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.

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.

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.

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.

Legumes have been recommended as staple foods in the anticipation of disease prevention. However, the scientific evidence of their benefits, particularly on mental well-being, remains preliminary. We longitudinally assessed the association between legume consumption and the risk of severe depressed mood (SDM) among a national cohort.

The study included adults aged 25–74 years who were examined in 1971–1975 as a part of the National Health and Nutrition Examination Survey. Legume consumption at baseline was obtained from a 3-month FFQ and categorised as infrequent (<1 time/week), moderate (1–2 times/week) and frequent (≥3 times/week). SDM was defined as Center for Epidemiologic Studies Depression Scale score ≥22 or taking anti-depression medication after an average of 10·6 years of follow-up (from 8·0 to 12·5 years).

Among women, the proportion of individuals with SDM was 17·75 %. For premenopausal women (n 1778), a significant linear trend of deleterious effect from legume consumption was observed (P for trend = 0·0148). The relative risks (RR) for infrequent, moderate and frequent consumptions were 1 (reference), 1·24 (95 % CI = 0·91, 1·70) and 1·75 (1·12, 2·75), respectively. However, moderate consumption showed a significant protective effect (RR = 0·52 (0·27, 1·00)) among women undergoing the menopausal transition (n 454). No association was obtained from either postmenopausal women (n 601) or men (n 2036).

These findings suggest that gender and menopausal status were effect modifiers of the association between legume consumption and SDM. Detrimental effects of frequent consumption of legumes may exist among premenopausal women; moderate consumption, however, may protect perimenopausal women against SDM.

The current study aimed to assess the nutritional quality of Australian secondary school canteen menus.

Stratified national samples of schools provided canteen menus in 2012–2013 and 2018, which were systematically assessed against a ‘traffic light’ classification system according to the National Healthy School Canteen Guidelines. Items were classified as green (healthiest and recommended to dominate canteen menus), amber (select carefully) or red (low nutritional quality, should not appear on canteen menus), and pricing and promotional strategies were recorded.

Australia.

Canteen menus from 244 secondary schools (2012–2013 n 148, 2018 n 96).

A total of 21 501 menu items were classified. Forty-nine percent of canteen menus contained at least 50 % green items; however, nearly all (98·5 %) offered at least one red item and therefore did not comply with national recommendations. Snacks and drinks had the least healthy profile of all product sectors, and a large proportion of schools supplied products typically of poor nutritional quality (meat pies and savoury pastries 91·8 %, sugary drinks 89·5 %, sweet baked goods 71·5 %, ice creams 64·1 % and potato chips 44·0 %). Red items were significantly cheaper than green items on average, and many schools promoted the purchase of red items on canteen menus (52·8 %). There were few differences between survey waves.

There is considerable room for improvement in the nutritional quality of canteen menus in Australian secondary schools, including in the availability, pricing and promotion of healthier options. Additional resources and services to support implementation of national guidelines would be beneficial.

To examine whether the association between soft drinks consumption and child behaviour problems differs by food security status and sleep patterns in young children.

Cross-sectional observational data from the Fragile Families and Child Wellbeing Study (FFCWS), which collected information on food insecurity, soft drinks consumption, sleep patterns and child behaviour problems. Bivariate and multivariate ordinary least-squares regression analyses predicting child behaviour problems and accounting for socio-economic factors and household characteristics were performed.

Twenty urban cities in the USA with a population of 200 000 or more.

Parental interviews of 2829 children who were about 5 years old.

Soft drinks consumption was associated with aggressive behaviours, withdrawn and attention problems for children aged 5 years. However, the association differed by food security status. The association was mostly statistically insignificant among food-secure children after accounting for socio-economic and demographic characteristics. On the other hand, soft drinks consumption was associated with behaviour problems for food-insecure children even after accounting for these factors. However, after accounting for child sleep patterns, the association between soft drinks consumption and child behaviour problems became statistically insignificant for food-insecure children.

The negative association between soft drinks consumption and child behaviour problems could be explained by sleep problems for food-insecure children. Since about 21 % of households with children are food insecure, targeted efforts to reduce food insecurity would help improve dietary (reduce soft drinks consumption) and health behaviours (improve sleep) and reduce child behaviour problems.

A new method known as ‘current-day dietary recall’ (current-day recall) is based on an application for mobile phones called ‘electronic 12 h dietary recall’ (e-12HR). This new method was designed to rank participants into categories of habitual intake regarding a series of key food groups. The present study compared current-day recall against a previously validated short paper FFQ.

Participants recorded the consumption of selected food groups using e-12HR during twenty-eight consecutive days and then filled out a short paper FFQ at the end of the study period. To evaluate the association and agreement between both methods, Spearman’s correlation coefficients (SCC), cross-classification analysis and weighted kappa statistics (κw) were used.

Andalusia, Spain, Southern Europe.

University students and employees over the age of 18 years.

One hundred and eighty-seven participants completed the study (64·2 % female, 35·8 % male). For all particpants, for all food group intakes, the mean SCC was 0·70 (SCC≥0·62 were observed for all strata); the mean percentage of participants cross-classified into categories of ‘exact agreement+adjacent’ was 90·1 % (percentages≥87·8 % were observed for all strata); and the mean κw was 0·55 (κw≥0·53 in ten of the twelve strata).

For the whole sample and for all strata thereof, the current-day recall has good agreement with the previously validated short paper FFQ for assessing food group intakes, rendering it a useful method for ranking individuals.

To describe fruit and vegetable intake of pre-school and school children in the Czech Republic and to provide information about their preferences and dietary habits.

Cross-sectional dietary survey conducted by the method of repeated 24 h recall on two non-consecutive days. Usual intakes were calculated for three age categories (4–6, 7–10 and 11–14 years).

The whole area of the Czech Republic.

A subgroup of 602 children aged 4–14 years was extracted from the representative sample of respondents participating in a national dietary survey (SISP) realized in the years 2003 and 2004.

Estimated average usual intakes of fruit and vegetables were 209 (sd 69) g/d in children aged 4–6 years, 230 (sd 84) g/d in children aged 7–10 years, and 284 (sd 133) g/d and 261 (sd 140) g/d respectively in boys and girls aged 11–14 years. Only 22 % of children had total daily intake of fruit and vegetables of five or more servings on the day of the survey. Fruits were consumed almost two times more often than vegetables in all age groups studied. The majority of fruit consumption comprised apples and bananas, which made up more than 60 % of the whole fruit intake. Fruiting vegetables were the most frequently consumed group of vegetables.

Fruit and vegetable intakes in all age categories were under recommended levels and the diversity of fruit and vegetables consumed by the Czech children was relatively low.

To evaluate the effect of fibre intake on the evolution of maternal BMI from pregnancy to postpartum and to identify dietary patterns associated with fibre intake.

Cohort study. Food intake was obtained using an FFQ. Focused principal component analysis was used focusing on the variables: postpartum weight retention and total dietary fibre intake. Poisson regression models with robust variance were built in order to measure the effect of fibre intake during the postpartum period on obesity risk.

Primary care clinics in southern Brazil.

Pregnant women (n 370) were followed until the 5th month postpartum.

The highest contribution to fibre intake came from the consumption of beans. Consumption of bread and rice indicated a common Brazilian food pattern along with beans. Participants retained a median of 4·4 (interquartile range 0·6, 7·9) kg of weight gained during pregnancy. Obesity risk, defined as an unfavourable evolution of BMI during pregnancy and postpartum, was present in 189 (55·1 %) women. Individual food items did not have an important effect on weight retention. In Poisson regression adjusting for maternal age, pre-pregnancy BMI and total gestational weight gain, inadequate postpartum fibre intake increased obesity risk by 24 % (relative risk = 1·24; 95 % CI 1·05, 1·47).

Important maternal weight retention occurred in these women. Adequate fibre intake may reduce obesity risk in the period following childbirth.

In 2012, the US government overhauled school nutrition standards, but few studies have evaluated the effects of these standards at the national level. The current study examines the impact of the updated school nutrition standards on dietary and health outcomes of schoolchildren in a nationally representative data set.

Difference-in-differences. We compared weekday fruit and vegetable intake between students with daily school lunch participation and students without school lunch participation before and after implementation of updated school nutrition standards using a multivariable linear regression model. Secondary outcomes included weekday solid fat and added sugar (SoFAS) intake and overweight and obesity prevalence. We adjusted analyses for demographic and family socio-economic factors.

USA.

K-12 students, aged 6–20 years (n 9172), from the National Health and Nutrition Examination Survey, 2005–2016.

Implementation of updated school nutrition standards was not associated with a change in weekday fruit and vegetable intake (β = 0·02 cups, 95 % CI −0·23, 0·26) for students with daily school lunch participation. However, implementation of the policy was associated with a 1·5 percentage point (95 % CI −3·0, −0·1) decline in weekday SoFAS intake and a 6·1 percentage point (95 % CI −12·1, −0·1) decline in overweight and obesity prevalence.

Changes to US school nutrition standards were associated with reductions in the consumption of SoFAS as well as a decrease in overweight and obesity in children who eat school lunch. However, we did not detect a change in weekday intake of fruits and vegetables associated with the policy change.

Low-income children are routinely screened for anaemia and elevated blood lead levels (EBLL) but not for vitamin D deficiency. We sought to determine the relative prevalence of and the relationship among vitamin D deficiency, anaemia and EBLL among healthy low-income paediatric clinic patients.

Retrospective chart review.

Paediatric outpatient clinic in an urban safety net hospital in a northern US state.

Healthy toddlers and children under 6 years of age (n 127) who were seen for a routine well child check-up (WCC).

The prevalence of vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) < 30 ng/ml) was 62 %; the prevalence of vitamin D deficiency (25(OH)D < 20 ng/ml) was 29 %. These rates were far higher than those for anaemia (Hb < 11·0 g/dl) at 10 %, EBLL (Pb > 9 μg/dl) at 1 % or even mildly EBLL (Pb 5–9 μg/dl) at 4 % (range: 1–11). There was no relationship among any of the following: vitamin D status, anaemia or EBLL. The vast majority of children with vitamin D deficiency had both normal Hb (86 %) and Pb level (100 %). After controlling for child's age, gender and race/ethnicity, there was no association between Hb (continuous, g/dl) and vitamin D deficiency (adjusted OR (aOR) = 0·97, 95 % CI 0·64, 1·47; P = 0·88). The only significant predictor of vitamin D deficiency was increasing age in years (aOR = 1·39, 95 % CI 1·03, 1·86; P = 0·03). None of these associations changed materially when deficiency was defined as <15 ng/ml.

Vitamin D deficiency was far more common than anaemia or EBLL, and Hb and Pb status were not predictors of vitamin D status.

To assess associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult metabolic syndrome (MetS).

A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Participants were asked to select which of nine body images most closely represented their body shape at ages 5 and 20 years, and it was used as a proxy of BMI. An incident case of MetS was diagnosed according to criteria of the International Diabetes Federation. Associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult MetS were estimated by multiple-adjusted odds ratios and their 95 % confidence intervals.

University of Navarra, Spain.

The study included 5317 university graduates, followed-up for a median of 6·1 years.

The incidence of MetS was 2·9 % (1·7 % in women and 5·1 % in men). Among men, body shape at age 5 years was inversely related to adult MetS (OR = 0·83, 95 % CI 0·72, 0·97), whereas weight gain during childhood to adolescence/young adulthood was directly associated with adult MetS (OR = 1·49, 95 % CI 1·01, 2·18); both childhood underweight (OR = 5·20, 95 % CI 1·87, 14·50) and childhood obesity (OR = 4·66, 95 % CI 1·40, 15·51) increased the likelihood of adult MetS. No association was apparent among women.

These results support treating childhood underweight and weight gain during childhood to adolescence/young adulthood as part of comprehensive adult MetS prevention efforts in men.

To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women.

BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey.

Participants were part of the Women’s Health Initiative Observational Study (WHI OS), where participants’ health was followed over time via questionnaires and clinical assessments.

Postmenopausal women (n 76 016; mean age 63·5 (sd 7·3) years).

Women with overweight (BMI=25·0–29·9 kg/m2) or obesity (BMI≥30·0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1·51 (1·35, 1·69) and 2·14 (1·72, 2·65), respectively) than normal-weight (BMI=18·5–24·9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<18·5 kg/m2) were associated with greater odds of SPI (1·97 (1·84, 2·11) and 1·35 (1·06, 1·71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1·52 (1·11, 2·09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0·52 (0·39, 0·71)).

Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.

To assess the relationship of dairy product consumption on diet quality and weight of low-income women.

Head Start centres in Texas and Alabama, USA.

Cross-sectional study. Women were divided into dairy consumption groups: ≤1, >1 to ≤2 and >2 servings/d. Nutrient intake/diet quality was determined by calculating the percentage meeting the Estimated Average Requirement, guidelines for fat and added sugar, and Mean Adequacy Ratio (MAR). Mean BMI was compared for the dairy consumption groups.

Mothers with children in Head Start; 609 African-Americans (43 %), Hispanic-Americans (32 %) and European-Americans (24 %).

Fifteen per cent of participants consumed >2 servings of dairy products and 57 % consumed ≤1 serving of dairy daily. Intakes of protein, vitamin D, riboflavin, P, Ca, K, Mg and Zn were significantly higher in those consuming >2 servings/d. Total SFA were higher and added sugars were lower in those consuming >2 servings of dairy products daily compared with those consuming ≤2 servings/d. Forty-one per cent of women consuming >2 servings of dairy daily had MAR scores under 85 compared with 94 % consuming ≤1 serving/d. Mean BMI was 30·36 kg/m2; there was no association between BMI and dairy product consumption.

Consumption of dairy products was low and was not associated with BMI in this low-income population. Higher levels of dairy product consumption were associated with higher MAR scores and improved intakes of Ca, K and Mg, which have been identified as shortfall nutrients in the diets of adults.

Food insecurity is not randomly dispersed throughout the population; rather, there are a number of risk and protective factors shaping both the prevalence and severity of food insecurity across households and sociodemographic populations. The present study examines some of these factors and the role that race and ethnicity among adolescent individuals in north-west Arkansas might play, paying specific attention to a subgroup of Pacific Islanders: the Marshallese.

The study uses cross-sectional survey data collected from a self-administered questionnaire of 10th–12th grade students.

A city in north-west Arkansas, USA.

The number of enrolled students in the selected high school at the time of the survey was 2148. Ten classrooms (116 students) were unable to participate at the time of the survey, making 2032 students eligible to be surveyed. Approximately 22% refused to participate and 105 students were absent from school, yielding a response rate of approximately 78% (n 1493).

Marshallese students had a higher prevalence of food insecurity than all other racial and ethnic groups in the study. After controlling for other sociodemographic, risk and protective factors, their odds of food insecurity remained significantly higher than both non-Hispanic White and Hispanic or Latinx students.

Adolescent food insecurity among Marshallese students must be made sense of in relation to structural-level determinants that shape the distribution of vital resources such as food across racial, ethnic and foreign-born lines.

To examine the contribution of child, maternal and household factors in stunting, wasting and underweight among children under 5 years in Ethiopia.

Quantitative cross-sectional design based on nationally representative data.

Urban and rural areas of Ethiopia.

Younger (0–24 months; n 4199) and older age groups (25–59 months; n 5497), giving a total of 9696 children.

Among the younger age group, 29 % were stunted, 14 % were wasted and 19 % were underweight; and among the older age group, the prevalence of stunting, wasting and underweight was 47, 8 and 28 %, respectively. Being female, intake of multiple micronutrients, household having a piped source of drinking-water, high maternal BMI, higher household wealth and higher maternal education were associated with decreased odds of at least one form of undernutrition in both groups. On the other hand, children who were anaemic, had low birth weight, drank from a bottle, and children of stunted or wasted or working mothers were more likely to be stunted, wasted or underweight in both groups (P<0·05). While most predictors and/or risk factors followed a similar pattern across the two age groups, child factors had higher leverage in the younger than the older group across the three forms of undernutrition.

Multiple set of factors predicted childhood undernutrition in Ethiopia. The study underscores the importance of intervening in the first 1000 days through promoting maternal education, maternal–child health services, mother’s nutrition and improving intrahousehold food distribution.

To analyse the cost-effectiveness of Baby-Friendly Hospital Initiative (BFHI) in promoting breast-feeding during the first hour of life (BFFHL) and reducing late neonatal mortality.

Cost-effectiveness economic assessment from the health system perspective, preceded by a prospective cohort of mother–baby followed from birth to 6 months of life. The direct costs associated with two health outcomes were analysed: intermediate end point (BFFHL) and final end point (reduction in late neonatal mortality).

Study was carried out in six hospitals in the city of São Paulo (Brazil), three being Baby-Friendly Hospitals (BFH) and three non-BFH.

Mothers with 24 h postpartum, over 18 years old, single fetus and breast-feeding at the time of the interview were included. Poisson regressions adjusted for maternal age and level of education were estimated to identify factors related to BFFHL and late neonatal mortality. Sensitivity analysis was performed to ensure robustness of the economic assessment.

Cost-effectiveness analysis showed that BFHI was highly cost-effective in raising BFFHL by 32·0 % at lower cost in comparison with non-BFHI. In addition, BFHI was cost-effective in reducing late neonatal mortality rate by 13·0 % from all causes and by 13·1 % of infant mortality rate from infections.

The cost-effectiveness of the BFHI in promoting breast-feeding and reducing neonatal mortality rates justifies the investments required for its expansion within the Brazilian health system.