questions on caregivers’ perceptions about their children’s experiences with school meals.
Participants:
Caregivers of students in elementary, middle and high schools in rural, suburban and urban communities in California (n 46) and Maine (n 20) were interviewed. Most (60·6 %) were caregivers of children who were eligible for free or reduced-price meals.
Results:
Caregivers reported that an important benefit of eating meals at school is their child’s opportunity to socialise with their peers. Caregivers also stated that their child’s favourite aspect of school lunch is socialising with friends. However, some caregivers reported the cafeteria environment caused their children to feel anxious and not eat. Other caregivers reported that their children sometimes skipped lunch and chose to socialise with friends rather than wait in long lunch lines.
Conclusions:
Socialising during school meals is important to both caregivers and students. Policies such as increasing lunch period lengths and holding recess before lunch have been found to promote school meal consumption and could reinforce the positive social aspects of mealtime for students.
Ultra-processed beverages (UPB) have known adverse impacts on health, but their impact on the environment is not well understood across different environmental indicators. This study aimed to quantify the environmental impacts of water-based UPB and bottled waters sold in Australia and assess the impacts of various scenarios which may reduce such impacts in the future.
Design:
This study presents a quantitative environmental impact assessment of a major sub-category of UPB (water-based UPB, including soft drinks, energy drinks, cordials and fruit drinks) and non-UPB (bottled waters) in Australia. Alternative mitigation scenarios based on existing health and environmental targets were also modelled using sales projections for 2027. Sales data from Euromonitor International were matched with environmental impact data from peer-reviewed lifecycle assessment databases. Environmental impact indicators included greenhouse gas emissions, land use, eutrophication potential, acidification potential, water scarcity and plastic use.
Setting:
The Australian beverage supply in 2022 and projected sales for 2027.
Participants:
N/A
Results:
Environmental impacts of UPB were higher than bottled waters. UPB accounted for 81–99 % of total environmental impacts, partly driven by the volume of sales. Reformulation, reducing UPB consumption and increasing recycling all led to meaningful reductions in environmental impacts but with diverse effects across different environmental indicators. The largest reductions occurred when policy scenarios were combined to represent a suite of policy actions which aimed to meet health and environmental targets (30–82 % environmental savings).
Conclusions:
The results indicate that implementing a suite of policies which act to target multiple drivers of environmental harm are likely to lead to the most environmental benefits.
n-6 and n-3 long-chain PUFA play opposing roles in inflammation, anxiety and nociception, all of which are closely associated with chronic pain. We hypothesised that diets high in n-6 arachidonic acid (C20:4n-6, AA) and low in combined n-3 EPA (C20:5n-3, EPA) and DHA (C22:6n-3, DHA) would be associated with higher odds of painful temporomandibular disorder (TMD).
Design:
We analysed baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Two 24-h dietary recall surveys quantified intake of long-chain n-6 and n-3 PUFA along with their precursors, linoleic acid (C18:2n-6, LA) and alpha linolenic acid (C18:3n-3, ALA), respectively. n-3 PUFA supplementation was quantified. Interviewer-administered questions assessed TMD. Survey multiple logistic regression estimated covariate-adjusted OR and 95 % confidence limits (CL) for associations between PUFA and TMD.
Setting:
From 2008 to 2011, HCHS/SOL recruited 16 415 adults of Hispanic/Latino backgrounds (Cuban, Puerto Rican, Dominican, Mexican, Central/South American), through field centres located in Miami, FL; San Diego CA; Chicago, IL; and the Bronx, NY.
Participants:
13 870 participants with non-missing data.
Results:
In analysis adjusted for covariates, each sd increase in dietary intake of C20:4n-6, AA was associated with 12 % higher odds of TMD (OR = 1·12, CL: 1·01, 1·24). Although the dietary intake of combined long-chain C20:5n-3, EPA and C22:6n-3 DHA was not associated with TMD, each sd increase in n-3 dietary supplement was associated with lower odds of TMD.
Conclusions:
A diet rich in C20:4n-6, AA was associated with higher odds of painful TMD.
To examine power and governance arrangements in food and nutrition policy formulation and agenda-setting in South Africa
Design:
Analysis of the policy implementation environment and in-depth interviews were conducted focussing on: existing policy content and priorities across food system sectors; institutional structures for cross-sectoral and external stakeholder engagement; exercise of power in relation to food system policies; and opportunities to strengthen action on nutrition.
Setting:
South Africa
Participants:
Interviews were conducted with 48 key stakeholders involved in the food and nutrition policy sphere: government sectors relevant to food systems (n=21), the private sector (n=4), academia (n=10), NGOs (n=11) and farmers (n=2).
Results:
This study found that there are power dynamics involved in shaping the planning agenda that is inadvertently generating a food system that undermines the right to food. The concept of nutrition governance remains poorly defined and applied in different ways and usually based on a relatively narrow interpretation – therefore limiting policy coherence and coordination. South Africa has strong legal institutions and practices, and social policies that support public provisioning of food, but a non-interventionist approach to the food system.
Conclusions:
The right to food and nutrition, as outlined in the South African Constitution, has not yet been effectively utilized to establish a robust normative and legal basis for tackling the dual challenges of food insecurity and malnutrition. Currently, the governance of the food system is grappling with substantial obstacles, balancing the influence of powerful stakeholders who uphold the status quo against its responsibilities for food justice.
To characterise children’s lunchbox contents for food, waste and packaging.
Design:
A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.
Setting:
Twenty-three sites across metropolitan Adelaide, South Australia including fourteen preschools and nine primary schools in low (n 8), medium (n 7) and high (n 8) socioeconomic areas.
Participants:
Preschool (ages 3–5 years) to Grade 7 primary school (ages 6–13 years) students.
Results:
673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92 % of lunchboxes having at least one item from that category, followed by fruits (78 %), snacks (62 %), dairy (32 %) and vegetables (26 %). Lunchboxes of preschool children contained more fruits (92 % v. 65 %; χ2(1) = 73·3, P < 0·01), vegetables (36 % v. 16 %; χ2(1) = 34·0, P < 0·01) and dairy items (45 % v. 19 %; χ2(1) = 53·6, P < 0·01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68 %) than preschool (55 %; χ2(1) = 11·2, P < 0·01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53 %) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.
Conclusions:
Sandwiches, fruits and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.