Dietary diversity, and in particular consumption of nutrient-rich foods including fruits, vegetables, nuts, beans and animal-source foods, is linked to greater nutrient adequacy. We developed a ‘dietary gap assessment’ to evaluate the degree to which a nation’s food supply could support healthy diets at the population level.

In the absence of global food-based dietary guidelines, we selected the Dietary Approaches to Stop Hypertension (DASH) diet as an example because there is evidence it prevents diet-related chronic disease and supports adequate micronutrient intakes. We used the DASH guidelines to shape a hypothetical ‘healthy’ diet for the test country of Cameroon. Food availability was estimated using FAO Food Balance Sheet data on country-level food supply. For each of the seven food groups in the ‘healthy’ diet, we calculated the difference between the estimated national supply (in kcal, edible portion only) and the target amounts.

In Cameroon, dairy and other animal-source foods were not adequately available to meet healthy diet recommendations: the deficit was −365 kcal (–1527 kJ)/capita per d for dairy products and −185 kcal (–774 kJ)/capita per d for meat, poultry, fish and eggs. Adequacy of fruits and vegetables depended on food group categorization. When tubers and plantains were categorized as vegetables and fruits, respectively, supply nearly met recommendations. Categorizing tubers and plantains as starchy staples resulted in pronounced supply shortfalls: −109 kcal (–457 kJ)/capita per d for fruits and −94 kcal (–393 kJ)/capita per d for vegetables.

The dietary gap assessment illustrates an approach for better understanding how food supply patterns need to change to achieve healthier dietary patterns.

The objective was to examine the association between parenting practices, toddler’s dietary intake and BMI. In addition, potential moderation of these associations by general parenting and child temperament was examined.

The current cross-sectional study assessed parenting practices using the Comprehensive Feeding Practices Questionnaire, general parenting using the Comprehensive General Parenting Questionnaire, child temperament using the Child Behavior Check List, and children’s dietary intake through parental questionnaires. Children’s weight and length were objectively measured to determine BMI z-scores. Associations were examined using multiple linear regression analyses. Moderation was examined using interaction terms.

Home setting.

393 Dutch toddlers (age 1–3 years) and their parents recruited through fifty childcare centres and preschools in the Netherlands.

Various practices were related to children’s diet and BMI. For instance, the availability of healthy foods is the most important predictor of healthy dietary intake (e.g. β = –0·35 for sweets; β = 0·18 for fruit). The association of availability with a healthier diet was strongest when parents scored low on the positive parenting style dimensions, including nurturance, structure and/or behavioural control. In addition, it seemed that a high availability of healthy foods and low availability of unhealthy foods is especially beneficial for children showing withdrawal/depressive, anxious or overactive behaviour, while encouraging balance and variety is not beneficial for these children. All other practices were related to children’s diet and/or BMI as well.

The findings underline the importance of viewing the impact of parenting practices in the context of general parenting and child temperament.

To evaluate if the inclusion of nutritional warnings in food ordering websites can discourage consumers from purchasing foods with excessive content of nutrients associated with non-communicable diseases (NCD).

Participants were randomly assigned to one of the two experimental conditions: control (n 225) or nutritional warnings (n 222). Nutritional warnings corresponded to separate black octagonal signs containing the word ‘Excess’ followed by the corresponding nutrient: total fat, saturated fat, sugars and sodium. Participants were asked to purchase a lunch for themselves using a simulated food ordering website.

Online study in Uruguay.

Convenience sample of 447 Uruguayan participants, recruited using social media.

In the control condition, 76 % of the participants selected a dish or a beverage with excessive content of at least one nutrient in the simulated food ordering website. When nutritional warnings were included, this percentage significantly decreased to 62 % (P = 0·002). In addition, nutritional warnings caused a significant reduction in the percentage of participants who selected dishes with excessive content of total fat: 50 % v. 62 % (P = 0·012).

Results from the present work provide preliminary evidence that the inclusion of nutritional warnings in food ordering websites could discourage consumers from selecting dishes and beverages with excessive content of nutrients associated with NCD.

To assess the intake and sources of non-milk extrinsic sugars (NMES) and fat among children in Scotland in relation to socio-economic status, and to estimate the changes in diet required to achieve recommended levels of intake.

Cross-sectional survey with diet assessed by semi-quantitative FFQ.

Eighty postcode sectors across Scotland.

Children (n 1398) aged 3–17 years recruited from the Child Benefit register (76 % of those contacted).

The mean intake of NMES of 17·4 (95 % CI 17·0, 17·8) % food energy was considerably higher than the UK recommended population average of 11 % food energy. The mean intake of total fat of 32·9 (95 % CI 32·7, 33·2) % food energy met the recommended population average of no more than 35 % food energy, while the mean intake of SFA of 13·8 (95 % CI 13·7, 14·0) % food energy was above the recommended population average of no more than 11 % food energy. Despite clear socio-economic gradients in the mean daily consumption of many ‘healthy’ and ‘unhealthy’ food groups, socio-economic differences in NMES as a percentage of food energy were limited and there was no significant variation in the intake of total fat or SFA as a percentage of food energy with socio-economic status. Modelling of the data showed that removing sugar-sweetened soft drinks and increasing fruit and vegetable intake by 50 % would not restore the intake of NMES and SFA to recommended levels.

Major changes in the intake of many food groups will be required to bring the NMES and saturated fat intake in line with current dietary recommendations.

The relationship between a child's environment and nutritional status is difficult to examine yet could offer an important guide to policy. The objective of the present work was to examine individual and environmental correlates with childhood height-for-age in Ghana.

Data were derived from the 2008 MEASURE Demographic and Health Survey in Ghana, the 2000 Ghana Population and Housing Census, and the World Wide Fund for Nature's eco-regions database. A generalized linear mixed regression model was used to estimate the effects of individual and environmental correlates on height-for-age.

The study examined 2225 Ghanaian children aged 0–59 months.

The setting was all districts in Ghana for the year 2008.

After accounting for individual characteristics of children, mothers and households, height-for-age was significantly associated with population density. Other significantly associated variables in the final model were the age of the child, vaccination status, the size of the child at birth, months of breast-feeding, mother's BMI, whether the child's mother had health insurance and wealth quintile.

In addition to a number of characteristics of the children and their households, the social milieu is important to understanding differences in height-for-age among children in Ghana. The biophysical environment was not associated with height-for-age.

To study the relationship between exercise by the mother and breast-feeding initiation and duration, and its effect on infant growth.

A cohort study of mothers and infants, recruited at birth. Infant feeding methods were recorded in detail and breast-feeding was categorised as ‘any’ or ‘full’. Exercise levels were categorised using the metabolic equivalent tasks approach based on details of physical activity recorded in questionnaires.

Perth, Western Australia.

A total of 587 mothers were interviewed on seven occasions over a period of 12 months.

There was no difference in the means of infant weight and length changes, indicating that exercise appeared to have no significant influence on infant growth up to 52 weeks after birth (P = 0.236 and 0.974, respectively). The mother's level of exercise was not significantly associated with breast-feeding to 6 or 12 months. This applied to ‘full’ and ‘any’ categories of breast-feeding.

Exercise does not affect breast-feeding outcomes at the usual levels of activity undertaken by mothers. Breast-feeding and exercise are important for maintaining and promoting health, and this study provides reassurance to health professionals wishing to encourage mothers to continue both behaviours.

To demonstrate that dietary datasets from the Continuing Survey of Food Intakes by Individuals, a US population survey, allow comparisons with national data and provide food composition datasets that can be used to generate similar dietary data.

Two studies are described: the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI), which used a 24-hour recall, and a Department of Defense Military Nutrition Research Task, which used 3-day dietary records. Both studies used the same food composition tables.

Rural Lower Mississippi Delta and an Army post.

Four hundred and nine residents (adults and children) from the rural Delta region of Arkansas, Louisiana and Mississippi, and 74 career soldiers from the Sergeants Major Academy, Fort Bliss, Texas.

The Delta NIRI study found that fruit and vegetable consumption for these rural residents was lower than that found nationally. Additionally, the quality of vegetable servings is of concern since a large percentage came from french fries and potato chips. In the Sergeants Major Academy study, the national survey food composition tables allowed for easy analysis of intake data and comparisons with dietary recommendations.

Strategies similar to those used for the Delta NIRI and Military Nutrition Research Task can be used widely, allowing comparisons of ‘defined populations’ with nationally distributed data. Additionally, measurement of dietary change is more efficient when the same protocol is used subsequently to collect more data, a method similar to that used by the US Department of Agriculture to describe food consumption patterns from one survey to another.

Low bone mass often leads to osteoporosis and increased risk of bone fractures. Soda consumption may contribute to imbalances that lead to decreased bone mineral density (BMD) and general bone health. We examined the relationship between soda consumption and osteoporosis risk in postmenopausal American-Indian women, an at-risk population because of nutritional and other lifestyle-related factors.

Cross-sectional analysis using logistic regression to examine associations between soda consumption and osteoporosis, and linear regression to examine the association between soda consumption and BMD, with and without adjustment for demographic and lifestyle factors. Quantitative ultrasound of the heel was performed to estimate BMD (g/cm2).

American-Indian communities in the Northern Plains and Southwestern USA.

A total of 438 postmenopausal American-Indian women.

Women with osteoporosis were significantly older and had lower BMI, average daily soda intakes, BMD levels and use of hormones than women without osteoporosis (P < 0·05). Soda consumption was not associated with increased odds of osteoporosis in either unadjusted or adjusted models (P > 0·05), although age (increased), BMI (decreased) and past hormone use (decreased) were all significantly associated with osteoporosis risk (P < 0·05).

Although the present study did not find associations between soda consumption and osteoporosis risk in postmenopausal American-Indian women, analyses did confirm confounding between soda consumption and age and BMI. This suggests that any potential effects of soda consumption on bone health are largely mediated through these factors.

The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice.

The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana.

Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South.

From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners.

The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence.

The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.

To describe the Na concentration of pre-packaged foods available in Hong Kong.

The Na concentrations (mg/100 g or mg/100 ml or per serving) of all pre-packaged foods available for sale in major supermarket chains in Hong Kong were obtained from the 2017 Hong Kong FoodSwitch database. Median and interquartile range (IQR) of Na concentration for different food groups and the proportion of foods and beverages considered low and high Na (<120 mg/100 g or mg/100 ml and >600 mg/100 g or mg/100 ml, respectively) were determined.

Hong Kong.

Not applicable.

We analysed 11 518 pre-packaged products. ‘Fruit and vegetables (including table salt)’ had the highest variability in Na concentration ranging from 0 to 39 000 mg/100 g, followed by ‘sauces, dressings, spreads and dips’ ranging from 0 to 34 130. The latter also had the highest median Na concentration (mg/100 g or mg/100 ml) at 1180 (IQR 446–3520), followed by meat and meat products (median 800, IQR 632–1068) and snack foods (median 650, IQR 453–926). Fish and fish products (median 531, 364–791) and meat and meat products (median 444, IQR 351–593) had the highest Na concentration per serving. Overall, 46·7 and 26·7 % of products were low and high in Na, respectively.

Our results can serve as a baseline for food supply interventions in Hong Kong. We have identified several food groups as priority areas for reformulation, demonstrating the potential of such initiatives to improve the healthiness of the food supply in Hong Kong.

Encouraging people to eat more seafood can offer a direct, cost-effective way of improving overall health outcomes. However, dietary recommendations to increase seafood consumption have been criticised following concern over the capacity of the seafood industry to meet increased demand, while maintaining sustainable fish stocks. The current research sought to investigate Australian accredited practising dietitians’ (APD) and public health nutritionists’ (PHN) views on seafood sustainability and their dietary recommendations, to identify ways to better align nutrition and sustainability goals.

A self-administered online questionnaire exploring seafood consumption advice, perceptions of seafood sustainability and information sources of APD and PHN. Qualitative and quantitative data were collected via open and closed questions. Quantitative data were analysed with χ2 tests and reported using descriptive statistics. Content analysis was used for qualitative data.

Australia.

APD and PHN were targeted to participate; the sample includes respondents from urban and regional areas throughout Australia.

Results indicate confusion around the concept of seafood sustainability and where to obtain information, which may limit health professionals’ ability to recommend the best types of seafood to maximise health and sustainability outcomes. Respondents demonstrated limited understanding of seafood sustainability, with 7·5 % (n 6/80) satisfied with their level of understanding.

Nutrition and sustainability goals can be better aligned by increasing awareness on seafood that is healthy and sustainable. For health professionals to confidently make recommendations, or identify trade-offs, more evidence-based information needs to be made accessible through forums such as dietetic organisations, industry groups and nutrition programmes.

To assess the prevalence of underweight, overweight and obesity in French children from 2013 to 2017.

Cross-sectional study performed in fourteen regions of France. Physical measures included weight, height and BMI. Underweight, overweight and obesity were defined according to age- and sex-specific BMI cut-off points from the International Obesity Task Force.

France.

Children (10 159 boys, 9757 girls) from the voluntary, non-representative Diagnoform programme between 2013 and 2017, at the age of 4–12 years.

The prevalence of overweight and obesity was higher in girls compared with boys (P < 0·001). Underweight was also more prevalent in girls (P < 0·05). Although there were no significant changes in the prevalence of obesity in boys or girls from 2013 to 2017, a significant decrease in overweight among boys and girls was found (P < 0·001) during the same time period. In contrast, the prevalence of underweight increased in girls and boys (from 10·0 to 20·0 %, P < 0·0001) between 2013 and 2017.

Results of the current study show that the prevalence of obesity was stable, while the prevalence of overweight decreased significantly, despite high in French children. Findings suggest also that thinness is becoming an important phenomenon in children. Developing preventive and nutritional programmes in order to modify the lifestyle might help control underweight and obesity in children.

To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.

Cross-sectional study.

Multicentre investigation conducted in ten European cities.

Adolescents aged 12·5–17·5 years (n 3215) who completed over 75 % of the NKT.

Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.

The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.

To evaluate the prevalence of vitamin B12 deficiency and factors associated with vitamin B12 status in Amazonian children.

Genetic risk score (GRS), socio-economic and nutritional status, and morbidity data were the independent variables used in multiple linear regression models to evaluate factors associated with vitamin B12 status in a population-based cross-sectional study. GRS was created by summing a number of known risk alleles for low serum vitamin B12.

Acrelândia, western Brazilian Amazon.

Children (n 988) aged <10 years.

Overall prevalence of vitamin B12 deficiency (<150 pmol/l) was 4·2 (95 % CI 3·0, 5·6) % and was highest in children aged <24 months: 13·6 (95 % CI % 8·8, 19·7) %. For children <24 months, wealth index (β=0·017, P=0·030) and animal protein intake (β=0·219, P=0·003) were positively associated with vitamin B12 status. GRS (β=−0·114, P<0·001) and serum homocysteine (β=–0·049, P<0·001) were negatively associated. Among children aged ≥24 months, vitamin B12 status was positively associated with wealth index (β=0·012, P<0·001), height-for-age Z-score (β=0·024, P=0·033) and serum vitamin A (β=0·089, P<0·001). Age≥60 months (β=–0·118, P<0·001), GRS (β=–0·048, P<0·001), maternal schooling <5 years (β=–0·083, P<0·001), low intake of animal-derived foods (β=–0·050, P=0·030), serum homocysteine (β=–0·053, P<0·001), serum folate ≥23·6 nmol/l (β=–0·055, P=0·012) and geohelminth infection (β=–0·141, P=0·017) were negatively associated with vitamin B12 status.

GRS, poverty, low intake of animal-derived foods, geohelminth infection, vitamin A and folate status were important factors associated with vitamin B12 status of children in our study.

The aim was to explore how the behaviour of consumers changed while they selected food in a supermarket environment after they were reminded about weight management. This investigation was carried out from the perspective of selection criteria, reading of package labels, nutritional quality of the products selected and time taken to select a product.

The subjects, who were actively watching their weight, participated in two consecutive tasks in a supermarket. They were given a shopping list of eleven food categories and asked to think aloud while selecting from each category a product they usually buy and a product they would use for weight management. The data (n 792 selections) were collected through interviews and a verbal analysis protocol combined with wireless audio-visual observation.

Thirty-six consumers were recruited from a sample of 367 supermarket customers.

Kuopio, Finland.

The subjects’ behaviour changed radically after they were reminded about weight management. In the first selection, taste and familiarity were the main food selection criteria while in the latter selection the energy/fat content predominated. Consequently, the nutritional quality of products improved greatly because subjects read package labels twice as much in the latter selection. The time taken to select a product increased significantly, on average, from 23 (sd 10) to 60 (sd 51) s/product (P = 0·000).

Only by reminding consumers about weight management was there a significant impact on their food selection behaviour. Marketing communication should be developed which quickly and easily promotes consumers’ awareness of healthy food in supermarkets.

In malnourished populations, the weight-for-height Z-score (WHZ) distribution is shifted to the left. The aim of nutrition interventions should be to restore a normal WHZ distribution for the whole population. The present paper examines the WHZ change needed by each individual to achieve this objective.

We developed a mathematical model of required individual change in WHZ as a function of characteristics of the initial population to restore a normal distribution. This model was then tested by simulating WHZ change needed to restore a normal WHZ distribution in a test population.

A rural area of Democratic Republic of the Congo with a high prevalence of undernutrition.

Children under 5 years of age.

To restore a normal distribution for the whole population, the WHZ of all children should be shifted. The desired WHZ change of each individual should be higher when the individual's initial WHZ is low, when the mean WHZ of the whole population is low and, for the most wasted individual, when the variance of WHZ and WHZ change in the population are high. Using the suggested model in a simulation on the test population resulted in a WHZ distribution close to the growth standard.

To restore a normal WHZ distribution in wasted populations, nutritional programmes should cover the whole population with a higher weight gain in areas where mean WHZ is low.

The aim of the present study was to develop and validate a vitamin D FFQ for assessment of dietary vitamin D intake in healthy adults in England, UK.

The current study assessed the agreement between a four-day food diary (4 d-FD) and a new vitamin D FFQ to measure dietary intake of vitamin D. Dietary intake was estimated using Nutritics dietary analysis software, and Spearman’s and Bland–Altman tests were utilised to assess correlation and agreement, respectively. Participants also provided a blood sample for plasma analysis of vitamin D concentrations.

Home setting.

Fifty participants were recruited to the study from the University of Chester and vicinity.

Results showed a strong correlation between vitamin D intake recorded by the FFQ and the 4 d-FD (r = 0·609; P < 0·0001) within 95 % limits of agreement. Furthermore, a significant correlation between plasma 25(OH)D concentrations and vitamin D intake measured by the FFQ (r = 0·290, P = 0·041) and the 4 d-FD (r = 0·360, P = 0·01) was observed.

Our analysis suggests this FFQ is a useful and rapid tool for researchers and health professionals to assess vitamin D dietary intakes in healthy adults in the UK.

There is growing evidence that childhood malnutrition is associated with non-communicable diseases (NCD) in adulthood and that body composition mediates some of this association. This review aims to determine if childhood body composition can be used to predict later-life cardiometabolic NCD and which measures of body composition predicts future NCD.

Electronic databases were searched for articles where: children aged under 5 years had body composition measured; cardiometabolic health outcomes were measured a minimum of 10 years later.

The databases Embase, Medline and Global Health were searched through July 2020.

Children aged under 5 years with a follow-up of minimum 10 years.

Twenty-nine studies met the inclusion criteria. Though a poor proxy measure of body composition, body mass index (BMI) was commonly reported (n 28, 97 %). 25 % of these studies included an additional measure (ponderal index or skinfold thickness). Few studies adjusted for current body size (n 11, 39 %).

Many studies reported that low infant BMI and high childhood BMI were associated with an increased risk of NCD-related outcomes in later life but no conclusions can be made about the exact timing of child malnutrition and consequent impact on NCD. Because studies focussed on BMI rather than direct measures of body composition, nothing can be said about which measures of body composition in childhood are most useful. Future research on child nutrition and long-term outcomes is urgently needed and should include validated body composition assessments as well as standard anthropometric and BMI measurements.

The primary aim was to investigate the association between food insecurity (FI) and eating disorders, which are nutrition-based public health problems, with traumatic event exposure in a low-income marginalized population. The study also investigated the association between traumatic event exposure, anxiety and weight stigma.

The study used self-report surveys in a cross-sectional design.

Food pantries affiliated with the local food bank in a major US city.

Participants (n 503) consisted of clients presenting to food pantries. Participants were predominantly female (76·5 %), Latino/Hispanic (64·6 %) and low-income (59 % reported earning under $US 10 000 per year).

Results indicated that 55·7 % of participants had directly experienced a traumatic event; this increased to 61·6 % when witnessing was included. Higher levels of FI were associated with greater traumatic event exposure. Increased exposure to traumatic events correlated with worsened overall eating disorder pathology (r=−0·239), weight stigma (r=−0·151) and anxiety (r=−0·210).

The present study is the first to investigate the association of FI, eating disorders and trauma in a low-income marginalized population. Results indicate that exposure to traumatic events is common in this civilian population and that traumatic event exposure is associated with higher levels of FI and eating disorder pathology. Results indicate that further research is warranted given that traumatic event exposure, eating disorder pathology, weight stigma and anxiety may complicate effective delivery of public health interventions in those living with FI.