Recently, school meal composition regulations have been implemented in France in order to improve the nutritional status of children. The present study investigated the link between school lunch attendance and the food intakes of schoolchildren aged 3–17 years.

Second French cross-sectional dietary survey (2006–2007). Eating frequencies were assessed for twenty-four food groups with a 7 d food record. Eating locations were recorded for main meals. Food group intakes at weekday lunches were compared for the school canteen and for other locations. The children’s overall dietary intake was compared based on school lunch attendance.

Mainland France.

Schoolchildren aged 3–17 years (n 1068).

Lunchtime food intake differed between the school canteen and other locations. Some intakes at school canteens were more in accordance with the regulations (more fruit and vegetables, fish and dairy products, and less sandwiches, soft drinks, chocolate and confectionery), whereas others highlighted needs for improvement (more sweet biscuits and pastries, ice cream and dairy desserts, pizzas and salty pastries). Many of these differences were also observed in the children’s overall diet: children regularly attending school lunches ate more mashed fruit, fish and sweet biscuits or pastries, and less sandwiches and soft drinks. The link between school lunch attendance and overall diet was less pronounced in secondary-school children.

School canteen attendance is associated with both potentially beneficial and deleterious differences in the lunchtime and overall diets of French children. These findings are important to consider when setting national regulations for school meal composition.

To emphasise the importance of defining a new nutrition science and food policy that includes social and environmental dimensions.

Nutrition science and food policy is put in the context of sustainable development. Examples are presented to show that a number of factors including exploitation of resources, disrespect for land and food insecurity contribute to the decline of a culture. The fate of cultures that lack implemented sustainable development strategies is discussed.

Pressure from low-income and economically challenged countries combined with the efforts of not-for-profit private institutions is proposed. The goal is to produce and provide science-based evidence and guidelines to be used as a tool to encourage institutions and organisations to redefine their policies to deal effectively with global issues.

In a cohort of government employees in Rio de Janeiro, Brazil, we investigated prospectively, sex-specific associations between education and BMI trajectories and their potential effect modification by race.

Of the 4030 participants in Phase 1 (1999), 3253 (81 %) participated in Phase 2 (2003) and 3058 (76 %) participated in Phase 3 (2006). Education was categorized as elementary, high school or college graduate. Study participants self-identified as White, Black or Pardo. BMI was calculated from measured weight and height. BMI trajectories were modelled using a generalized additive regression model with mixed effects (GAMM).

The Pro-Saúde Study, a longitudinal investigation of social determinants of health.

Women (n 1441) and men (n 1127) who participated in the three phases of data collection and had complete information for all study variables.

Women and men with less than high school, or only a high school education, gained approximately 1 kg/m2 more than college graduates (women: 1·06 kg/m2 (P<0·001) and 1·06 kg/m2 (P<0·001), respectively; men: 1·04 kg/m2 (P=0·013) and 1·01 kg/m2 (P=0·277), respectively). For women only, race was independently associated with weight gain. Women identifying as Pardo or Black gained 1·03 kg/m2 (P=0·01) and 1·02 kg/m2 (P=0·10), respectively, more than Whites. No effect modification by race was observed for either men or women.

While both lower education and darker race were associated with greater weight gain, gender similarities and differences were observed in these associations. The relationship between weight gain and different indicators of social status are therefore complex and require careful consideration when addressing the obesity epidemic.

To assess the relative validity of a FFQ developed for the Pelotas Birth Cohort Studies.

Participants completed a ninety-two-food-item FFQ and then answered two 24-h recalls (24HR), one in-person interview and a second one by telephone, administered 14–28 d apart. Median and relative differences of energy, fifteen nutrients and eleven food groups were estimated based on the FFQ and the average of two 24HR. Nutrients were log-transformed and energy-adjusted using residual method. Validity was assessed by crude, energy-adjusted and de-attenuated Pearson and Lin’s concordance correlation coefficients. Agreement of quartiles and weighted κ were performed. Differences in energy and nutrient estimations between methods were plotted in Bland–Altman graphs.

Pelotas, southern Brazil.

Two hundred fifty-four participants randomly selected from the 1993 Pelotas Birth Cohort during the 22-year follow-up (2015).

The FFQ overestimated energy and most nutrients and food groups compared with the two 24HR. Energy-adjusted and de-attenuated Pearson correlation coefficients ranged from 0·21 to 0·66. The highest energy-adjusted and de-attenuated concordance correlation coefficients were observed for Ca (0·48), niacin (0·32), Na (0·29), vitamin C (0·28) and riboflavin (0·25). The percentage of nutrients classified into the same and opposite quartiles ranged from 36·5 to 60·3 %, and from 4·8 to 19·1 %, respectively. Weighted κ was moderate for Ca (0·51), beans and legumes (0·50) and milk and dairies (0·49).

The FFQ provides a reasonable dietary intake assessment for habitual food consumption. However, the relative validity was weak for specific nutrients and food groups.

To rigorously develop a tool which enables rapid yet comprehensive appraisal of the consumer food retail environment and provision of real-time feedback to store managers and owners, based on the ‘4Ps’ principles of marketing.

Multi-stage iterative approach including (1) Systematic literature review; (2) Stakeholder consultation; (3) Assessment of existing tools against identified needs; (4) Tool development; (5) Pilot testing and (6) Transition of tool to mobile application (the Store Scout app).

Northern Territory, Australia.

Nine remote Aboriginal community food stores; public health nutritionists, retailers, store board directors, Aboriginal community members, government representatives.

Forty-seven existing tools and thirty-four stakeholder interviews informed the development of the current instrument, which comprised: (1) seven product categories (Fruit & Vegetables, Drinks, Snack Foods, Meals & Convenience Foods, Meat & Seafood, Dairy & Eggs, Breads & Cereals) across the ‘4Ps’ (Product, Placement, Price, Promotion); (2) Store manager questions about context and perceived importance of key principles about the store environment and (3) a scoring and feedback component. The tool was considered feasible and acceptable by all testers.

The developed tool addresses an unmet need to measure the consumer food retail environment across all 4Ps whilst also incorporating manager perspectives and immediate feedback. Our objectives of developing a comprehensive, feasible and acceptable instrument were achieved during pilot testing. The tool will support implementation of best practice within stores to encourage healthy food choices and has potential for broad application in retail settings locally and internationally, as well as for research purposes.

To determine if exclusive breast-feeding counselling modifies the association of experience of any lifetime or specific forms of domestic violence (DV) on duration of exclusive breast-feeding (EBF).

In the MINIMat trial pregnant women were randomized to receive either usual health messages (UHM) or usual health messages with breast-feeding counselling (BFC) in eight visits. During pregnancy (30 weeks), lifetime experience of any or specific forms of DV was measured. Infant feeding practice information was collected from 0 to 6 months at 15 d intervals.

Matlab, Bangladesh.

Pregnant and postpartum women (n 3186) and their infants.

Among women in the UHM group, those who had experienced any lifetime DV exclusively breast-fed for a shorter duration than women who did not experience any lifetime DV (P=0·02). There was no difference, however, in duration of EBF among women in the BFC group based on their experience of any lifetime DV exposure (P=0·48). Using Cox regression analysis, there was an interaction of exposure to any lifetime DV, sexual violence and controlling behaviour, and counselling group with duration of breast-feeding at or before 6 months (P-interaction≤0·08). Among the UHM group, experience of any lifetime DV, sexual violence or controlling behaviour was associated with fewer days of EBF (P<0·05). In contrast, among the BFC group, experience of DV was not associated with duration of EBF.

The experience of DV compromises EBF and the support of breast-feeding counselling programmes could assist this vulnerable group towards better infant feeding practices.

To assess the agreement between self-perceived weight status and BMI status, calculated from self-reported height and weight, in nurses and to evaluate the relationship between weight status misperceptions and personal body weight, demographics and health status.

Cross-sectional questionnaire survey.

A large university in London, UK.

Four hundred and fifty-six student nurses and 588 qualified nurses attending university were surveyed; 355 student nurses and 409 qualified nurses completed questionnaires representing a response rate of 78 % and 70 %, respectively.

The respondents were mainly female (90·0 %), 66·5 % were white and their mean age was 31 years. Sixty-eight per cent of qualified nurses and 77 % of student nurses correctly perceived their weight status. In logistic regression, (mixed) black ethnicity (OR = 2·53, 95 % CI 1·01, 6·32), overweight by BMI (OR = 3·10, 95 % CI 1·31, 7·33) and ≥3 family histories of obesity co-morbidities (OR = 2·51, 95 % CI 1·04, 6·08) were significantly associated with misperceptions in the sample of student nurses, whereas overweight by BMI (OR = 5·32, 95 % CI 2·66, 10·67) was the only significant variable in the sample of qualified nurses.

A substantial proportion of nurses misclassified their weight status. Nurses’ misperception of weight status was related to their own BMI status, ethnic background and obesity-related family histories. Being aware of this may help nurses not only promote their own healthy weight, but also fulfil their public health role to practise weight management successfully with both patients and the public. While limitations of the sample mean that the study findings cannot be generalized, they do provide grounds for future larger-scale research.

The present paper aimed to demonstrate how 24 h dietary recall data can be used to generate a nutrition-relevant food list for household consumption and expenditure surveys (HCES) using contribution analysis and stepwise regression.

The analysis used data from the 2011/12 Bangladesh Integrated Household Survey (BIHS), which is nationally representative of rural Bangladesh. A total of 325 primary sampling units (PSU=village) were surveyed through a two-stage stratified sampling approach. The household food consumption module used for the analysis consisted of a 24 h open dietary recall in which the female member in charge of preparing and serving food was asked about foods and quantities consumed by the whole household.

Rural Bangladesh.

A total of 6500 households.

The original 24 h open dietary recall data in the BIHS were comprised of 288 individual foods that were grouped into ninety-four similar food groups. Contribution analysis and stepwise regression were based on nutrients of public health interest in Bangladesh (energy, protein, fat, Fe, Zn, vitamin A). These steps revealed that a list of fifty-nine food items captures approximately 90 % of the total intake and up to 90 % of the between-person variation for the key nutrients based on the diets of the population.

The study illustrates how 24 h open dietary recall data can be used to generate a country-specific nutrition-relevant food list that could be integrated into an HCES consumption module to enable more accurate and comprehensive household-level food and nutrient analyses.

To reduce prevalence of anaemia in low-income postpartum women.

A randomised, non-blind clinical trial was conducted among 959 low-income, postpartum women in eleven clinics in Mississippi. The clinics were randomised to one of three treatment groups: (i) selective anaemia screening of high-risk women as recommended currently (control); (ii) universal anaemia screening and treatment of anaemic women (group I); and (iii) universal Fe supplementation of 65 mg/d for two months to all low-income women (group II). All study participants within each clinic received the same treatment. Women were followed up at 6 months after delivery. Hb was measured at baseline and at follow-up. The primary outcome variable was the proportion of women with anaemia after treatment.

Eleven health clinics in Mississippi.

Low-income, postpartum women.

Baseline characteristics of the three study groups were compared using one-way ANOVA and an appropriate post hoc test for continuous variables and the χ2 test for categorical variables. Fifty-two per cent of postpartum women were anaemic (Hb < 12·0 g/dl) and the rate decreased to 33 % at 6 months after the intervention. Group II women, who received universal Fe supplementation, improved their Hb status significantly (P < 0·001) at 6 months postpartum compared with the other groups. Prevalence of anaemia was also significantly lower among group II women (22·5 %) compared with controls (34 %) and group I women (43 %; P < 0·001).

A universal Fe supplementation strategy was effective in reducing the prevalence of anaemia among low-income postpartum women.

To identify countries in sub-Saharan Africa (SSA) that have not yet achieved at least 90 % universal salt iodization and factors associated with the consumption of non-iodized salt among women of reproductive age.

A cross-sectional study using data from Demographic and Health Surveys (DHS). The presence of iodine in household salt (iodized or non-iodized), which was tested during the survey process, was the study outcome. Multivariable logistic regression models were used to determine independent factors associated with the consumption of non-iodized salt among women of reproductive age.

There were eleven countries in SSA that participated in the DHS since 2015 and measured the presence of iodine in household salt.

Women (n 108 318) aged 15–49 years.

Countries with the highest rate of non-iodized salt were Senegal (29·5 %) followed by Tanzania (21·3 %), Ethiopia (14·0 %), Malawi (11·6 %) and Angola (10·8 %). The rate of non-iodized salt was less than 1 % in Rwanda (0·3 %), Uganda (0·5 %) and Burundi (0·8 %). Stepwise multivariable logistic regression showed that women were more likely to be using non-iodized salt (adjusted OR; 95 % CI) if they were poor (1·62; 1·48, 1·78), pregnant (1·16; 1·04, 1·29), aged 15–24 years (v. older: 1·14; 1·04, 1·24) and were not literate (1·14; 1·06, 1·23).

The use of non-iodized salt varies among SSA countries. The higher level of use of non-iodized salt among poor, young women and pregnant women is particularly concerning.

It is often assumed that there are substantial sex differences in eating behaviour (e.g. women are more likely to be dieters or emotional eaters than men). The present study investigates this assumption in a large representative community sample while incorporating a comprehensive set of psychological eating-related variables.

A community sample was employed to: (i) determine sex differences in (un)healthy snack consumption and psychological eating-related variables (e.g. emotional eating, intention to eat healthily); (ii) examine whether sex predicts energy intake from (un)healthy snacks over and above psychological variables; and (iii) investigate the relationship between psychological variables and snack intake for men and women separately. Snack consumption was assessed with a 7d snack diary; the psychological eating-related variables with questionnaires.

Participants were members of an Internet survey panel that is based on a true probability sample of households in the Netherlands.

Men and women (n 1292; 45 % male), with a mean age of 51·23 (sd 16·78) years and a mean BMI of 25·62 (sd 4·75) kg/m2.

Results revealed that women consumed more healthy and less unhealthy snacks than men and they scored higher than men on emotional and restrained eating. Women also more often reported appearance and health-related concerns about their eating behaviour, but men and women did not differ with regard to external eating or their intentions to eat more healthily. The relationships between psychological eating-related variables and snack intake were similar for men and women, indicating that snack intake is predicted by the same variables for men and women.

It is concluded that some small sex differences in psychological eating-related variables exist, but based on the present data there is no need for interventions aimed at promoting healthy eating to target different predictors according to sex.

To explore parents’ responses to sponsorship of children’s sport by unhealthy food brands and two alternative pro-health sponsorship options.

Between-subjects online experiment with four sponsorship conditions: (i) non-food branding (control); (ii) unhealthy food branding; (iii) healthier food branding; (iv) public health nutrition campaign branding. Participants were shown a short video and a promotional flyer for a fictional junior sports programme, with sponsor content representing their assigned brand. Afterwards, participants were asked a series of questions assessing their brand awareness, brand attitudes and preference for food sponsor branded products.

Australia.

Australian parents (n 1331) of children aged 6–9 years.

Compared with the control condition, unhealthy food sponsorship promoted increased awareness, branded product preferences and favourable attitudes towards unhealthy food sponsor brands. Healthier food sponsorship promoted similar effects for healthier food sponsor brands, except there was no significant increase in positive attitudes towards these brands. Sponsorship by public health nutrition campaigns promoted more negative attitudes towards unhealthy food sponsor brands and increased preference for healthier food sponsor branded products. Overall, healthier food sponsors and public health campaign sponsors were perceived to have better programme–sponsor fit and to be more appropriate sponsors of children’s sport than unhealthy food sponsors.

Restrictions on unhealthy food sponsorship of children’s sport are needed to prevent unhealthy food brands from exploiting junior sport sponsorship to enhance their appeal. Sponsorship of children’s sport by healthier food brands or public health nutrition campaigns could help promote healthier food choices among parents.

Our objectives were to explore attitudes regarding food retail policy and government regulation among managers of small food stores and examine whether manager views changed due to the 2014 Minneapolis Staple Foods Ordinance, a city policy requiring retailers to stock specific healthy products.

Manager interviewer-administered surveys were used to assess views on food retail policy four times from 2014 to 2017. We examined baseline views across manager and store and neighbourhood characteristics using cross-sectional regression analyses and examined changes over time using mixed regression models. In 2017, open-ended survey questions asked about manager insights on the Minneapolis Staple Foods Ordinance.

Minneapolis, MN, where the ordinance was enacted, and St. Paul, MN, a control community, USA.

Managers from 147 small food retail stores.

At baseline, 48 % of managers were likely to support a policy requiring stores to stock healthy foods/beverages, 67·5 % of managers were likely to support voluntary programmes to help retailers stock healthy foods and 23·7 % agreed government regulation of business is good/necessary. There was a significant increase in overall support for food retail policies and voluntary programmes from 2014 to 2017 (P < 0·01); however, neither increase differed by city, suggesting no differential impact from the ordinance. Minneapolis store managers reported some challenges with ordinance compliance and offered suggestions for how local government could provide support.

Findings suggest that managers of small food retail stores are becoming increasingly amenable to healthy food policies; yet, challenges need to be addressed to ensure healthy food is available to all customers.

As ageing is associated with changes in body composition, BMI may not be the appropriate obesity measure for older adults. To date, little is known about associations between obesity measures and health-related quality of life (HRQoL). Thus, we aimed to compare different obesity measures in their association with HRQoL and self-rated physical constitution (SRPC) in older adults.

Seven obesity measures (BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, fat mass percentage based on bioelectrical impedance analysis, hypertriglyceridaemic waist (HTGW) and sarcopenic obesity) were assessed at baseline in 2009. HRQoL, using the EQ-5D questionnaire, and SRPC, using one single question, were collected at baseline and at the 3-year follow-up in 2012. Linear and logistic regression analyses were used to examine the associations between the obesity measures and both outcomes. Model comparisons were conducted by area under the receiver-operating characteristic curve, R2, Akaike and Schwarz Bayesian information criteria.

KORA-Age study in Southern Germany (2009–2012).

Older adults (n 883; aged ≥65 years).

Nearly all obesity measures were significantly inversely associated with both outcomes in cross-sectional analyses. Concerning HRQoL, the WC model explained most of the variance and had the best model adaption, followed by the BMI model. Regarding SRPC, the HTGW and BMI models were best as rated by model quality criteria, followed closely by the WC model. Longitudinal analyses showed no significant associations.

These results suggest that, with regard to HRQoL/SRPC, simple anthropometric measures are sufficient to determine obesity in older adults in medical practice.

To explore shoppers’ responses to the taste of different types of cow’s milk in a blind taste test and to examine their willingness to purchase lower-fat milk as part of an in-store marketing intervention.

Participants were recruited on-site in the supermarket to participate in a blind taste test of three varieties of cow’s milk and asked to guess what type they sampled.

The taste testing was conducted as part of the Healthy Retail Solution (HRS) intervention that took place in four large supermarkets in Philadelphia, PA, USA over the course of six months.

Adults (n 444) at participating Philadelphia supermarkets.

The majority of participants at all stores reported typically purchasing higher-fat milk. Forty per cent of participants reported buying whole milk, 38 % purchased milk with 2 % fat. Very few participants correctly identified all three milk samples during the taste test (6·9 %) and a majority of participants were unable to identify the type of milk they self-reported typically purchased.

Most consumers could not accurately distinguish between various types of milk. Taste testing is a promising strategy to introduce lower-fat milks to consumers who have not tried them before. Campaigns to purchase skimmed, 1 % or 2 % milk may result in significant energy reduction over time and can serve as a simple way to combat overweight and obesity.

Increasing a parent’s ability to influence a child’s vegetable intake may require reducing the parent’s use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices.

A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices.

The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion.

Parents of 307 pre-school children (3–5 years old).

Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized β=0·349, P<0·0001) and desire (standardized β=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized β=–0·215, P<0000), the habit of active child involvement in vegetable selection (standardized β=–0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized β=–0·133, P=0·009), autonomy (standardized β=–0·118, P=0.014), attitude about negative effects of vegetables (standardized β=–0·118, P=0·015) and descriptive norms (standardized β=–0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices.

The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.

To investigate (i) associations between adolescents’ frequency of breakfast and family functioning (close relations to parents, quality of family communication and family support) and (ii) if any observed associations between breakfast frequency and family functioning vary by sociodemographic factors.

School-based cross-sectional study. Students completed a web-based questionnaire. Associations were estimated by multilevel multivariate logistic regression.

Danish arm of the Health Behaviour in School-aged Children study, 2014.

Adolescents aged 13 and 15 years (n 3054) from a random sample of forty-one schools.

Nearly one-quarter of the adolescents had low breakfast frequency. Low breakfast frequency was associated with low family functioning measured by three dimensions. The OR (95 % CI) of low breakfast frequency was 1·81 (1·40, 2·33) for adolescents who reported no close relations to parents, 2·28 (1·61, 3·22) for adolescents who reported low level of quality of family communication and 2·09 (1·39, 3·15) for adolescents who reported low level of family support. Joint effect analyses suggested that the odds of low breakfast frequency among adolescents with low family functioning compared with high family functioning were highest among adolescents being girls, immigrants and living in other than a traditional family structure.

Low breakfast frequency was associated with low family functioning measured by close relations to parents, quality of family communication and family support. Further, analyses suggested that the associations were more pronounced among girls, immigrants and adolescents from other family structure than traditional. The study highlights the importance of the family setting in promoting regular breakfast frequency among adolescents.

The objective of the present study was to evaluate the effect of settlement on the nutrition and health status of pastoral women of reproductive age.

A cross-sectional survey that included a 24 h dietary recall was administered to 224 randomly selected Gabra women. Height and weight were used to compute BMI. Whole capillary blood was used to measure Hb. Additional capillary blood was collected on filter paper and dried blood spots were analysed for transferritin receptor, C-reactive protein and α1-acid glycoprotein. Descriptive statistics were used to analyse population characteristics. The t test and the χ2 test were used to determine population differences. Multiple criteria models were used to determine the prevalence of Fe deficiency, anaemia and inflammation.

Settled and semi-settled women in Kalacha Location in Marsabit County, Kenya.

Non-pregnant women aged 15–49 years.

Fe repletion was observed in 43 % of settled and 40 % of semi-settled women. Fe-deficiency erythropoiesis in was found in 18 % of settled and 20 % of semi-settled women, whereas 15 % of settled compared with 25 % of semi-settled women were suffering from Fe-deficiency anaemia. Anaemia due to chronic diseases was more prevalent in semi-settled women than in settled women, and more common than Fe-deficiency anaemia.

Settled women were significantly less anaemic than semi-settled women, but had similarly high levels of chronic energy deficiency. While anaemia and Fe deficiency were more pronounced in semi-settled than settled women, anaemia of chronic disease and chronic infection were highly prevalent in both communities. Policies should be put in place to improve overall nutrition among pastoral women.

The current study aimed to understand how moderate and severe food-insecure people living with HIV (PLHIV) in the Dominican Republic perceive a healthy diet and explore facilitators and barriers to engaging in healthy dietary behaviours as a means of HIV self-management.

We conducted semi-structured interviews with PLHIV. We generated codes on food insecurity among PLHIV and used content analysis to organise codes for constant comparison between and within participants.

Two urban HIV clinics in the Dominican Republic.

Thirty-two PLHIV participated in the interviews.

Factors that contributed to dietary behaviours include individual factors, such as knowledge of nutrition, views and attitudes on healthy dietary behaviours, beliefs about dietary needs for PLHIV and diet functionality. Interpersonal factors, including assistance from family and peers in providing food or funds, were deemed critical along with community and organisational factors, such as food assistance from HIV clinics, accessibility to a variety of food store types and the availability of diverse food options at food stores. Policy-level factors that influenced dietary behaviours were contingent on respondents’ participation in the labour market (i.e. whether they were employed) and consistent access to government assistance. Food insecurity influenced these factors through unpredictability and a lack of control.

PLHIV who experience food insecurity face various barriers to engaging in healthy dietary behaviours. Their diets are influenced at multiple levels of influence ranging from individual to structural, requiring multi-level interventions that can address these factors concurrently.