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.

Intake of white potatoes in and out of school was estimated to provide context for a recent proposal by the US Department of Agriculture to limit provision of white potatoes in US school meals.

Mean daily servings of white potatoes and other vegetables consumed in and out of school for school-aged children were estimated from two days of 24 h dietary recall data from the National Health and Nutrition Examination Surveys (NHANES). Total energy intake and percentage energy contribution from discretionary oils and solid fats were also estimated for all white potato dishes consumed.

The NHANES is nationally representative of the US civilian non-institutionalized population.

Children and adolescents aged 6–19 years (n 8466) from three combined NHANES cycles (2003–2004, 2005–2006 and 2007–2008).

White potatoes represented 32 % of all vegetable servings consumed by US children and adolescents. Preparations high in fats and oils, including French fries, were most popular both in and out of school. Mean consumption of white potatoes obtained from school cafeterias was approximately 0·05 servings/d among all children and adolescents, and about 0·15 servings/d among children and adolescents acquiring at least one item from the school cafeteria, implying current weekly intake levels well below the limit of 2 servings/week proposed by the US Department of Agriculture.

Although white potatoes represent a substantial proportion of vegetable consumption among school-aged children, it is unclear that proposed limits would influence white potato intake from school cafeterias. Policy makers should consider targeting preparation methods to improve the healthfulness of white potato dishes.

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.

To categorize and assess all foods, beverages and ingredients provided over one week at Australian long day care (LDC) centres according to four levels of food processing and to assess the contribution of Na from each level of processing.

Cross-sectional.

Menus for lunch, morning and afternoon snacks were collected from LDC centres. The level of food processing of all foods, beverages and ingredients was assessed utilizing a four-level food processing classification system: minimally processed (MP), processed culinary ingredients (PCI), processed (P) and ultra-processed (ULP).

A total of thirty-five menus (lunch, n 35; snacks, n 70) provided to 1–5-year-old children were collected from seven LDC centres. Proportions of foodstuffs classified as MP, PCI, P and ULP were 54, 10, 15 and 21 %, respectively. All lunches were classified as MP. ULP foods accounted for 6 % of morning snacks; 41 % of afternoon snacks. Mean daily amount of Na provided per child across all centres was 633 (sd 151) mg. ULP foods provided 40 % of Na, followed by P (35 %), MP (23 %) and PCI (2 %).

Centres provided foods resulting in a mean total daily Na content that represented 63 % of the recommended Upper Level of Intake for Na in this age group. A significant proportion of ULP snack foods were included, which were the major contributor to total daily Na intake. Replacement of ULP snack foods with MP lower-Na alternatives is recommended.

To assess the association between household food insecurity (FI) and major depressive episodes (MDE) amid Covid-19 pandemic in Brazil.

Cross-sectional study carried out with data from four consecutive population-based studies.

The study was conducted between May and June 2020, in Bagé, a Brazilian southern city. Household FI was measured using the short-form version of the Brazilian Food Insecurity Scale. Utilising the Patient Health Questionnaire-9, we used two different approaches to define MDE: the cut-off point of ≥ 9 and the diagnostic criteria proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Association between FI and MDE was analysed using crude and adjusted Poisson regression models.

1550 adults (≥ 20 years old).

The prevalence of household FI was 29·4 % (95 % CI 25·0, 34·4). MDE prevalence varied from 4·4 % (95 % CI 3·1, 6·0), when we used the DSM-IV-TR criteria to define this condition, to 9·6 % (95 % CI 7·3, 12·5) of the sample, when we used the cut-off point of ≥ 9 as definition. The prevalence of MDE was more than two times higher in those individuals living with FI, independent of the criteria adopted to define the outcome. Adjustment for potential confounders did not change the association’s magnitude.

Household FI has been positively associated with MDE amid Covid-19 pandemic, independent of socio-demographic characteristics of participants. Actions are needed to warrant basic living conditions to avoid FI and hunger and its consequences for the Brazilian population, especially those consequences linked to mental health disorders.

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 assess the associations among eating behaviour traits, food label use and diet quality and to evaluate if the association between eating behaviour traits and diet quality is mediated by food label use.

Eating behaviour traits were assessed using the Three-Factor Eating Questionnaire (TFEQ), the Restraint Scale and the Intuitive Eating Scale, whereas food label use was measured with the Label Reading Survey. Diet quality (Canadian Healthy Eating Index) was assessed with an FFQ.

Cross-sectional study.

Adults (n 385; mean (sd): BMI = 26·0 (4·9) kg/m2, age = 41·1 (15·0) years) involved in two previous experimental studies.

When controlling for potential covariates, general food label use (β = 1·18 (se 0·26), P < 0·0001) was the main determinant of diet quality, explaining 6·7 % of its variance. General food label use partly mediated the association between TFEQ-cognitive restraint and diet quality; the indirect effect (βindirect (se); 95 % CI) was stronger in men (0·32 (0·10); 0·15, 0·55) than women (0·16 (0·05); 0·08, 0·27). General food label use also partly mediated the negative association between unconditional permission to eat and diet quality; the indirect effect (βindirect (se); 95 % CI) was also stronger in men (−1·88 (0·55); −3·11, −0·96) than women (−1·03 (0·33); −1·81, −0·49).

General food label use was the main determinant of diet quality and partly mediated the association between eating behaviour traits and diet quality. The stronger mediating effect observed in men suggests they rely more on food labelling when attempting to restrained themselves, which translates into better diet quality.

To capture a more holistic picture of eating behaviour by investigating the impact of the social living conditions and weight status of parents and daughters on food consumption frequency, the context of meals and daily portion sizes.

Cross-sectional Berlin School Children's Cohort study.

A total of sixty-nine schools in Berlin (3 400 000 inhabitants, eastern Germany) participated in the present study.

A total of 1519 girls aged 11–14 years were selected. Bi- and multivariate analyses were performed to examine the impact of age, migration background, socio-economic status (SES), parental education, family situation and the weight status of parents and daughters on three different eating behaviour scores according to nutritional recommendations.

For the three dependent eating behaviour variables, different patterns of influencing factors emerged. Multivariate regression (model 1) revealed that low and middle SES, two-parent migration background and older age were significant risk factors. Meal context was also significantly influenced by living with a single parent. Similar results were obtained for the daily portion size scores and maternal overweight status was the most influential. Model 2 succeeded in showing that, within the composite variable of family SES, mothers’ level of education was the dominant component.

SES as a whole, and especially the component of mothers’ level of education and two-parent migration background, was the strongest risk factor for an unfavourable eating pattern among adolescent girls. The results clearly indicated preventive potential. Using three different measures of eating behaviour simultaneously provided an in-depth understanding of general patterns and potential risk factors.

The purpose of the present study was to explore the relationship between family meals and parental encouragement of healthy eating overall and by ethnicity.

Family meal frequency was measured with one item asking how many times in the past 7 d all or most of the family ate a meal together, which was then categorized to represent three levels of family meals (≤2 times, 3–6 times and ≥7 times). Parental encouragement of healthy eating assessed how often parents encouraged the student to eat fruits and vegetables, drink water, eat wholegrain bread, eat breakfast and drink low-fat milk (never to always). An overall scale of parental encouragement of healthy eating was created. Mixed-effect regression analyses were run controlling for gender, ethnicity, age and socio-economic status. Moderation by ethnicity was explored.

Middle schools.

Participants included 2895 US eighth grade students participating in the Central Texas CATCH (Coordinated Approach To Child Health) Middle School Project (mean age 13·9 years; 24·5 % White, 52·7 % Hispanic, 13·0 % African-American, 9·8 % Other; 51·6 % female).

Eating more family meals was significantly associated with having parents who encouraged healthy eating behaviours (P for trend <0·001). The number of family meals was positively associated with encouragement of each of the healthy eating behaviours (P for trend <0·0001). There were no differences in the relationships by ethnicity of the students.

Families who eat together are more likely to encourage healthy eating in general. Interventions which promote family meals may include tips for parents to increase discussions about healthy eating.

To provide baseline evidence of sugar-sweetened beverage (SSB) consumption in a sample of Irish children prior to the introduction of the SSB tax; to identify the energy contribution of SSB to daily energy intake; and to explore the association between SSB consumption and overweight/obesity.

Cross-sectional study.

Primary schools in Cork, Ireland in 2012.

1075 boys and girls aged 8–11 years. SSB consumption was assessed from 3-d food diaries. BMI was used to define obesity (International Obesity Taskforce definitions). Plausible energy reporters (n 724, 68 % of total sample) were classified using Schofield equation.

Eighty-two per cent of children with plausible energy intake consumed SSB. Mean energy intake from SSB was 485 kJ (6 % of total kJ). Mean kilojoules from SSB increased with weight status from 443 kJ for normal-weight children to 648 kJ for children with overweight/obesity (5·8 and 7·6 % of total kJ, respectively). Mean SSB intake was significantly higher in children with overweight/obesity than normal-weight children (383 and 315 ml/d). In adjusted analyses, children consuming >200 ml/d had an 80 % increased odds of overweight/obesity compared to those consuming <200 ml/d (OR 1·8, 95 % CI 1·0, 3·5). Family socioeconomic status and lifestyle determinants, including frequency of takeaway consumption and TV viewing, were also significantly associated with SSB consumption.

SSB account for a substantial proportion of daily energy intake and are significantly associated with child overweight/obesity. This study provides baseline data from a sample of children from which the impact of the SSB tax can be benchmarked.

The objective of the present study was to examine the relationship between plasma alkyresorcinol (AR) concentrations, which are biomarkers of whole-grain intake, and atherosclerotic progression over 3 years in postmenopausal women with coronary artery disease.

Plasma AR concentrations were measured by a validated GC–MS method in fasting plasma samples. Atherosclerosis progression was assessed using change in mean minimal coronary artery diameter (MCAD) and percentage diameter stenosis (%ST), based on mean proximal vessel diameter across up to ten coronary segments. Dietary intake was estimated using a 126-item interviewer-administered FFQ.

A prospective study of postmenopausal women participating in the Estrogen Replacement and Atherosclerosis trial.

For the analysis of plasma AR concentrations and atherosclerotic progression, plasma samples and follow-up data on angiography were available for 182 women.

Mean whole-grain intake was 9·6 (se 0·6) servings per week. After multivariate adjustment, no significant associations were observed between plasma AR concentrations and change in mean MCAD or progression of %ST. Plasma AR concentrations were significantly correlated with dietary whole grains (r=0·35, P<0·001), cereal fibre (r=0·33, P<0·001), bran (r=0·15, P=0·05), total fibre (r=0·22, P=0·003) and legume fibre (r=0·15, P=0·04), but not refined grains, fruit fibre or vegetable fibre.

Plasma AR concentrations were not significantly associated with coronary artery progression over a 3-year period in postmenopausal women with coronary artery disease. A moderate association was observed between plasma AR concentrations and dietary whole grains and cereal fibre, suggesting it may be a useful biomarker in observational studies.

We examined the association of household food insecurity with educational outcomes and explored the moderating effect of gender and school lunch programme.

The study used a cross-sectional design. Data were collected in 2014 using interviewer-administered questionnaires and school administrative records. We measured household food insecurity using the Household Food Insecurity Access Scale. Educational outcomes referred to knowledge, attitudes and skills that students are expected to obtain while attending school. We obtained sixteen different measures of educational outcomes, ranging from academic grades to beliefs and attitudes towards school and education. Data were analysed using multilevel modelling with covariates at the student and school levels. We conducted moderation tests by adding a two-way interaction between food insecurity and gender, and between food insecurity and school lunch programme.

The study was conducted in 100 schools located in fifty-four districts within Ghana’s eight administrative regions in 2014.

Participants included 2201 school-going adolescents aged 15–19 years.

More than 60 % of adolescents were from food-insecure households. Household food insecurity was negatively associated with Math grade and school attendance. Food insecurity was also inversely associated with socio-emotional outcomes, including academic self-efficacy, commitment to school and academic aspirations and expectations. We did not find a moderating effect of gender and school lunch programme.

Food insecurity is negatively associated with wide-ranging educational outcomes related to both learning and socio-emotional abilities. Our study supports prior evidence suggesting the importance of food access on both cognitive and non-cognitive educational outcomes.

Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines.

Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017–2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated.

Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included.

In total, 2521 participants (18–50 years) were included in the study.

Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall.

Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.

Accurate measurements of food volume and density are often required as ‘gold standards’ for calibration of image-based dietary assessment and food database development. Currently, there is no specialised laboratory instrument for these measurements. We present the design of a new volume of density (VD) meter to bridge this technological gap.

Our design consists of a turntable, a load sensor, a set of cameras and lights installed on an arc-shaped stationary support, and a microcomputer. It acquires an array of food images, reconstructs a 3D volumetric model, weighs the food and calculates both food volume and density, all in an automatic process controlled by the microcomputer. To adapt to the complex shapes of foods, a new food surface model, derived from the electric field of charged particles, is developed for 3D point cloud reconstruction of either convex or concave food surfaces.

We conducted two experiments to evaluate the VD meter. The first experiment utilised computer-synthesised 3D objects with prescribed convex and concave surfaces of known volumes to investigate different food surface types. The second experiment was based on actual foods with different shapes, colours and textures. Our results indicated that, for synthesised objects, the measurement error of the electric field-based method was <1 %, significantly lower compared with traditional methods. For real-world foods, the measurement error depended on the types of food volumes (detailed discussion included). The largest error was approximately 5 %.

The VD meter provides a new electronic instrument to support advanced research in nutrition science.

There is an increasing awareness that the provision of healthy food relies on the co-ordinated efforts of a number of diverse disciplines, not merely those traditionally linked with food. This paper documents the development of a food and health strategy, commissioned by the health alliance for the city of Cardiff, and focuses on the areas of sustainability, education and training as well as nutrition, food provision and food safety.

The aim of the strategy was to increase the uptake of a healthy, safe and sustainable diet for all those living in Cardiff.

The methodology included a rapid appraisal of food initiatives operating within the city, establishing a food and health strategy working group and the production of strategy documentation. Multi-agency collaboration and consultation were key components of the approach.

As the strategy developed, seven action areas became apparent, including education and training, public sector procurement and rewarding excellence. These action areas were incorporated into seven ‘action tables’, which constitute the core of the strategy. The food and health strategy document was ratified by the Local Health Alliance board in August 2004. But, far greater benefits were realised as a consequence of setting up the strategy working group. Long before the document was written, the strategy process was operating as ‘multidisciplinary public health in action’.

The network that comprised the food and health strategy working group was already able to commence delivery of a more integrated approach to food and health within Cardiff.

To collect context-specific insights into maternal and child health and nutrition issues, and to explore potential solutions in Nanoro, Burkina Faso.

Eleven focus groups with men and women from eleven communities, facilitated by local researchers.

The study took place in the Nanoro Health district, in the West-Central part of Burkina Faso.

Eighty-six men (18–55 years) and women by age group: 18–25; 26–34 and 35–55 years, participated in the group discussions.

Participants described barriers to optimal nutrition of mothers and children related to a range of community factors, with gender inequality as central. Major themes in the discussions are related to poverty and challenges generated by socially and culturally determined gender roles. Sub-themes are women lacking access to food whilst pregnant and having limited access to health care and opportunities to generate income. Although communities believe that food donations should be implemented to overcome this, they also pointed out the need for enhancing their own food production, requiring improved agricultural technologies. Given the important role that women could play in reducing malnutrition, these communities felt they needed to be empowered to do so and supported by men. They also felt that this had to be carried out in the context of an enhanced health care system.

Findings reported here highlight the importance of nutrition-sensitive interventions and women’s empowerment in improving maternal and child nutrition. There is a need to integrate a sustainable multi-sectorial approach which goes beyond food support.

Dairy products contain essential nutrients to ensure healthy growth and bone development in children. However, a significant proportion of children in developed countries fail to consume the daily recommended intake of dairy products. Parents are the gatekeepers of familial nutritional intake and represent a potential vehicle through which to increase dairy consumption in children. As such, formative research was conducted to gain insight into parents’ perceived barriers to and benefits of purchasing and consuming dairy products and to develop innovative message content that could be utilized in future public health campaigns.

Seven in-depth group interviews were conducted in two phases between February and May 2015.

Interviews were conducted in local recreational centres and libraries in British Columbia, Canada.

Mothers (n 21, mean age 38 (sd 5) years) and fathers (n 9, mean age 38 (sd 3) years) of children aged 4–10 years.

Parents perceived both positive and negative physical outcomes associated with consuming dairy. Lack of trustworthy information was a frequently discussed barrier theme to purchasing and consuming dairy products. Mothers were concerned about the cost of dairy products. Differences in purchasing and consumption strategies were reported between parents of children who consumed adequate dairy and those who did not. Parents believed the most appropriate communication channel was through print material.

Messages targeting parents, as a means of increasing dairy consumption in children, should address barriers identified by parents. In addition, practical tips should be provided to promote purchasing and consumption of dairy products.

We examined whether folic acid (FA) supplementation prevented congenital hydrocephalus (CH) in more than 200 000 births in China.

A large population-based cohort study.

All births at 20 complete gestational weeks, including live births, stillbirths and pregnancy terminations, and all structural birth defects regardless of gestational week were recorded. The prevalence of births with CH was classified by maternal characteristics and FA supplementation. CH was diagnosed in accordance with code 742.3 of the International Classification of Diseases, Ninth Revision, Clinical Modification, while non-neural tube defect (NTD) CH refers to CH without anencephaly (740), spina bifida (741) or encephalocele (742·0).

A total of 247 831 pregnant women who delivered with known outcomes were included.

A total of 206 cases of CH (0·83 per 1000 births) and 170 cases of non-NTD CH (0·69 per 1000 births) were recorded in the study. The prevalence of CH and non-NTD CH was higher in women in the no supplementation group than those in the FA supplementation group (0·92 and 0·72 v. 0·75 and 0·65 per 1000 births, respectively). FA supplementation during the periconceptional period significantly prevented CH (OR = 0·29, 95 % CI 0·12, 0·69) and non-NTD CH (OR = 0·34, 95 % CI 0·12, 0·97) in northern China, especially in a high-compliance group (≥ 80 %).

Periconceptional FA supplementation did not significantly prevent CH overall in the current study. However, in the north of China with common maternal folate insufficiency, there was some evidence.