This study aimed to develop a shared understanding about the drivers of nutrition security in Puerto Rico (PR) from the collective perspective of multi-sector stakeholders in the agri-food, environmental and the health/disease systems.

A participatory community-based system dynamics approach (group model building) engaged stakeholders during one 4-h workshop March 2023 (followed by two 2.5-h member checking sessions).

San Juan, PR.

Stakeholders (n 22) in PR representing the agri-food, environmental and health/disease systems from multiple sectors (commercial food retail and technology, food production, public servants, academia and civil society) participated in the workshop.

Stakeholders collectively framed nutrition security as an outcome of six interconnected subsystems exacerbated by climate change: (1) governance and public policy; (2) demographic change and rural disinvestment; (3) climate change and adaptive capacity; (4) local food production economy; (5) food culture; and (6) nutrition security and health. Stakeholders identified leverage points mostly focused on strengthening information flow within and across subsystems and expanding cross-sectoral collaboration (systems structures and elements). We identified three paradigms that have the potential to transform the system structure and function: ecological conscience, traditional and healthy food culture, and social cohesion.

These findings deepened the collective understanding of systemic interdependencies that drive nutrition security as stakeholders identified locally feasible leverage points.

The food system is a major contributor to the global burden of disease, ecosystem destruction and climate change, posing considerable threats to human and planetary health and economic stability. Evidence-based food policy is fundamental to food system transformation at global, national and local or institutional levels. This study aimed to critically review the content of universities’ food sustainability policy documents.

A systematic search of higher education institutions’ policies, using targeted websites and internet searches to identify food sustainability policy documents, was conducted between May and August 2023. A quantitative content analysis of the identified documents was conducted independently by multiple researchers using a coding template. Inconsistencies in coding were subsequently checked and amended through researcher consensus.

163 UK higher education institutions.

N/A.

Approximately 50 % of universities had a publicly available food sustainability policy. The most common food sustainability commitments therein were communication and engagement (95·2 %), food waste (94·0 %) and quality standards and certification (91·7 %). The scope of policy commitments varied between institutions; however, comprehensive documents included multifaceted commitments tackling more than one dimension of sustainability, for example, waste mitigation strategies that tackled food insecurity through food redistribution. Few (17·9 %) policies included a commitment towards research and innovation, suggesting university operations are considered in isolation from academic and educational activities.

Multifaceted policy commitments are capable of uniting numerous food-related actions and institutional activities. As such, they are likely to support food system transformation, with broader positive outcomes for the university, students and the wider community.

While associations of ultra-processed food (UPF) consumption with adverse health outcomes are accruing, its environmental and food biodiversity impacts remain underexplored. This study examines associations between UPF consumption and dietary greenhouse gas emissions (GHGe), land use and food biodiversity.

Prospective cohort study. Linear mixed models estimated associations between UPF intake (g/d and kcal/d) and GHGe (kg CO2-equivalents/day), land use (m2/d) and dietary species richness (DSR). Substitution analyses assessed the impact of replacing UPF with unprocessed or minimally processed foods.

368 733 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Europe.

Stronger associations were found for UPF consumption in relation with GHGe and land use compared with unprocessed or minimally processed food consumption. Substituting UPF with unprocessed or minimally processed foods was associated with lower GHGe (8·9 %; 95 % CI: –9·0, –8·9) and land use (9·3 %; –9·5; –9·2) when considering consumption by gram per day and higher GHGe (2·6 %; 95 % CI: 2·5, 2·6) and land use (1·2 %; 1·0; 1·3) when considering consumption in kilocalories per day. Substituting UPF by unprocessed or minimally processed foods led to negligible differences in DSR, both for consumption in grams (–0·1 %; –0·2; –0·1) and kilocalories (1·0 %; 1·0; 1·1).

UPF consumption was strongly associated with GHGe and land use as compared with unprocessed or minimally processed food consumption, while associations with food biodiversity were marginal. Substituting UPF with unprocessed or minimally processed foods resulted in differing directions of associations with environmental impacts, depending on whether substitutions were weight or energy based.

Multiple sclerosis (MS) is a chronic, auto-immune, neurodegenerative condition with increasing global prevalence. People living with MS (plwMS) have reported limited guidance relating to nutrition information. Paired with varied health literacy levels, this makes plwMS susceptible to nutrition misinformation.

A cross-sectional online social network analysis (SNA) examining nutrition information for MS.

A systematic SNA using Twitter/X and YouTube platforms using NodeXL to summarise metrics. Quality was assessed using the QUEST tool. Content analysis of YouTube videos was synthesised into themes for misinformation.

Online publicly available social media user posts and video content.

Twitter/X SNA revealed keywords used most by an account representing 72·8 % of the user network with common diet mentions including Wahls (57 times), paleo (15 times) and ketogenic (11 times). ‘Favourite count’ metrics were strongly correlated with ‘repost count’ (r = 0·83, P = 0·000). Videos which endorsed a diet were more likely to have a lower QUEST score. User engagement metrics were higher for lower quality videos. The quality of online nutrition information relating to MS was moderate (61 %). Physicians were the most likely source of nutrition information endorsing a diet for MS. The content analysis identified a knowledge gap for both medical professionals and plwMS.

Nutrition misinformation for MS occurs on social media and information quality is variable. Audiences need to be cautioned about users with large followings and evaluate the credibility of all information. This study reiterates the importance of evidence-based information for the MS community.

Household food insecurity (HFI) is a social determinant of health globally. Rates of HFI have risen in many high-income countries in recent years, particularly in households with children. The health outcomes associated with HFI for children and adolescents have not been systematically synthesised. This review was conducted to support advocacy efforts for meaningful policy action to reduce HFI in households with children.

A systematic search was conducted in Medline, Embase and PsycInfo databases. Primary studies measuring the association between physical or mental health outcomes and HFI were included. Studies were appraised and population, setting, measures and outcomes were extracted. Findings were grouped by related outcomes. Due to heterogeneity, findings were synthesised narratively. Rapid review methodology was used to accommodate resource constraints.

High-income countries.

Youth aged less than 18 years.

Thirty-six studies were included. Most were cross-sectional studies conducted in the USA. Outcomes included general health, early childhood, cardiometabolic, asthma, dental caries, mental health, sleep, diet and anaemia. Despite substantial heterogeneity in HFI measures and analysis, findings support associations between HFI and negative outcomes for general health status, asthma, dental caries and mental health. Findings for other outcomes were mixed.

This review clarifies the effects of HFI on children and adolescents. Findings highlight trends for negative physical and mental health outcomes associated with HFI during youth, particularly related to mental health, oral health, asthma and general health status. Policy-level action should address rising rates of HFI and long-term effects on these vulnerable populations.

To identify and present (i) how responsibility for poor diets in the UK is framed across the public, mass media and the government and (ii) how groups experiencing socio-economic disadvantage are presented within this framing.

A scoping review of peer-reviewed literature was conducted using six databases. A systematic narrative synthesis guided by qualitative content analysis was applied to summarise the findings.

Thirty-six articles were included. Studies exploring public perceptions of poor diets acknowledged personal and broader systems drivers, with individual responsibility predominating across studies. Research analysing media portrayals showed similar patterns of individual responsibility among right-leaning newspapers, which focused on individual lifestyle changes. However, left-wing newspapers highlighted the role of the food industry and the government. Studies analysing government policies identified citizens as the primary agents of change through rational decision-making. Framing from socio-economically disadvantaged groups showed a preference for prioritising their own choice, but were limited by household income, food prices and family food preferences. Policies and media portrayals provided limited emphasis on these populations, with individual responsibility narratives prevailing.

The framing of responsibility for poor diets in the UK centred on the individual, obscuring the powerful influence of food manufacturers and retailers and the role of government in providing safe, healthy environments for all. This review highlights the urgent need to challenge this narrative, with the public health nutrition community working collectively to force a radical shift in public, media and policy framing and incite strong regulatory action by governments.

This study compared dietary diversity and nutrient adequacy across age groups and seasons within an indigenous Karen community.

Cross-sectional survey.

Dietary intake was assessed using a single-day 24-h dietary recall among Karen community members living in two villages of Laiwo subdistrict, Sangkhlaburi district, Kanchanaburi province, Thailand.

In total, 312 Karen people participated during the rainy season and 344 during the dry season, including school-age children (6–12 years), working-age people (19–59 years) and older people (≥ 60 years).

Dietary diversity scores and food variety scores significantly differed across age groups for both seasons. However, seasonal dietary diversity score differences were not observed within any group, except for the food variety scores of school-age children. Over 70 % of participants in all age groups had inadequate intake of key micronutrients – Ca, Fe, vitamin A, vitamin C, Zn, vitamin B6 and vitamin B12 – as indicated by nutrient adequacy ratios < 0·75. Moderate to strong positive correlations between dietary diversity scores and nutrient adequacy ratios for energy, vitamin B2, vitamin C, niacin and mean adequacy ratio (r = 0·418–0·691, P < 0·001) were observed exclusively in the dry season and across all age groups.

Among the Karen people, who are also facing triple burden malnutrition, dietary diversity is limited, micronutrient inadequacy is prevalent and overall dietary quality is insufficient despite frequent vegetable consumption. Findings highlight the need to address systemic challenges related to food variety and to promote education on appropriate food quantities, preparation methods and sustainable traditional food systems to improve nutrition.

To examine the intra- and inter-device reliability of devices using pressure-mediated reflection spectroscopy (the Veggie Meter®).

A cross-sectional research study was conducted across eight sites in the USA. Using two Veggie Meters® at each site, participants completed five, counter-balanced pairs of finger scans. Intra-device comparisons included intra-class correlation coefficients (ICC) and calculation of the CV and 95 % CI of each device/site; hypothesised to be ≤ 6 %. Inter-device comparisons included ICC, absolute relative differences (ARD) and 95 % CI, and equivalence; both hypothesised to be ≤ 10 %.

Eight sites across the USA.

Across sites, participants’ (n 282) average age ranged 24·7–39·0 years; sex ranged 60·0–85·7 % women and Non-Hispanic White ranged 20·0–94·3 %.

Intra-device ICC ranged from 0·77 to 0·99. The CV ranged from 6·2 to 14·2 %, with an average of 8·8 %. A majority (63 %; n 10) of the Veggie Meter® devices had significantly higher CV from the hypothesised 6 %. Inter-device ICC ranged from 0·58 to 0·94. The ARD ranged from 7·5 to 22·0 %, with an average of 13·9 %. ARD in a majority (n 5) of sites was significantly higher than the hypothesised 10 %. Five sites (63 %) demonstrated equivalence below the hypothesised 10 %.

Our study demonstrates the intra-device and inter-device reliability to be moderate to high, as per ICC. The observed margin of difference within a device was up to 14 %, with an average of 9 %. The observed margin of difference between devices was up to 22 %, with an average of 14 % between devices.

To describe Brazilian parents’ perceptions of non-sugar sweeteners (NSS) in beverages consumed by children and their views for NSS front-of-package labels (FOPL).

A qualitative-driven mixed-methods embedded design was used. Seven focus groups with parents of children explored perceptions of NSS. Qualitative data were coded and analyzed using thematic analysis. Participants also completed a closed-ended survey assessing familiarity with NSS-containing beverages, ability to identify NSS on ingredient labels and perceptions of NSS FOPL. Survey responses were summarised using descriptive statistics.

Public and private schools and early childhood education centres in urban areas of two municipalities in the State of São Paulo, Brazil.

Forty parents of children aged 2–5 and 6–11.

About 35 % of participants reported their children consumed at least one NSS-containing beverage weekly in the past month; 17 % reported daily consumption. Parents expressed a preference for natural products and confusion over the term ‘edulcorantes’ (Portuguese for NSS). They shared concerns about the health effects of both sugar and NSS, particularly for children. NSS were seen as acceptable in specific cases, such as if a child has diabetes. Most parents supported a FOPL like Mexico’s, stating ‘not recommended for children’. In the survey, 85 % of the parents correctly identified beverages with NSS, but 82 % misclassified non-NSS ingredients (e.g. sugar syrup, caramel) as NSS. The Mexico-style FOPL was preferred by 95 % of the parents, who found it helpful and easy to understand.

A FOPL clearly indicating NSS presence, especially one recommending against consumption by children, may help parents make informed choices and reduce children’s intake of NSS-containing beverages.

Although guidelines recommend targeted vitamin D testing for high-risk populations, testing has increased globally. Limited studies have examined real-world testing patterns and their relationship with deficiency outcomes. This study investigates trends, demographic determinants and deficiency outcomes associated with voluntary vitamin D testing among Taiwanese adults.

A retrospective cohort study analysing electronic medical records to assess vitamin D testing trends, demographic predictors of deficiency and status changes following consecutive tests within 2 years. Vitamin D status was classified based on serum 25-hydroxyvitamin D levels as deficient (< 20 ng/ml), insufficient (20–29·9 ng/ml) or sufficient (≥ 30 ng/ml).

A tertiary medical centre in Taiwan.

Between 2013 and 2022, 13 381 outpatients underwent voluntary vitamin D testing. After excluding those aged < 18 years, with advanced renal disease, osteomalacia, rickets or hyperparathyroidism, 8383 were included in the final analysis.

Testing increased sharply after 2019. Although women underwent twice as many tests, men had a higher deficiency prevalence (56·94 % v. 53·01 %). Adults aged 18–34 years had the highest prevalence (67·81 %). Obstetrics and Gynecology specialists ordered the most tests, particularly for female infertility, with 65·73 % of patients deficient. Among those with repeat tests, deficiency prevalence decreased from 59.32 % to 43·25 %.

The increase in voluntary vitamin D testing with demographic disparities highlights the importance of understanding testing behaviours and public health implications. Improved vitamin D status at follow-up suggests potential benefits in identifying high-risk individuals and emphasises the need for further research to evaluate outcomes and guide prevention strategies.

To assess the nutritional composition, adequacy and environmental impact of menus served, consumed and wasted by 11–12-year-old students in public and charter schools in northern Spain.

A cross-sectional observational study (2017–2018) involving photographing menus before and after consumption, visual portion size estimation using a validated photographic catalogue and food waste assessment via the quarter-waste visual method. Nutritional composition was analysed using food composition databases and greenhouse gas emissions using life cycle assessment data.

Ten primary schools (five public and five charter) in northern Spain.

1000 school menus for students aged 11–12 years.

Menus served exceeded energy recommendations (791·5 (sd 176·7) kcal) and were high in fat (39·7 (sd 13·4) g), protein (29·7 (sd 10·0) g) and Na (980·4 (sd 302·2) mg) but low in carbohydrates (74·7 (sd 18·1) g), fibre (8·8 (sd 3·7) g) and several micronutrients. Food waste averaged 140·5 g per menu, mainly vegetables and fruit, leading to nutrient losses, particularly in fibre, vitamins A and C and Fe. The carbon footprint of menus averaged 1·489 kg CO2-eq, primarily from meat and fish, with waste contributing 0·298 kg CO2-eq. Public schools served more nutrient-dense food but had higher waste (public 151·5 (sd 112·3) g v. charter 129·5 (sd 86·3) g, P < 0·001); charter schools served more energy-dense food, with higher Na and fat (P < 0·001).

Menus showed nutritional imbalances, with excessive energy and Na and insufficient fibre and several micronutrients. Food waste worsened dietary adequacy while increasing environmental impact. Public schools offered more nutrient-rich food but faced greater waste compared with charter schools. Institutional differences suggest the need for tailored strategies to enhance both nutritional quality and sustainability.

To examine how home food inventories and food procurement practices changed due to the COVID-19 pandemic.

Cross-sectional baseline data from a randomised controlled trial of a home food environment intervention. Telephone interviews were conducted from October 2020 to December 2022.

Four 2–1–1 United Way agencies in Georgia, USA.

2–1–1 clients (n 602); 80·6 % identified as Black and 90·9 % as women. Mean age was 42·8 (sd = 11·80). The majority were food insecure (73·4 %) and received Supplemental Nutrition Assistance Program (SNAP) benefits (65·8 %).

A majority of participants reported smaller inventories of fresh fruits and vegetables (65·1 %) and unhealthy snacks (61·6 %) in the home relative to before COVID-19. The majority (55·8 %) also reported decreased shopping for fruits and vegetables and decreased use of fast food for family meals (56·1 %). Over half (56·2 %) started to use a food pantry, and 44·9 % started ordering groceries online due to COVID-19. A COVID-19 stressors scale was significantly associated with decreased odds of a smaller fresh fruit and vegetable inventory (OR = 0·61, CI 0·51, 0·73) and a smaller unhealthy snack inventory (OR = 0·86, CI 0·74, 0·99). COVID-19 stressors were also associated with changed food procurement practices, including increased online grocery shopping (OR = 1·19, CI 1·03, 1·37), and starting to use a food pantry (OR = 1·31, CI 1·13, 1·51).

The pandemic had a significant impact on home food inventories and procurement practices. Understanding how major events such as pandemics affect home food environments may help to stave off negative nutritional outcomes from similar events in the future.

During the COVID-19 pandemic, the US Department of Agriculture allowed all US schools to offer meals at no cost regardless of family income, a policy known as Universal Free Meals (UFM). Despite the recognised benefits of UFM, the policy expired in June 2022. The goal of this study was to gather perceptions of school staff in Arizona about school meals, UFM and the discontinuation of UFM.

This mixed-method study collected data using an online survey. Open-ended survey questions were analysed using qualitative thematic analysis, and closed-ended questions were analysed using descriptive analysis.

The survey was distributed to school staff in the two major metropolitan areas in Arizona between September and October 2022, soon after the UFM policy expired.

Survey responses were received from 1255 school staff, including teachers, cafeteria staff, administrators and other staff.

Most school staff (93 %) were supportive of UFM, and the support was consistent across all staff categories and across different political leanings. Thematic analysis demonstrated that staff felt UFM helped to meet students’ basic needs, reduced stigma and lessened the burden on teachers to use their own resources to provide food to students. Despite strong support, some staff reported concerns about food quality, programme waste and time available for lunch.

UFM policies were strongly supported by school staff, despite some concerns about programme implementation. Understanding these views is important to the discussion of expanding UFM policies in the USA and globally.

Bubble tea is known to have adverse health impacts due to its high sugar content. However, the influence of digital marketing on its consumption, especially among young people, remains unclear. This study aimed to describe the digital marketing strategies of Chinese bubble tea brands.

A content analysis of all marketing posts made by the top three Chinese bubble tea brands (by market share) – XIXUE, HEYTEA and NAYUKI – on Bilibili between 1 January 2023 and 31 December 2023.

Bilibili, a popular social media platform among Chinese young people, in 2023.

Not applicable.

Branding is central to the digital marketing strategies of bubble team brands, with the majority of posts using brand logos (99 %), branded effects (80·1 %) and branded characters (63 %), including children’s characters (19 %). Marketing strategies promoting user interaction were also common, reflected in the frequent use of hashtag campaigns (63 %), general engagement strategies (43 %) and competitions (10 %). Cultural elements that are integrated into the marketing message to resonate with the audience’s cultural identity were present in 47 % of posts.

Bubble tea brands are using a range of digital marketing strategies to engage consumers and build brand presence in the competitive bubble tea market in China. Measures to protect young consumers from the exposure of such marketing should be considered as a way of improving population diets and reducing excess weight gain.

To evaluate research exploring food policy, practice and provision in early childhood education and care (ECEC) settings, using the socio-ecological model (SEM).

A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). Five databases were systematically searched. Eligible studies were retrieved after full-text screening. Data were extracted and synthesised based on food policy, practice and provision concepts and grouped according to SEM level. Results were presented using a narrative summary.

Twenty-four studies were included, the majority had qualitative (n 13, 54 %) or cross-sectional study designs (n 11, 46 %) and presented findings at the organisational SEM level. Nursery settings were most represented (n 16, 67 %), followed by childminders (n 5, 21 %), then preschools (n 3, 13 %). Studies were conducted in England (n 20, 83 %) and Scotland (n 2, 8 %); however, no studies were undertaken in Wales or Northern Ireland. Studies reported poor adherence to food policies in ECEC. Recommended practices were frequently adhered to; however, food provided did not consistently meet nutritional recommendations. Common barriers to implementing healthy food practices and provision were cost, staff shortages, lack of training and awareness of available guidance.

This review identified a need for research that targets a range of SEM levels and is conducted in Scotland, Wales and Northern Ireland. Our findings support the need for increased governmental support for ECEC, through food standards, free meal provision for ECEC and more accessible nutrition training.

To describe the drivers of dietary behaviours among young South Asian adults (18–35 years) in Australia and examine the influence of acculturation and the host environment in shaping these behaviours.

A cross-sectional qualitative study design was used to collect data through Zoom focus groups. The analysis of the qualitative data followed Vears and Gilliam’s inductive content analysis approach. Demographic data were presented descriptively, and the findings were reported in accordance with the standard for reporting qualitative research.

Sydney, New South Wales, Australia.

A total of twenty-one young South Asian migrants (aged 18–35 years), mostly from India and Pakistan, participated in four online focus groups.

Six main themes were identified, highlighting the complex interplay of acculturation, cultural identity, family influence and other socio-economic factors in shaping dietary behaviours. (1) Acculturation and exposure to diverse cuisines, (2) interplay between religion and culture during special occasions, (3) influence of social networks and community norms, (4) structural and practical constraints shaping food choices, (5) shifting perceptions around healthy eating and (6) empowerment through knowledge. Participants reported incorporating Western and multicultural cuisines, often balancing convenience and cultural preferences.

Numerous drivers, including but not limited to acculturation and the host environment, influence the dietary behaviours of young South Asian adults in Australia. Despite limitations in representativeness, the study provides valuable insights highlighting the need for inclusive health promotion efforts for Australia’s growing South Asian population.

To describe changes in the community food environment between 2010 and 2022 in all municipalities in the state of Rio Grande do Sul (RS), Brazil, and to evaluate the possible associated sociodemographic inequities.

This ecological study was based on an analysis of the distribution and density of food retail establishments between 2010 and 2022 and their associations with the sociodemographic characteristics of the municipalities. Sociodemographic and food retail variables were extracted from secondary government databases. The establishments were classified according to the degree of processing of the foods they predominantly sold. Non-parametric tests and linear and Prais–Winsten regressions were used to analyse data.

State of RS, Brazil.

All 497 municipalities.

There was a significant reduction in overall food retail density (Coef.: –2·97; 95 % CI: –3·34, –2·61; P < 0·001). The greatest reduction occurred in establishments that sourced ultra-processed foods (Coef.: –3·34; 95 % CI: –3·65, –3·02; P < 0·001), which, despite the decrease, remained the most widely present. In 2022, the density of these establishments (median: 24·5; min/max: 4·4–124·8) was twice the density of establishments supplying fresh/minimally processed foods and culinary ingredients (median: 13·1; min/max: 0·0–95·8). Cities with greater social vulnerability had lower densities of establishments and greater reductions in the density of establishments over the evaluated period.

The reduction in food retail outlets disproportionately affected the most vulnerable municipalities and negatively impacted the availability of healthy foods. These findings reinforce the need for food and nutrition policies that promote equity in the food environment.

To propose nutrition-related corporate reporting metrics for Australian packaged food manufacturers, retailers and quick-service restaurants and explore their feasibility of implementation.

Proposed metrics were developed based on (1) a review of current corporate reporting frameworks and relevant literature to collate nutrition-related recommendations, metrics and principles of best-practice reporting and (2) adaptation of existing recommendations into reporting metrics. Interviews with representatives from fifteen food companies were conducted to understand implementation considerations.

Australia

There is a wide range of existing globally applicable nutrition-related recommendations and reporting metrics for food companies. Based on nine key principles identified for best-practice corporate reporting on nutrition, we devised forty-one reporting metrics (including five flagged as priorities) tailored to food companies operating in Australia across five focus areas: ‘corporate strategy and governance’, ‘product formulation’, ‘nutrition labelling and information’, ‘promotion practices’ and ‘product accessibility and affordability’. Company representatives expressed support for the proposed metrics, noting that additional information technology infrastructure and resources would be required for their routine reporting by companies.

The proposed set of reporting metrics offers evidence-based guidance for the disclosure of nutrition-related actions by Australian food companies. The proposed metrics can inform government, public health groups and investors on best-practice approaches to monitor corporate nutrition practices and guide related policy decisions. Widespread implementation of the reporting metrics would be facilitated by integration with mandatory corporate sustainability reporting standards, with routine monitoring and enforcement by government, coupled with fit-for-purpose tools for comparing the healthiness of company product portfolios.

The complexity and nuance of how social networks shape dietary behaviours and health dynamics remain underexplored, particularly in collectivist societies where family and peer relationships strongly impact health. This study applies social network analysis to examine these dynamics in Singapore.

An online household survey of young adults (age 21–35) and family (21+) assessed the consumption of healthy food groups (fruit, vegetable intake), unhealthy food groups (fast food, snack consumption) and social network characteristics (interaction frequency, emotional closeness, shared meals and perceived health influence). Data were analysed using network analysis, mixed regression models and generalised estimating equations.

Online Singaporean household survey.

Among 116 participants from thirty-six households, 345 unique individuals and 1145 dyadic relationships were identified, with networks averaging 9·7 nodes (sd: 4·7) and 33·2 edges (sd: 27·3). Mutual health influence was strongest in spousal (β = 0·89, 95 % CI: 0·42, 1·35) and intergenerational ties (older-to-younger: β = 0·62, 95 % CI: 0·29, 0·94; younger-to-older: β = 0·36, 95 % CI: 0·03, 0·68) and associated with emotional closeness (β = 0·38, 95 % CI: 0·30, 0·46) and shared meals (β = 0·43, 95 % CI: 0·36, 0·49). Greater family health effort correlated with lower snack (Adjusted Odds Ratio [AOR]: 0·50, 95 % CI: 0·29, 0·85) and fast-food consumption (AOR: 0·41, 95 % CI: 0·22, 0·77), while higher perceived family health associated with increased snack intake (AOR: 3·21, 95 % CI: 1·58, 6·52). Frequent meals with friends associated with lower fast-food intake (AOR: 0·50, 95 % CI: 0·30, 0·84), but no associations with fruit or vegetable intake were found.

Findings highlight intergenerational and spousal ties as key health influencers, particularly through shared meals, and the complex role of social networks in shaping diet. Analyses suggest network-based interventions may be more useful in reducing unhealthy rather than promoting healthy eating behaviours.