Despite differences in obesity and ill health between urban and rural areas in the UK being well documented, very little is known about differences in dietary patterns across these areas. The present study aimed to examine whether urban/rural status is associated with dietary patterns in a population-based UK cohort study of children.

Dietary patterns were obtained using principal components analysis and cluster analysis of 3 d diet records collected from children at 10 years of age. Rurality was obtained from the 2001 UK Census urban/rural indicator at the time of dietary assessment. General linear models were used to examine the relationship between rurality and dietary pattern scores from principal components analysis; multinomial logistic regression was used to assess the association between rurality and dietary clusters.

The Avon Longitudinal Study of Parents and Children (ALSPAC), South West England.

Children (n 5677) aged 10 years (2817 boys and 2860 girls).

After adjustment, increases in rurality were associated with increased scores on the ‘health awareness’ dietary pattern (β=0·35; 95 % CI 0·14, 0·56; P<0·001 for the most rural compared with the most urban group) and lower scores on the ‘packed lunch/snack’ dietary pattern (β=−0·39; 95 % CI −0·59, −0·19; P<0·001 for the most rural compared with the most urban group). The odds ratio for participants being in the ‘healthy’ compared with the ‘processed’ dietary cluster for the most rural areas was 1·61 (95 % CI 1·05, 2·49; P=0·02) compared with those in the most urban areas.

There is evidence to suggest that differences exist in dietary patterns between rural and urban areas. Similar results were found using two different methods of dietary pattern analysis, showing that children residing in rural households were more likely to consume healthier diets than those in urban households.

With political support from the Danish Organic Action Plan 2020, organic public procurement in Denmark is expected to increase. In order to evaluate changes in organic food procurement in Danish public kitchens, reliable methods are needed. The present study aimed to compare organic food procurement measurements by two methods and to collect and discuss baseline organic food procurement measurements from public kitchens participating in the Danish Organic Action Plan 2020.

Comparison study measuring organic food procurement by applying two different methods, one based on the use of procurement invoices (the Organic Cuisine Label method) and the other on self-reported procurement (the Dogme method). Baseline organic food procurement status was based on organic food procurement measurements and background information from public kitchens.

Public kitchens participating in the six organic food conversion projects funded by the Danish Organic Action Plan 2020 during 2012 and 2013.

Twenty-six public kitchens (comparison study) and 345 public kitchens (baseline organic food procurement status).

A high significant correlation coefficient was found between the two organic food procurement measurement methods (r=0·83, P<0·001) with measurements relevant for the baseline status. Mean baseline organic food procurement was found to be 24 % when including measurements from both methods.

The results indicate that organic food procurement measurements by both methods were valid for the baseline status report of the Danish Organic Action Plan 2020. Baseline results in Danish public kitchens suggest there is room for more organic as well as sustainable public procurement in Denmark.

This study assessed the level of fathers’ involvement in childcare activities and its association with the diet quality of their children in Northern Ghana.

The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation.

A community-based comparative analytical cross-sectional study.

A sample of 422 rural mother–father pairs who had at least one child aged 6–36 months.

The overall level of fathers’ involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father’s involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)).

The findings confirm earlier studies that show that fathers’ involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

The current study assessed intake of iron-and-folic-acid (IFA) tablet/syrup (grouped into none, < 100 d of IFA consumption or < 100 IFA and ≥ 100 d of IFA consumption or ≥ 100 IFA) among prospective mothers and its association with various stages of low-birth weight (ELBW, extremely low-birth weight; VLBW, very low-birth weight and LBW, low-birth weight) and neonatal mortality (death during day 0–1, 2–6, 7–27 and 0–27) in India.

The cross-sectional, nationally representative, 2015–2016 National Family Health Survey (NFHS-4) data were used. Weighted descriptive analysis and multiple binary logistic regression modelling were used.

NFHS-4 covered 640 districts from thirty-seven states and union territories of India.

A total of 120 374 and 143 675 index children aged 0–59 months were included to analyse LBW and neonatal mortality, respectively.

Overall, 30·7 % mothers consumed ≥ 100 IFA in 2015–2016, and this estimate ranged from 0·0 % in Zunheboto district of Nagaland state to 89·5 % in Mahe district of Puducherry of India. Multiple regression analysis revealed that children of mothers who consumed ≥ 100 IFA had lower odds of ELBW, VLBW, LBW and neonatal mortality during day 0–1, as compared with mothers who did not buy/receive any IFA. Consumption of IFA (< 100 IFA and ≥ 100 IFA) had a protective association with neonatal death during day 7–27 and 0–27. Consumption of IFA was not associated with neonatal death during day 2–6.

While ≥ 100 IFA consumption during pregnancy was found to be associated with preventing select types of LBW and neonatal mortality, a large variation in coverage of ≥ 100 IFA consumption across 640 districts is concerning.

To describe relationships between the portion sizes of a range of foods commonly consumed by Irish children and adolescents and key indicators of dietary quality on the days they were consumed.

Cross-sectional data from the Irish National Children’s Food Survey (2003–2004; 7 d weighed record) and National Teens’ Food Survey (2005–2006; 7 d semi-weighed record) were used to compare mean values for a number of dietary quality indicators (e.g. energy-adjusted intakes of saturated fat, dietary fibre and Na) across portion size tertiles for a range of foods, on the days the foods were consumed.

The Republic of Ireland.

Nationally representative samples of children aged 5–12 years (n 594) and adolescents aged 13–17 years (n 441).

Relationships between food portion sizes and indicators of dietary quality on the days the foods were consumed were similar in both children and adolescents. Lower dietary energy density and saturated fat intakes, and higher dietary fibre intakes, were observed on the days larger portions of fruit and boiled potatoes were consumed. Higher dietary energy density and lower micronutrient intakes were observed on the days larger portions of sugar-sweetened beverages were consumed. Higher Na intakes were observed on the days larger portions of frying meats were consumed.

The current work identifies foods for which larger portion sizes may be associated with positive dietary attributes, as well as the opposite. Findings will form an evidence base from which more specific dietary guidance relating to portion size may be developed for Irish children and adolescents.

To assess the more prevalent beliefs about body weight and the factors involved in weight changes in the Spanish adult population.

A national survey was carried out according to an established protocol on Spanish subjects selected by a multistage procedure following a random route model, which was quota-controlled for several sociodemographic variables. This study was undertaken by the Spanish arm of a pan-European survey and was performed with a validated questionnaire. It contained questions to evaluate some aspects concerning the relationship between obesity, physical activity and health. We also estimated the proportion of self-reported overweight and obesity.

Spain.

The sample included 1000 subjects aged 15 years or older.

Eleven per cent of the sample were obese (body mass index, BMI > 30 kg m-2) and an additional 32% were overweight (BMI > 25 and < 30 kg m-2). Obesity prevalence was higher among older individuals, those with lower education and socioeconomic levels, and among housewives and retired or unemployed people. Most Spanish people believed that fat intake (51%) and the amount of food consumption (44%) were the major factors involved in weight gain, while physical activity was less mentioned (12%). The method most frequently used to lose weight was diet (9%). Individuals from central and southern regions payed more attention to genetics (20–27%) and physical activity (12–20%) as determinants of weight gain than people living in the north or northwest regions (15–17% and 8–9%, respectively). Normal weight people participated more often in some physical activity during their leisure time.

The Spanish population is not familiar with factors influencing weight gain. Health promotion strategies should emphasize the role of physical activity, especially among older individuals, retired or unemployed subjects, those from lower educational or socioeconomic levels and among people living in the north or northwest of Spain.

Tobacco consumption among low- and middle-income countries where food insecurity remains a challenge poses several concerns. This review examines the available global evidence linking smokeless tobacco (SLT) use with public health nutrition and its implications.

Systematic review of articles extracted from PubMed and Scopus from January 2000 to December 2020.

Included studies that demonstrated the relationship between SLT and nutrition-related factors, that is, BMI, malnutrition, anaemia, poor birth outcomes and metabolic disorders. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines have been followed to conduct the systematic evidence review.

A total of thirty-four studies were finally used in the systematic review, which included cross-sectional (thirty-one) and cohort (three).

SLT use has a huge impact on body weight, alteration in taste, poor oral health, and consumption of fruits and vegetables leading to malnutrition. Maternal use of SLT not only leads to anaemia but also hampers birth outcomes. Increased risk of metabolic syndrome and gallstone disease among SLT users are also well documented in the studies.

The review highlights the linkages between SLT usage and poor nutritional outcomes. Tobacco control efforts should be convergent with public health nutrition to achieve overall health benefits. Attention is also required to explore suitable mechanisms for SLT cessation combined with enhancing food and nutrition security at the community level in sync with investments in public health nutrition intervention.

To examine associations between serum micronutrients and neurobehavioural function and the mediating role of sleep quality in early adolescents.

In this cross-sectional study, peripheral blood samples were analysed for Fe and Zn levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioural function, respectively. The logistic/linear regressions and generalised structural equation modelling were performed to estimate the associations.

Jintan, China

In total, 226 adolescents (106 females) from the Jintan Child Cohort study.

Adolescents with low Fe (<75 μg/dl) (OR = 1·29, P = 0·04) and low Zn (<70 μg/dl) (OR = 1·58, P < 0·001) were associated with increased odds for poor sleep quality. Adolescents with low Fe and Zn were associated with fast (Fe: β = –1353·71, P = 0·002, Zn: β = –2262·01, P = 0·02) but less-accurate (Fe: β = –0·97, P = 0·04; Zn: β = –1·76, P = 0·04) performance on non-verbal reasoning task and poor sleep quality partially mediated the associations between low Fe/Zn and non-verbal reasoning (P < 0·05). Additionally, low Fe was associated with a slower reaction on spatial processing task (β = 276·94, P = 0·04), and low Zn was associated with fast (β = –1781·83, P = 0·03), but error-prone performance (β = –1·79, P = 0·04) on spatial processing ability and slower reaction speed (β = 12·82, P = 0·03) on the attention task. We observed similar trends using a cut-off point of 75 μg/dl for low serum Zn, except for the association with attention task speed (P > 0·05).

Fe and Zn deficiencies may possibly be associated with poor sleep and neurobehavioural function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioural function.

Stunted children have an increased risk of diminished cognitive development, diabetes, degenerative and CVD later in life. Numerous modifiable factors decrease the risk of stunting in children. This study aimed to assess the role of the individual, household and social factors on stunting in Zimbabwean children.

A 1:2 unmatched case–control study.

This study was conducted in two predominantly rural provinces (one with the highest national prevalence of stunting and one with the lowest prevalence) in Zimbabwe.

Data were obtained from the caregivers of 150 children aged between 6 and 59 months with stunting and from the caregivers of 300 children without stunting.

Multiple (39) correlates of stunting were identified. Child’s age, birth length, birth weight, and weight-for-age outcome (child-related factors), caregiver’s age, maternal HIV status, occupation, and education (parental factors), breast-feeding status, number of meals, and dietary quality (dietary factors), child’s appetite, diarrhoeal and worm infection (childhood illnesses), income status, access to safe water, access to a toilet, health clubs and maternal support in infant feeding (household, socio-cultural factors) were all found to be significant predictors of childhood stunting.

Nearly all aspects under review from the individual-, household- to social-level factors were significantly associated with childhood stunting. These findings add to the growing body of evidence supporting the WHO stunting framework and strengthen the need to focus interventions on a multi-sectoral approach to effectively address stunting in high prevalence countries.

To quantify perceptions of tap water among low-income mothers with young children residing in Michigan and examine associations between perceptions of tap water, mothers’ and young children’s beverage intake, and mothers’ infant feeding practices.

Cross-sectional study.

Online survey.

Medicaid-insured individuals who had given birth at a large Midwestern US hospital between fall 2016 and fall 2020 were invited by email to complete a survey in winter 2020 (N 3881); 15·6 % (N 606) completed eligibility screening, 550 (90·8 %) were eligible to participate, and 500 (90·9 %) provided valid survey data regarding perceptions of tap water, self and child beverage intake, and infant feeding practices.

Two-thirds (66·2 %) of mothers reported that their home tap water was safe to drink without a filter, while 21·6 % were unsure about the safety of their home tap water. Mothers’ perceptions of their home tap water were associated with their own tap and bottled water intake and their young children’s tap water and bottled water intake. Mothers with more negative perceptions of tap water in general, independent of their perceptions about their home tap water, consumed more bottled water and sugar-sweetened beverages, and their young children drank bottled water and fruit drinks more frequently. Few associations were observed between mothers’ perceptions of tap water and infant feeding practices.

Uncertainty about tap water safety and negative perceptions of tap water are common among low-income Michigan mothers. These beliefs may contribute to less healthful and more costly beverage intake among mothers and their young children.

‘DASH for Asthma’ (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches.

Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses.

Forty-six intervention participants (survey response rate was 65–72 %) and two lifestyle coaches.

Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to self-efficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants.

The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.

To quantify the potential effect of iron defortification in the USA on iron-deficiency anaemia (IDA).

Monte Carlo models were built to simulate iron nutrition in the US population. A hypothetical cohort of 15 000 persons from the general population was used in 15-year simulations to compare the prevalence of IDA with and without fortification.

With iron fortification, the prevalence of IDA was 2.4% for children aged 3–5 years, 5.4% for women aged 20–49 years, and 0.14% for men aged 20–49 years. The corresponding IDA estimates under iron defortification were 4.5%, 8.2% and 0.46%, respectively. Defortification had little effect on the distribution of iron indicators at or above the 50th percentile within each of these three groups and little effect on the distributions of iron indicators among adult men.

Iron defortification is likely to increase IDA among children and women of reproductive age, but is not likely to have meaningful effects on the iron status of men or the majority of women and children.

To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles.

Cross-sectional data from the Irish National Teens’ Food Survey (2005–2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups.

The Republic of Ireland.

Nationally representative sample of teens aged 13–17 years (n 441).

The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r −0·343, P < 0·001) and Emotional scales (r −0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02).

External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat.

This study aimed to verify the association between socio-economic and demographic characteristics and dietary patterns (DP) of children assisted by the Conditional Cash Transfer Program, Bolsa Família Program (BFP).

This is a cross-sectional study. DP were defined using a principal component analysis. The association of the predictive variables and DP was modelled using multilevel linear regression analysis.

This study was conducted in six municipalities from the State of Alagoas, Brazil.

The participants were children aged 6–24 months who were assisted by the BFP.

A total of 1604 children were evaluated. Four DP were identified (DP1, DP2, DP3 and DP4). DP1 is composed of traditional Brazilian food. DP2 is formed mostly from ultra-processed foods (UPF). DP3 consists of milk (non-breast) with added sugar, while DP4 consists of fresh and minimally processed foods. Caregivers with higher age and education (β = −0·008; (95 % CI −0·017, −0·000); β = −0·037; (95 % CI −0·056, −0·018), respectively) were negatively associated with DP2. We observed a negative association between households with food insecurity (β = −0·204; (95 % CI −0·331, −0·078)) and DP4 and a positive association between caregivers with higher age and education (β = 0·011; (95 % CI (0·003; 0·019); β = 0·043; (95 % CI 0·025, 0·061), respectively) and DP4.

This study identified the association between socio-economic inequities and DP early in life, with an early introduction of UPF, in children assisted by BFP in the State of Alagoas.

To explore the #SugarTax debate on Twitter to assess actors involved, their connections and the topics being discussed during the implementation and first anniversary of the UK Soft Drink Industry Levy.

The structure of the #SugarTax debate on Twitter was assessed using social network analysis. The actors involved, their connections and the topics of discussion taking place were also explored using content, sentiment and thematic analyses.

Twitter between 2017 and 2019.

Twitter users engaging in discussions relating to the hashtag ‘SugarTax’.

Tweets (n 5366) posted between 5 August 2017 and 7 May 2019 containing #SugarTax were downloaded from Twitter using Network Overview for Discovery and Exploration in Excel. The network included 1883 users, with 686 unique edges and 4679 edges with duplicates. The majority of tweets were negative in sentiment, when assessed by both automatic (64 %, n 141) and manual sentiment analysis (52 %, n 115) methods. Nine key themes were identified and grouped into two groups according to ‘support for a sugar or SSB tax’ or ‘opposition for a sugar or SSB tax’.

Twitter was used as a platform for debating the benefits and limitations of sugar-sweetened beverage taxes. The findings indicate that numerous actors are involved in the debates on Twitter, with advocates and lobbyists using the platform to raise support for their campaigns and reshape public perceptions. The findings and the methods used may be of interest to policymakers as well as to academics and members of the public looking to explore and engage in policy debates.

To assess the strength of correlation and agreement between mid-upper arm circumference (MUAC) and BMI, and determine suitable MUAC cut-offs, to detect wasting and severe wasting among non-pregnant adult women in India.

Cross-sectional studies were conducted in five high-burden pockets of four Indian states.

Prevalence of malnutrition among women and children is very high in these pockets and the government plans to implement community-based pilot projects to address malnutrition in these areas.

Anthropometric measurements were carried out on 1716 women with children <5 years of age. However, analyses were conducted on 1538 non-pregnant adult women.

The results showed a strong correlation between MUAC and BMI in the non-pregnant women, with correlation coefficient of 0·860 (95 % CI 0·831, 0·883; P < 0·001). Cohen’s κ of 0·812 and 0·884 also showed good agreement between MUAC and BMI in identifying maternal wasting and severe wasting, respectively. The univariate regression model between MUAC and BMI explained 0·734 or 73 % of the variation in BMI. The MUAC cut-offs for wasting (BMI < 18·5 kg/m2) and severe wasting (BMI < 16·0 kg/m2) were calculated as 232 and 214·5 mm, respectively.

MUAC is a strong predictor of maternal BMI among non-pregnant women with children <5 years in high-burden pockets of four Indian states. In a resource-constrained setting where BMI may not be feasible, the MUAC cut-offs could reliably be used to screen wasting and severe wasting in non-pregnant women for providing appropriate care.

The present study reviewed the literature on iodine status among women of childbearing age and pregnant women in the UK. Particular attention was given to study quality and methods used to assess iodine status.

A systematic review was conducted to examine the literature and critically evaluate study design.

Studies were identified in PubMed, Web of Science, Scopus and Ovid MEDLINE databases, as well as from secondary references.

Women of childbearing age or pregnant, living in the UK.

Fifty-seven articles were identified and twelve articles were selected, including a total of 5283 women. Nine studies conducted urinary iodine assessments, three studies conducted dietary assessments only, and seven studies classified their target population as iodine deficient according to WHO criteria.

No single study from the selected articles could produce nationally representative results regarding the prevalence of iodine deficiency among the female population in the UK. Consideration of the evidence as a whole suggests that women of childbearing age and pregnant women in the UK are generally iodine insufficient. Further large-scale research is required for more accurate and reliable evidence on iodine status in the UK.

This study aimed to report the WHO infant and young child feeding (IYCF) indicators from Kuwait and to investigate the associations between these indicators and anthropometric measurements.

The Kuwait Nutritional Surveillance System uses observational cross-sectional approach to collects data by face-to-face interviews with mothers or child guardians using a structured questionnaire that was developed based on the WHO IYCF indicators. The weight and height of infants and young children were measured using digital scales in a standardised manner.

Vaccination centres in all governorates (provinces) of Kuwait.

Infants and young Kuwaiti children aged 0–23 months (N 5839).

The prevalence of exclusive breastfeeding and age-appropriate breastfeeding were 8·0 and 7·4 %, respectively. The prevalence of stunting and wasting was 7·5 and 2·4 %, respectively, while the prevalence of overweight and obesity was 6·5 and 1·6 %, respectively. In the multivariable analysis, exclusive breastfeeding and age-appropriate breastfeeding were more common in children with stunted growth (AOR 1·71 (95 % CI 1·08, 2·70; P = 0·021) and 1·44 (95 % CI 1·01, 2·06; P = 0·046), respectively). The introduction of solid/semisolid or soft foods was inversely associated with stunting (AOR 0·52; 95 % CI 0·30, 0·90; P = 0·021). Only age-appropriate breastfeeding was inversely associated with overweight (AOR 0·62; 95 % CI 0·39, 0·98; P = 0·043).

Our findings showed that indicators of breastfeeding are low in Kuwait. Our findings suggest that the associations between different WHO IYCF indicators and stunting as well as overweight is complex, which highlights the need for a better understanding of WHO IYCF indicators in both low- and high-income countries.