Management of moderate wasting (MW) is an important component of country-level strategies to address wasting, given high caseloads and susceptibility to illness and death. However, many countries experience challenges in providing targeted supplementary feeding programmes with specially formulated foods involved in managing MW. Some implementing agencies have developed a community-based programme using locally available foods (LF) for MW management known as Tom Brown. This study assessed the costs and cost-efficiency of three Tom Brown programmes (two with an 8-week supplementation duration, one with a 10-week duration).

We assessed institutional costs and selected estimates of societal costs to households and community volunteers.

Northeast Nigeria

Programme staff

Total cost per child ranged from $155 to $184 per 8-week programme and $493 per 10-week programme. Monthly LF supplementation cost per child ranged from $5 to $21. Unit costs were influenced by implementation duration and variations in programme features including storage and transportation models, the inclusion of voucher transfers and volunteer cadre models. Opportunity costs to beneficiaries and volunteers in preparing recipes were substantial. Cash/voucher components, when used, represented a cost driver for institutional and societal costs.

An updated WHO guideline emphasises the role of LF for supplementing MW children who lack other risk factors. Given that specially formulated foods are not necessary for all MW children to recover, programme approaches using LF are important options for managing MW. This study from Nigeria provides the first cost estimates for using LF to manage MW. Future research is needed on the effectiveness and cost-effectiveness of these approaches.

Traditional diets are culturally accepted and adapted to local environments, but globalisation has shifted towards unhealthy, unsustainable eating habits. This study aims to assess the literature on the effects of traditional, place-based diets on health and sustainability and examines the suitability of common tools used to evaluate them.

A systematic search was conducted using the PRISMA 2020 guidelines across seven databases (CINAHL, Cochrane Library, MEDLINE, Scopus, Web of Science, PubMed and Google Scholar), and the protocol was registered with PROSPERO (CRD42023445750). The inclusion criteria were traditional place-based diets, studies examining the nutritional, health benefits and sustainability impacts of traditional food consumption, published in English, with no date restriction.

Eleven studies from Spain, Romania, Portugal, Mexico, Chile, Japan, Uganda and India met the criteria. Assessment tools included carbon footprints (via LCA), nitrogen footprints, NRF9.3, Nutri-Score and EAT-Lancet; some incorporated qualitative methods. Mediterranean, Atlantic and Japanese diets aligned well with health and sustainability, whereas meat-heavy or nutrient-deficient patterns raised concerns. Most studies relied on standardised tools and secondary datasets, with limited use of region-specific environmental data or qualitative insights. Only one intervention study was identified.

Traditional diets show promise as culturally appropriate models for sustainable and healthy eating. Current tools designed around standardised, reductionist frameworks often fail to capture the complexity of traditional food systems, including local practices, preparation methods and cultural meaning. To better assess traditional diets, future research should develop regionally adapted indicators and integrate quantitative measures with qualitative insights from local communities.

To examine how school food policies and perceived barriers influence food provision in New Zealand primary school canteens, using the ‘Healthy Food and Drink Guidance for Schools’.

Cross-sectional analyses of school food menus and school food policy and practices surveys completed by school leaders/principals.

New Zealand primary schools.

239 primary schools completed the school food policies and practices survey, and eighty schools provided canteen menus.

Most schools reported having a healthy food and drink policy in their school (76·2 %) and promoted healthy eating during school hours (87·4 %). Two-thirds (69·5 %) identified barriers to healthy food and drink provision, most commonly the convenience of ready-made foods (39·3 %), and resistance from parents (34·3 %). The number of reported barriers was not a significant predictor for the presence of a school food policy (OR-1·034, P = 0·841). School menus (n 80) consisted of 16·4 % ‘green’ items, 34·7 % ‘amber’ items and 36·8 % ‘red’ items. There was no relationship between the percentage of ‘green’, ‘amber’ and ‘red’ items and the presence of a school food policy or reported barriers. More than a third (38·9 %) of menus from schools that reported they had a ‘Plain Milk and Water’ only policy still contained sugar-sweetened beverages.

Although most New Zealand primary schools had healthy food policies, this was not consistently reflected in healthy food items on canteen menus. Further research is needed to understand how systemic barriers, such as cost, convenience and parental influence, affect policy implementation and school food provision.

To cognitively test questions for inclusion in a national nutrition survey, ensuring the questions are interpreted as intended, and to inform further improvements.

A draft nutrition survey questionnaire was developed based on existing questionnaires and expert input. Twelve questions on dietary habits and food security were selected for cognitive testing as these were newly developed, amended from existing questions or identified to no longer reflect the current food environment or concepts. Cognitive interviews were conducted using both think-aloud and probing techniques to capture respondents’ thought processes used to arrive at an answer. Interviews were audio-recorded and transcribed verbatim. Qualitative data were analysed for recurring patterns and unique discoveries across the survey questions.

New Zealand.

Sixty-eight participants aged 11 years and older, representing diverse socio-demographics including gender, ethnicity and education level.

Three main cognitive challenges were identified: (1) interpreting ambiguous terms, (2) understanding dietary or technical terms and (3) following complex or unclear instructions. Questions were refined based on the study findings and further advice from experts in nutrition and survey design to enhance participant understanding and accuracy.

The cognitive testing findings and expert input led to the refinement and potential improvement of selected questions for inclusion in a national nutrition survey. Changes included simplified terminology, clearer instructions, improved examples and better question order. Our methodological approach and findings may be valuable for those designing similar questions for dietary surveys.

To adapt current iron intake reference values for Brazilian children aged 7–11 and 12–23 months, using the opportunity to apply the principles and rationale of the harmonisation approach.

Nutrient reference values (NRV), including the average requirement (AR) and population reference intake (PRI), were estimated for children aged 7–11 and 12–23 months. We applied and adapted methods from the Institute of Medicine (IOM) and the European Food Safety Authority (EFSA) to estimate the NRV. Body iron losses, iron needs for growth and dietary iron bioavailability were estimated using both local and external data.

Rio de Janeiro, Brazil.

Data on dietary intake from a probabilistic sample of children aged 7–23 months in the city of Rio de Janeiro, Brazil, were used to estimate iron consumption and bioavailability.

The mean physiological iron requirements were 0·78 mg/d (7–11 months, male), 0·53 mg/d (7–11 months, female), 0·79 mg/d (12–23 months, male) and 0·54 mg/d (12–23 months, female). Mean dietary iron bioavailability was 7·5 % across all age and sex groups. AR and PRI were 10 mg/d and 19 mg/d for children aged 7–11 months, and 7 mg/d and 13 mg/d for those aged 12–23 months. NRV did not differ by sex.

The AR for children aged 7–11 and 12–23 months were 11 mg/d and 8 mg/d, respectively. The corresponding PRI were 20 mg/d and 14 mg/d. The estimated Brazilian NRV were higher than those of the IOM and EFSA. Iron bioavailability was the most influential factor explaining the differences from other NRV.

Half of people living in the USA do not consume tap water. Surveys have assessed perceptions of water and water utilities, but less is known about how these perceptions relate to the preference for tap or bottled water. The present analysis examined whether beliefs about tap water and the water utility were associated with drinking water preferences.

In a cross-sectional survey, six water beliefs were measured: trust in tap water, the water utility, and the local government; perceived safety and quality of tap water; and awareness that the water utility frequently tests tap water. Regression models adjusted for sociodemographic characteristics were used to estimate the odds of preferring tap over bottled water dependent on respondents’ beliefs about their tap water.

Virginia, USA.

Adults aged 18 years and older (n 808).

More than two-thirds of respondents had positive beliefs about their tap water, but only 54 % reported tap as their preferred drinking water source. All water beliefs, except for awareness of the frequency of water testing, were associated with higher odds of preferring tap water over bottled (adjusted OR range: 1·56–3·2).

Our findings suggest that favourable tap water beliefs may be necessary, but not sufficient, to motivate people to drink from the tap. There remains a critical need for future research to bridge the gap between tap water perceptions and consumption, which should include enhancing the trustworthiness of tap water and the water utility as well as improving consumers’ perceptions of water quality and safety.

To explore adults’ perceptions towards obesity and factors influencing eating behaviour and physical activity in North Lebanon, using a variation of the Photovoice method.

This research is part of a broader qualitative study exploring factors influencing the rising levels of obesity and understanding the barriers and enablers for effective policy for obesity prevention using a socio-ecological model as a guiding framework. For this study, a variation of ‘Photovoice’ was used to collect photographs to explore participants’ perspectives of obesity and its causes in Lebanon, using these photographs to generate discussion in one-to-one face-to-face interviews. Inductive and deductive thematic analyses were used to analyse the transcribed interviews.

Tripoli, North Governorate, Lebanon.

Twenty Lebanese adults aged 20–64 years were recruited.

The participants (n 20) generated 257 photographs representing both positive and negative influences related to food choice and physical activity, and the various factors perceived to be associated with rising obesity in Lebanon: changes in the food and eating landscape, sedentary behaviours, food environments, eating out and food marketing on social media platforms. Several themes specific to Lebanon were also identified, including the perceptions towards obesity, the central role of women in Lebanese food preparation and the family and the sociocultural importance of food and social gatherings.

This study highlights how influences across the five levels of the socio-ecological model shaped the participants’ food choices and physical activity levels. Collaborative initiatives and public policies are necessary to address the identified barriers and curb the increasing prevalence of obesity in Lebanon.

To co-design a systems approach aimed at promoting the wide-scale adoption of whole-school approaches to food in UK primary schools to improve school food environments, food provision and dietary intake in children.

A systems framework (Action Scales Model) was used to guide the co-design of the systems approach. The process involved identifying leverage points within the UK primary school food system that, if influenced, could alter the way in which the system functions. Actions were then agreed upon to influence those leverage points.

Co-design workshops were held online between September 2021 and February 2022.

Members of the co-design team comprised twelve school stakeholders (headteachers, school food improvement officers, catering leads, representatives of UK school food organisations and a dietician) and a team of researchers with expertise in school food, systems thinking and intervention development. Our partnership board included decision-makers and advocates of the whole-school approach to food in England and Northern Ireland.

Identified leverage points included the priorities of headteachers, who are instrumental in instigating whole-school approach to food adoption. Direction from local and national policymakers was also identified. Actions to influence these leverage points included providing direct support to schools (through an online resource) and encouraging policymakers to monitor the adoption of the approach.

The methods described here can be replicated by others to promote the adoption of whole-school approaches to food in other contexts and contribute to the growing literature on developing systems-wide approaches to promote the adoption of public health initiatives.

Nutrition education plays a crucial role in improving the nutritional status of pregnant women, yet evidence of its impact in low-income settings like Ethiopia is limited. This study evaluated the effectiveness of facility-based nutrition education and counseling on pregnant women’s knowledge, dietary practices, and Fe-folic acid supplement use.

A cluster randomised controlled trial was conducted in Addis Ababa, Ethiopia, involving 683 pregnant women across twenty health centres assigned to intervention or control groups. Antenatal care providers in the intervention group received training on pregnancy nutrition and counseling, while the control group continued standard care per national guidelines. A total of 683 pregnant women were enrolled during their first and second antenatal care (ANC) visits. Mixed-effects linear regression was used to evaluate outcomes.

The study was conducted in Addis Ababa, Ethiopia, from August to December 2017.

Pregnant women attending ANC follow-ups and healthcare providers working in ANC units.

The intervention group demonstrated significant improvements in knowledge, including iodised salt use (difference-in-differences (DID) 23 %), correct Fe-folic acid supplementation duration (DID 68 %) and the need for additional meals during pregnancy (DID 49·9 %). Dietary practices improved with higher dietary diversity (DID 32·3 %), increased dairy consumption (MD 1·2 v. –0·1; DID 1·2 per week) and higher Fe-folic acid supplementation (MD 4·9 v. 1·6; DID 3·2 per week).

Nutrition education and counseling during ANC visits significantly improved pregnant women’s knowledge and dietary practices. Integrating and strengthening these interventions into routine ANC services could effectively enhance dietary intake and health outcomes.

The first year of life is a critical period when nutrient intakes can affect long-term health outcomes. Although household food insecurity may result in inadequate nutrient intakes or a higher risk of obesity, no studies have comprehensively assessed nutrient intakes of infants from food insecure households. This study aimed to investigate how infant nutrient intakes and BMI differ by household food security.

Cross-sectional analysis of the First Foods New Zealand study of infants aged 7–10 months. Two 24-h diet recalls assessed nutrient intakes. ‘Usual’ intakes were calculated using the multiple source method. BMI z-scores were calculated using WHO Child Growth Standards.

Dunedin and Auckland, New Zealand.

Households with infants (n 604) classified as: severely food insecure, moderately food insecure or food secure.

Nutrient intakes of food insecure and food secure infants were similar, aside from slightly higher free and added sugars intakes in food insecure infants. Energy intakes were adequate, and intakes of most nutrients investigated were likely to be adequate. Severely food insecure infants had a higher mean BMI z-score than food secure infants, although no significant differences in weight categories (underweight, healthy weight and overweight) were observed between groups.

Household food insecurity, in the short term, does not appear to adversely impact the nutrient intakes and weight status of infants. However, mothers may be protecting their infants from potential nutritional impacts of food insecurity. Future research should investigate how food insecurity affects nutrient intakes of the entire household.

This study aims to provide an overview of evidence on factors affecting Mediterranean diet (MD) adherence across socio-ecological levels (individual, interpersonal and environmental) in Mediterranean countries, which can be target points for future interventions to promote MD adherence.

A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines and registered in the Prospero database (CRD42020189337). Literature was searched in PubMed, Web of Science and PsycINFO.

The MD is one of the healthiest dietary patterns, reducing risk of chronic disease while promoting better health outcomes. However, adherence to the MD remains challenging, even in Mediterranean countries.

Healthy adults aged 18 years and older, living in a Mediterranean country.

A total of thirty-seven cross-sectional studies were included, with 190 to 13 262 participants. Most studies (30/37) were conducted in European Mediterranean countries, primarily Italy (n 14), Spain (n 9) and Greece (n 6). All studies involved community-based samples; two studies included only women. Individual-level determinants were the most frequently examined. Higher socio-economic status, regular breakfast consumption, being unemployed, a job seeker or retired were linked to better MD adherence. Socio-cognitive and interpersonal factors were underexplored. At the environmental level, COVID-19 confinement boosted adherence, whereas the effects of economic crises were inconsistent. Effect sizes were mostly very small to small, and findings are based on low-quality studies.

This systematic review highlighted several socio-economic and environmental factors potentially influencing MD adherence. However, more robust research is needed to better understand socio-cognitive and ecological factors.

Classroom celebrations and food rewards are substantial sources of unhealthy foods within the school environment in the USA. This study was designed to describe classroom food reward practices and examine the association between food rewards and constructs of the Health Belief Model (HBM).

An online survey using summated scales of food reward frequency and HBM constructs.

The online survey was distributed to elementary schools throughout seven Midwestern states from November through December 2023.

Elementary school teachers (n 256).

Candy was the most frequently used food reward with the majority of teachers (55·9 %) reporting they utilised candy at least ‘sometimes’. Bi-variant analysis revealed food reward frequency was positively correlated with perceived barriers to refraining from the use of food rewards (r = 0·47, P < 0·01) and negatively correlated with policy cues to action (r = −0·22, P < 0·01). Multiple regression analysis predicted food reward frequency (R = 0·47, F (3247) 23·62, P < 0·001), but only perceived barriers (β = 0·45; P < 0·001) contributed significantly to the prediction.

Classroom food rewards are common, and perceived barriers (but not perceived threat or policy cues) were associated with food rewards among this sample of teachers. Reducing barriers to refraining from the use of food rewards may begin to reduce the practice of using classroom food rewards.

Declining participation by family childcare home (FCCH) providers in the Child and Adult Care Food Program (CACFP) may stem from inadequate tiered reimbursements for nutritious foods. During the COVID-19 pandemic, federal waivers temporarily eliminated tiers and increased reimbursements. We evaluated provider, sponsor and family perceptions of CACFP benefits and challenges in general and regarding the temporary removal of tiers and increased reimbursement rates.

From September 2023 to February 2024, FCCH providers, CACFP sponsors and CACFP family recipients in California participated in semi-structured interviews about CACFP benefits and challenges, perception of tiers and the COVID-19 waiver, quality of food and business viability. Thematic analysis was conducted using the immersion crystallisation method.

Virtual interviews with California providers, sponsors and families.

FCCH providers (n 31), CACFP sponsors (n 10) and CACFP family recipients (n 6).

Providers and sponsors reported that the higher temporary reimbursement rate positively impacted food budgets and quality. Pandemic-era facilitators of CACFP participation included the higher reimbursement rate, tier removal and a hybrid model for monitoring visits. Benefits beyond the pandemic included nutrition education and supporting child food security. Families valued CACFP for providing a variety of high-quality foods. However, barriers to CACFP participation persist, including administrative burden, inadequate reimbursements, strict regulations and the impacts of the pandemic and inflation.

Increasing CACFP reimbursements while reducing other participation barriers can better support FCCH providers’ and sponsors’ participation. Supporting FCCH CACFP participation and retention can enhance access to healthy and nutritious meals for children from families with low income.

To examine policy processes and industry opposition surrounding the first US healthy checkout ordinances (HCO), which mandate nutritional standards for foods and beverages displayed in grocery checkout areas.

Qualitative case study comparison using Kingdon’s Multiple Streams Framework, triangulating city records, advocacy materials and key informant interviews.

Local governments of Berkeley and Perris, California, USA.

Informants, identified from documents and snowball sampling, included community-based organisation members/local advocates (Berkeley n 6; Perris n 1), staff from national nongovernmental organisations providing assistance (Berkeley n 2; Perris n 2), city councilmembers (Berkeley n 2; Perris n 2), city commissioner (Berkeley n 1) and city staff (Perris n 2).

We described and compared each city’s HCO enactment process. In both, prior commitments to community-led food environment reforms enabled advocates to garner financial and technical support for early coalition building. Berkeley used soda tax proceeds for a youth-led citizen science project to formulate an enforceable HCO and assess public support. These experiences fostered political commitment to define applicable stores, checkout areas and nutritional standards. Campaigns emphasised protecting children and parents from predatory marketing and impulse buying. Berkeley’s campaign quietly and cautiously engaged mostly independent retailers, attracting limited industry attention; Perris engaged all retailers and after enactment faced open opposition from a chain store and trade associations. Perris’ amended HCO included concessions allowing unhealthy items at many endcaps and long checkout lanes.

HCO enactment may be facilitated by prior food policy experience, community capacity, early coalition building, careful policy design and framing and anticipating and managing industry opposition.

The Food Access Research Atlas (FARA) is a common measure of food access developed by the US Department of Agriculture. However, its sole focus on supermarkets lacks specificity for culturally appropriate food. This ecological study assesses the relationship of FARA and our novel Yelp-based Ethnic Store Measure with diabetes rates among Asian Americans and Native Hawaiians or Pacific Islanders (AAPI).

This study leveraged crowd-sourced Yelp data to develop six culturally appropriate food access variables and compare them with FARA at the census tract (CT) level. Estimates of CT AAPI diabetes rates were calculated from hospital and emergency department discharge data. Spatial trends were examined visually and with Moran’s I. Ordinary least squares (OLS) and spatial lag regression (SLR) models assessed covariate-adjusted z-score standardised associations between food access measures and AAPI diabetes rates.

San Diego, California, USA

All 626 CT in San Diego, CA

Most food access variables showed strong spatial autocorrelation. The FARA measure – percent of AAPI population beyond 0·5 miles of a supermarket – was positively associated with AAPI diabetes in OLS (1·88; 95 % CI 0·76, 3·0; P = 0·001) but not SLR. Our Yelp-based variable – number of AAPI restaurants per AAPI population – was negatively associated with AAPI diabetes in both OLS (–1·15; 95 % CI –2·17, –0·13; P = 0·03) and SLR (–1·32; P = 0·004). No other variables were significantly associated with diabetes.

Area-level, culturally sensitive measures of food access offer valuable insights into the role of culturally appropriate food access on cardiometabolic health among racial and ethnic minorities.