Adequate and appropriate nutrition education is expected to contribute towards preventing risk of child stunting and maternal overweight/obesity. Understanding women’s information-seeking behaviours is an important key step for health professionals and departments of health in order to improve the development of optimal and targeted nutrition education during pregnancy. This study investigated the experience of Indonesian women in seeking and receiving nutritional information during pregnancy and its relationship to women’s socio-demographic and pregnancy characteristics.

An online cross-sectional study.

Malang City, Indonesia.

Women who had given birth within the past 2 years (n 335).

All women in this study sought or received food and nutrition information from multiple sources, including social and health professional contacts and media sources. The women frequently discussed nutrition issues with their family, particularly their husband (98·2 %) and mother or mother-in-law (91·6 %). This study identified four groups of sources based on women’s search habits. Women from high socio-economic strata were more likely to discuss food and nutrition issues or received nutrition information from obstetricians, their family or online sources (adjusted R2 = 26·3 %). Women from low socio-economic strata were more likely to receive nutrition information from midwives, health volunteers or Maternal and Child Health books (adjusted R2 = 14·5 %).

A variety of nutrition information sources needs to be provided for women from different socio-economic strata. Involvement of family members in antenatal nutrition education may improve the communication and effectiveness of young mothers’ dietary and nutrition education.

We investigated the association between dietary oxidative balance score (DOBS) and mortality and whether this association can be modified by sleep duration.

We calculated DOBS to estimate the overall oxidative effects of the diet, with higher DOBS reflecting more antioxidant intake and less pro-oxidant intake. Cox proportional hazards models were employed to examine the associations between DOBS and all-cause, CVD and cancer mortality in the general population and people with different sleep durations.

Prospective analysis was conducted using data from the US National Health and Nutrition Examination Survey (NHANES, 2005–2015).

A total of 15 991 US adults with complete information on dietary intake, sleep duration and mortality were included.

During a median follow-up of 7·4 years, 1675 deaths were observed. Participants in the highest quartile of DOBS were significantly associated with the lower risk of all-cause mortality (hazard ratio (HR) = 0·75; 95 % CI 0·61, 0·93) compared with those in the lowest. Furthermore, we found statistically significant interactions between DOBS and sleep duration on all-cause mortality (P interaction = 0·021). The inverse association between DOBS and all-cause mortality was significant in short sleepers (HR = 0·66, 95 % CI 0·48, 0·92), but not in normal and long sleepers.

Our study observed that higher DOBS was associated with lower all-cause mortality, and this association appeared to be stronger among short sleepers. This study provides nutritional guidelines for improving health outcomes in adults, especially for short sleepers.

Understanding food insecurity and its health consequences is important for identifying strategies to best target support for individuals and communities. Given the limited information that exists for indigenous groups in Latin America, this study aimed to understand the association between food insecurity and mental health in an indigenous population in Panama.

Cross-sectional data were collected using a survey conducted with Kuna Indians residing off the coast of Panama. Data sources included measures from the Panamanian prevalence of risk factors associated with CVD survey, and validated measures for psychosocial factors and standardised health outcome measures. Regression models with each of the mental health outcomes (depression, serious psychological distress, perceived stress) were used to examine the association between food insecurity and mental health outcomes.

Indigenous Kuna community residing on the San Blas Islands of Panama.

Two-hundred nine adults.

Food insecurity was reported by 83 % of the participants. Across demographic categories, the only significant difference was by age with higher prevalence in younger ages. After adjusting for demographics, higher food insecurity was significantly associated with higher number of depressive symptoms and more serious psychological distress, but not with levels of perceived stress.

Based on these findings, treatment for mental health in the Kuna community may need to account for social determinants of health and be tailored to meet the needs of younger age groups in this population. In addition, interventions designed to decrease food insecurity should be considered as a possible means for improving mental health.

To reduce children’s sugar-sweetened beverage intake, California’s Healthy-By-Default Beverage law (SB1192) mandates only unflavoured dairy/non-dairy milk or water be the default drinks with restaurant children’s meals. The objective of this study is to examine consistency with this law for meals sold through online platforms from restaurants in low-income California neighbourhoods.

This observational, cross-sectional study examines beverage availability, upcharges (additional cost) and presentation of beverage options consistent with SB1192 (using four increasingly restrictive criteria) within a random sample of quick-service restaurants (QSR) in Supplemental Nutrition Assistance Program Education eligible census tracts selling children’s meals online from November 2020 to April 2021.

Low-income California neighbourhoods (n 226 census tracts).

QSR that sold children’s meals online via a restaurant-specific platform, DoorDash, GrubHub and/or UberEats (n 631 observations from 254 QSR).

Seventy percent of observations offered water; 63 % offered unflavoured milk. Among all beverages, water was most likely to have an upcharge; among observations offering water (n 445), 41 % had an upcharge (average $0·51). Among observations offering unflavoured milk (n 396), 11 % had an upcharge (average $0·38). No observations upcharged for soda (regular or diet). Implementation consistency with SB1192 ranged from 40·5 % (using the least restrictive criteria) to 5·6 % (most restrictive) of observations.

Based on observations from restaurant websites and three of the most popular online ordering platforms, most California QSR located in low-income neighbourhoods are not offering children’s meal beverages consistent with the state’s Healthy-By-Default Beverage law. As the popularity of online ordering increases, further work to ensure restaurants offering healthy default beverages with children’s meals sold online is necessary.

Are diets with a greater environmental impact less healthy? This is a key question for nutrition policy, but previous research does not provide a clear answer. To address this, our objective here was to test whether American diets with the highest carbon footprints predicted greater population-level mortality from diet-related chronic disease than those with the lowest.

Baseline dietary recall data were combined with a database of greenhouse gases emitted in the production of foods to estimate a carbon footprint for each diet. Diets were ranked on their carbon footprints and those in the highest and lowest quintiles were studied here. Preventable Risk Integrated Model (PRIME), an epidemiological modelling software, was used to assess CVD and cancer mortality for a simulated dietary change from the highest to the lowest impact diets. The diet–mortality relationships used by PRIME came from published meta-analyses of randomised controlled trials and prospective cohort studies.

USA.

Baseline diets came from adults (n 12 865) in the nationally representative 2005–2010 National Health and Nutrition Examination Survey.

A simulated change at the population level from the highest to the lowest carbon footprint diets resulted in 23 739 (95 % CI 20 349, 27 065) fewer annual deaths from CVD and cancer. This represents a 1·83 % (95 % CI 1·57 %, 2·08 %) decrease in total deaths. About 95 % of deaths averted were from CVD.

Diets with the highest carbon footprints were associated with a greater risk of mortality than the lowest, suggesting that dietary guidance could incorporate sustainability information to reinforce health messaging.

To evaluate various diet quality indices and to estimate their associations with major non-communicable diseases (NCD) (i.e. diabetes mellitus (DM) and myocardial infarction (MI)) and risk for overweight (OW).

Four dietary diversity indices (namely, count index (Count), dietary diversity score index, berry index (BI) and entropy index (EI)) and three Chinese dietary guideline-based indices (namely, China healthy diet index, Chinese food pagoda score and diet quality divergence index) were employed to evaluate Chinese diet quality. DM, MI and OW were used as diet-related health indicators. Logit regressions were employed to unveil the associations between diet quality indices and NCD and risk for OW. The relationships between diet quality indices and daily energy intakes were checked with ordinary least squares linear regressions.

Four recent waves (2004, 2006, 2009, 2011) of longitudinal individual data from China Health and Nutrition Survey.

Chinese adults (aged 18–64 years) from twelve provinces were included in the analysis (n 30 350).

Count, BI, and EI were positively associated with higher OW risk and daily energy intakes. As dietary guideline-based indices got better, people were exposed to lower DM and OW risks and got lower daily energy intakes. Finally, dietary guideline-based indices properly revealed the expected relationships that high-quality diets would reduce NCD and risk for OW, while high diversity indices were usually correlated with over-nutrition and high risks.

Increasing diversity of the diet does not necessarily improve the nutrition and health. Dietary guideline-based indices are more robust than dietary diversity indices; thus, they should be highly recommended when evaluating diet quality.

This study is a secondary data analysis that examines the association between parent modelling of dietary intake and physical activity and the same child behaviours among different races/ethnicities using innovative, rigorous and objective measures.

Ecological momentary assessment surveys were sent to parents to assess whether their child had seen them exercise or consume food. Dietary recall data and accelerometry were used to determine dietary intake and physical activity behaviours of children.

Participants were randomly selected from primary care clinics, serving low-income and racially/ethnically diverse families in Minnesota, USA.

Participants were families with children aged 5–7 years old who lived with parents 50 % of the time and shared at least one meal together.

A 10 percentage point higher prevalence in parent modelling of fruit and vegetable intake was associated with 0·12 higher serving intake of those same foods in children. The prevalence of parent modelling of eating energy dense foods (10 % prevalence units) was associated with 0·09 higher serving intake of sugar-sweetened beverages. Furthermore, accelerometry-measured parent sedentary hours was strongly correlated with child sedentary time (0·37 child sedentary hours per parent sedentary hours). An exploratory interaction analysis did not reveal any statistical evidence that these relationships depended on the child’s race/ethnic background.

Interventions that increase parent modelling of healthy eating and minimise modelling of energy dense foods may have favourable effects on child dietary quality. Additionally, future research is needed to clarify the associations of parent modelling of physical activity and children’s physical activity levels.

The current study sought to describe and compare study type, research design and translation phase of published research in nutrition and dietetic journals in 1998 and 2018.

This was a repeat cross-sectional bibliographic analysis of Nutrition and Dietetics research. All eligible studies in the top eight Nutrition and Dietetics indexed journals in 1998 and 2018 were included. Two independent reviewers coded each study for research design (study type and study design) and translation phase (T0-T4) of the research using seminal texts in the field.

Not relevant.

Not relevant.

The number of publications (1998, n 1030; 2018, n 1016) has not changed over time, but the research type, design and translation phases have. The proportion of intervention studies in 1998 (43·8 %) was significantly higher than 2018 (19·4 %). In 2018, more reviews (46·9 % v. 15·6 % in 1998) and less randomised trials (14·3 % v. 37·8 % in 1998) were published. In regard to translation phase, there was a higher proportion of T2–T4 research in 2018 (18·3 % v. 3·8 % in 1998); however, the proportion of T3/T4 (dissemination, implementation and population-level research) research was still low (<3 %). Our sensitivity analysis with the four journals that remained in the top eight journal across the two time periods found no differences in the research type, design and translation phases across time.

There was a reduction in intervention and T0 publications, alongside higher publication of clinical study designs over time; however, published T3/T4 research in Nutrition and Dietetics is low. A greater focus on publishing interventions and dissemination and implementation may be needed.

There has been a growing interest in tailored nutrition education over the previous decade, with a number of literature reviews suggesting this intervention strategy holds considerable potential. Nevertheless, the majority of intervention trials undertaken to date have employed subjective self-report outcome measures (such as dietary recalls). The aim of the present review is to further consider the likely true effect of tailored nutrition education by assessing the findings of tailored nutrition education intervention trials where objective outcome measures (such as sales data) have been employed.

Four trials of tailored nutrition education employing objective outcome measures were identified: one was undertaken in eight low-cost supermarkets in New Zealand (2010; n 1104); one was an online intervention trial in Australia (2006; n 497); and two were undertaken in US supermarkets (1997 and 2001; n 105 and 296, respectively). Findings from the high-quality New Zealand trial were negative. Findings from the US trials were also generally negative, although reporting was poor making it difficult to assess quality. Findings from the high-quality online trial were positive, although have limited generalisability for public health.

Trials employing objective outcome measures strongly suggest tailored nutrition education is not effective as a stand-alone strategy. However, further large, high-quality trials employing objective outcome measures are needed to determine the true effectiveness of this popular nutrition intervention strategy. Regardless, education plays an important role in generating social understanding and acceptance of broader interventions to improve nutrition.

To determine the association between food insecurity and HIV infection with depression and anxiety among new tuberculosis (TB) patients.

Our cross-sectional study assessed depression, anxiety and food insecurity with Patient Health Questionnaire (PHQ-9), Zung Anxiety Self-Assessment Scale (ZUNG) and Household Food Insecurity Access Scale, respectively. Poisson regression models with robust variance were used to examine correlates of depression (PHQ-9 ≥ 10) and anxiety (ZUNG ≥ 36).

Gaborone, Botswana.

Patients who were newly diagnosed with TB.

Between January and December 2019, we enrolled 180 TB patients from primary health clinics in Botswana. Overall, 99 (55·0 %) were HIV positive, 47 (26·1 %), 85 (47·2 %) and 69 (38·5 %) indicated depression, anxiety and moderate to severe food insecurity, respectively. After adjusting for potential confounders, food insecurity was associated with a higher prevalence of depression (adjusted prevalence ratio (aPR) = 2·30; 95 % CI 1·40, 3·78) and anxiety (aPR = 1·41; 95 % CI 1·05, 1·91). Prevalence of depression and anxiety was similar between HIV-infected and HIV-uninfected participants. Estimates remained comparable when restricted to HIV-infected participants.

Mental disorders may be affected by food insecurity among new TB patients, regardless of HIV status.

The present study aimed to examine the availability and price of healthier compared with less healthy foods by geography, store category and store type for convenience stores, and by store size for grocery stores in Nova Scotia.

A cross-sectional study that examined differences in the overall availability and price of healthier compared to less healthy foods in grocery and convenience stores in Nova Scotia. The Nova Scotia Consumer Food Environment project was part of a larger initiative of the Nova Scotia government (Department of Health and Wellness) to assess the food and beverage environment in Nova Scotia in 2015/16.

Four geographic zones (Nova Scotia Health Authority Management Zones) in Nova Scotia, Canada.

A sample of forty-seven grocery stores and fifty-nine convenience stores were selected from a list of 210 grocery stores and 758 convenience stores in Nova Scotia to ensure geographic and store type representation in our sample.

Findings indicate that rurality had a significant effect on food availability as measured by the Nutrition Environment Measures Surveys (NEMS) score (P < 0·01); there was a higher availability of healthy foods in rural compared to urban areas for convenience stores but not grocery stores. Healthier foods were also more available in chain stores compared to independent stores (P < 0·01) and in large stores compared to small and medium stores (P < 0·001 and P < 0·01, respectively).

The availability of and accessibility to less healthy foods in Nova Scotia food environment suggests that there is a need for government policy action to support a food environment that contributes to healthier diets.

To assess availability, variety, price and quality of different food products in a convenience sample of supermarkets in Germany and the USA.

Cross-sectional study using an adapted version of the Bridging the Gap Food Store Observation Form.

Information on availability, quality, price and variety of selected food products in eight German and seven US supermarkets (discount and full service) was obtained and compared by country.

A general tendency for lower prices of fruits and vegetables in Germany was observed, while produce quality and variety did not seem to differ between countries, with the exception of the variety of some vegetables such as tomatoes. Chips and cereals did not differ significantly in variety nor price. In both countries, high energy-dense foods were lower in energy costs than lower energy-dense foods.

The influence of food prices and availability on consumption should be further explored, including the impact of country differences.

Food marketing is an important factor influencing children’s food preferences. In Slovenia the use of magazines is widespread among children. We investigated food advertising in children’s and teens’ magazines (CTM) in 2013 and 2017. The penetration of food advertising was compared with magazines targeting the adult population.

A repeated cross-sectional study. Magazines were searched for branded food references (BFR). All BFR were categorised and evaluated using the WHO Europe nutrient profile model.

Slovenia.

All issues of CTM and a selected sample of issues of adult-targeting magazines and newspapers published in Slovenia in 2013 and 2017.

One hundred and seventy-five issues of CTM (ninety-two in 2013, eighty-three in 2017) and 675 issues of adult-targeted magazines and newspapers were analysed (345 in 2013, 330 in 2017). In 2017, food advertising in CTM dropped notably but the opposite was found for adult-targeted magazines. Regular advertisements dominated in 2017 in CTM, while in 2013, 83 % of BFR types were games/puzzles, competitions and product placements. Chocolate and confectionery were the most advertised in CTM and food supplements in adults’ magazines. Most foods in CTM were classed as ‘not permitted’ in both years (98 % in 2013 and 100 % in 2017).

The advertisements in CTM still mostly refer to unhealthy foods. The extent of food advertising has dropped considerably since 2013. On the contrary, food advertising in printed media targeting adults has increased, chiefly referring to food supplements and foods that do not pass the WHO Europe nutrient profile model criteria.

Childhood obesity is of increasing concern in South Africa, and interventions to promote healthy behaviours related to obesity in children are needed. Young children in urban low-income settings are particularly at risk of excess adiposity. The current study aimed to describe how parents of preschool children in an urban South African township view children’s movement and dietary behaviours, and associated barriers and facilitators.

A contextualist qualitative design was utilised with in-depth interviews conducted in the home setting and analysed using reflexive thematic analysis. Field notes were used to contextualise findings.

Four neighbourhoods in a predominantly low-income urban township.

Sixteen parents (fourteen mothers, two fathers) of preschool-age children were recruited via preschools.

Four themes were developed: children’s autonomy and the limits of parental control; balancing trust and fears; the appeal of screens; and aspirations and pressures of parenthood. Barriers to healthy behaviours included children’s food preferences, aspirations and pressures to consume unhealthy foods, other adults giving children snacks, lack of safe places to play, unhealthy food environments and underlying structural factors. Facilitators included set routines, the preschool environment, safe places to play and availability of healthy foods.

Low-income families in Soweto face many structural challenges that cannot easily be addressed through public health interventions, but there may be opportunities for behavioural interventions targeting interpersonal and organisational aspects, such as bedtime routines and preschool snacks, to achieve positive changes. More research on preschoolers’ movement and dietary behaviours, and related interventions, is needed in South Africa.

Waist-to-height ratio has been shown to be an important indicator of cardiometabolic risk. There are few studies evaluating this measure against existing measures of adiposity and cardiometabolic markers in early childhood. The objectives were: (i) to determine in young children the ability of waist-to-height ratio, BMI z-score, weight for length, and sum of skin fold thickness to predict cardiometabolic risk and (ii) to examine this association at ages 1, 3 and 5 years.

Prospective cohort study.

A university hospital in Toronto, Ontario.

Infants at 1 (n 406), 3 (n 112) and 5 years of age (n 94) born to mothers with and without gestational diabetes mellitus.

Weight for length and BMI z-score demonstrated the strongest correlations with biochemical measures compared to waist-to-height ratio, including leptin (at 5 years, weight for length z-score: ρ = 0·65, P < 0·001; BMI z-score: ρ = 0·67, P < 0·001) and measures of insulin resistance (at 3 years, weight for length z-score: ρ = 0·25, P = 0·02; BMI z-score: ρ = 0·24, P = 0·02). The magnitude of associations between anthropometric measures and biochemical measures strengthened over time. Weight for length and BMI z-scores were moderately correlated with overall measures of fat mass as measured by dual-energy X-ray absorptiometry (ρ = 0·65, P = 0·00; ρ = 0·61, P = 0·01).

Waist-to-height ratio was not superior to existing measures in predicting cardiometabolic risk in young children. BMI z-score is a preferred measure of adiposity between birth and 5 years of age.

The aim of the present study was to identify correlates of body image perception and dissatisfaction among school-aged children from Colombia, a country undergoing the nutrition transition.

Cross-sectional study. Using child-adapted Stunkard scales, children were asked to indicate the silhouette that most closely represented their current and desired body shapes. Body image dissatisfaction (BID) score was estimated as current minus desired silhouette. Height and weight were measured in all children. Sociodemographic data were collected through questionnaires completed by the children's mothers.

Public primary schools in Bogotá, Colombia.

Children aged 5–12 years (n 629) and their mothers.

Mean BID score was 0·1 (sd 1·7). The strongest predictor of BID was actual BMI-for-age Z-score (BAZ). Compared with children with BAZ ≥ −1 and <1, those with BAZ ≥ 2 had a 1·9 units higher BID score (P for trend <0·0001). BID tended to be higher in girls than boys at any level of BAZ. Other correlates of BID included child's height-for-age Z-score, maternal BMI and dissatisfaction with the child's body, and home ownership.

Among school-aged children from a country experiencing the nutrition transition, body image perception was associated with the child's weight and height, and with maternal BMI, dissatisfaction with the child's body and socio-economic level.

To examine the impacts of Seattle’s minimum wage ordinance on food prices by food processing category.

Supermarket food prices were collected for 106 items using a University of Washington Center for Public Health Nutrition market basket at affected and unaffected supermarket chain stores at three times: March 2015 (1-month pre-policy enactment), May 2015 (1-month post-policy enactment) and May 2016 (1-year post-policy enactment). Food items were categorized into four food processing groups, from minimally to ultra-processed. Data were analysed across time using a multilevel, linear difference-in-differences model at the store and price level stratified by level of food processing.

Six large supermarket chain stores located in Seattle (‘intervention’) affected by the policy and six same-chain but unaffected stores in King County (‘control’), Washington, USA.

One hundred and six food and beverage items.

The largest change in average price by food item was +$US 0·53 for ‘processed foods’ in King County between 1-month post-policy and 1-year post-policy enactment (P < 0·01). The smallest change was $US 0·00 for ‘unprocessed or minimally processed foods’ in Seattle between 1-month post-policy and 1-year post-policy enactment (P = 0·94). No significant changes in averaged chain prices were observed across food processing level strata in Seattle v. King County stores at 1-month or 1-year post-policy enactment.

Supermarket food prices do not appear to be differentially impacted by Seattle’s minimum wage ordinance by level of the food’s processing. These results suggest that the early implementation of a city-level minimum wage policy does not alter supermarket food prices by level of food processing.

To quantify the inflammatory potential of the diet of rural and urban Black South Africans using an adapted energy-adjusted dietary inflammatory index (AE-DII) and to investigate its relationship with inflammatory and cardio-metabolic disease risk markers. Dietary inflammatory potential has not been investigated in African populations.

Cross-sectional investigation.

Rural and urban sites in the North West province of South Africa.

1885 randomly selected, apparently healthy Black South Africans older than 30 years.

AE-DII scores ranged from –3·71 to +5·08 with a mean of +0·37. AE-DII scores were significantly higher in men (0·47 ± 1·19) than in women (0·32 ± 1·29), and in rural (0·55 ± 1·29) than urban participants (0·21 ± 1·19). Apart from its dietary constituents, AE-DII scores are primarily associated with age, rural–urban status and education. Contrary to the literature, alcohol consumption was positively associated with AE-DII scores. Of the four tested inflammatory and thirteen cardio-metabolic biomarkers, the AE-DII was only significantly negatively associated with albumin and HDL cholesterol, and positively with waist circumference and fasting glucose, upon full adjustment.

Rural men consumed the most pro-inflammatory diet, and urban women the least pro-inflammatory diet. The diet of the participants was not overtly pro- or anti-inflammatory and was not associated with measured inflammatory markers. The inflammatory potential of alcohol at different levels of intake requires further research. Understanding dietary inflammatory potential in the context of food insecurity, unhealthy lifestyle practices and lack of dietary variety remains limited.

To investigate feeding practices in infants under the age of 4 months in Liverpool, England with particular reference to the cost of infant feeding.

A cross–sectional survey consisting of self–completion questionnaires and interviews.

Subjects' homes within Central and South Liverpool Primary Care Trust areas.

One hundred and forty–nine women (aged 18 to 43 years) and their infants (mean age 13 weeks).

The average weekly cost of breast–feeding was £11.58 compared with £9.60 for formula–feeding. Many breast– and formula–feeding women spent money however on items that were not needed or used only once or twice. This was especially true of first–time mothers. Characteristics significantly associated with higher spending were: feeding method – mothers that had or were partially breast–feeding (P=0.001), education – those educated to degree level (P=0.028), socio–economic status – those in social classes I and II (P=0.002) and age – those aged 30 years and over (P=0.003).

This study demonstrates that while breast–feeding is often promoted as being free, this is not the case. Better information needs to be given to parents to avoid wasting money on items that are unnecessary, or where cheaper alternatives are available.

To determine if specific dietary patterns are associated with breast cancer (BC) risk in Chinese women.

Latent class analysis (LCA) was performed to identify generic dietary patterns based on daily food-frequency data.

The Chinese Wuxi Exposure and Breast Cancer Study (2013–2014).

A population-based case–control study (695 cases, 804 controls).

Four dietary patterns were identified, Prudent, Chinese traditional, Western and Picky; the proportion in the controls and cases was 0·30/0·32/0·16/0·23 and 0·29/0·26/0·11/0·33, respectively. Women in Picky class were characterised by higher extreme probabilities of non-consumption of specific foods, the highest probabilities of consumption of pickled foods and the lowest probabilities of consumption of cereals, soya foods and nuts. Compared with Prudent class, Picky class was associated with a higher risk (OR = 1·42, 95 % CI 1·06, 1·90), while the relevant association was only in post- (OR = 1·44, 95 % CI 1·01, 2·05) but not in premenopausal women. The Western class characterised by high-protein, high-fat and high-sugar foods, and the Chinese traditional class characterised by typical consumption of soya foods and white meat over red meat, both of them showed no difference in BC risk compared with Prudent class did.

LCA captures the heterogeneity of individuals embedded in the population and could be a useful approach in the study of dietary pattern and disease. Our results indicated that the Picky class might have a positive association with the risk of BC.