A community-based participatory nutrition promotion (CPNP) programme, involving a 2-week group nutrition session, attempted to improve child feeding and hygiene. The implementation, utilization and influence of the CPNP programme were examined by programme impact pathway (PIP) analysis.

Five CPNP programme components were evaluated: (i) degree of implementation; (ii) participants’ perception of the nutrition sessions; (iii) participants’ message recall; (iv) utilization of feeding and hygiene practices at early programme stage; and (v) participants’ engagement in other programmes.

Habro and Melka Bello districts, Ethiopia.

Records of 372 nutrition sessions, as part of a cluster-randomized trial, among mothers (n 876 in intervention area, n 914 in control area) from a household survey and CPNP participants (n 197) from a recall survey.

Overall, most activities related to nutrition sessions were successfully operated with high fidelity (>90 %), but a few elements of the protocol were only moderately achieved. The recall survey among participants showed a positive perception of the sessions (~90 %) and a moderate level of message recall (~65 %). The household survey found that the CPNP participants had higher minimum dietary diversity at the early stage (34·0 v. 19·9 %, P=0·01) and a higher involvement in the Essential Nutrition Action (ENA) programme over a year of follow-up (28·2 v. 18·3 %; P<0·0001) compared with non-participants within the intervention area.

Our PIP analysis suggests that CPNP was feasibly implemented, promoted a sustained utilization of proper feeding behaviours, and enhanced participation in the existing ENA programme. These findings provide a possible explanation to understanding CPNP’s effectiveness.

We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition.

(Part A) A systematic review and meta-analysis informing (Part B) the intervention analysed in the world’s largest prospective multi-centre cohort study on hands-on cooking and nutrition education for medical trainees, providers and patients.

(A) Medical educational institutions. (B) Teaching kitchens.

(A) Medical trainees. (B) Trainees, providers and patients.

(A) Of the 212 citations identified (n 1698 trainees), eleven studies met inclusion criteria. The overall effect size was 9·80 (95 % CI (7·15, 12·45) and 95 % CI (6·87, 13·85); P < 0·001), comparable with the machine learning (ML)-augmented results. The number needed to treat for the top performing high-quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study were applied for medical trainees and providers who subsequently taught patients in the same curriculum (n 5847). The intervention compared with standard medical care and education alone significantly increased the odds of superior diets (high/medium v. low Mediterranean diet adherence) for residents/fellows most (OR 10·79, 95 % CI (4·94, 23·58); P < 0·001) followed by students (OR 9·62, 95 % CI (5·92, 15·63); P < 0·001), providers (OR 5·19, 95 % CI (3·23, 8·32), P < 0·001) and patients (OR 2·48, 95 % CI (1·38, 4·45); P = 0·002), results consistent with those from ML.

The current study suggests that medical trainees and providers can improve patients’ diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.

To identify the most cost-effective options/contributors of under-consumed food groups and nutrients in the USA.

Twenty-four-hour dietary recall data were used for the dietary sources of under-consumed food groups and nutrients. Costs were estimated using USDA National Food Price Database 2001–2004 after adjustments for inflation using Consumer Price Index.

National Health and Nutrition Examination Survey, 2013–2016.

A total of 10 112 adults aged 19+ years.

Top five cost-effective options for food groups were apple and citrus juice, bananas, apples, and melons for fruit; baked/boiled white potatoes, mixtures of mashed potatoes, lettuce, carrots and string beans for vegetables; oatmeal, popcorn, rice, yeast breads and pasta/noodles/cooked grains for whole grain; and reduced-fat, low-fat milk, flavoured milk and cheese for dairy. Top five cost-effective sources of under-consumed nutrients were rice, tortillas, pasta/noodles/cooked grains, rolls and buns, and peanut butter–jelly sandwiches for Mg; grits/cooked cereals, low- and high-sugar ready-to-eat (RTE) cereal, rolls and buns, and rice for Fe; low- and high-sugar RTE cereals, rice, protein and nutritional powders, and rolls and buns for Zn; carrots, margarine, other red and orange vegetables, liver and organ meats, butter and animal fats for vitamin A; and citrus juice, other fruit juice, vegetable juice, mustard and other condiments, and apple juice for vitamin C.

Apple/citrus juice, white potatoes/carrots, oatmeal, RTE cereals and milk were the most cost-effective food sources of multiple under-consumed food groups and nutrients and can help promote healthy eating habits at minimal cost.

Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity.

Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey.

Washington State, USA.

Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more.

The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not.

Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity.

Navajo Nation residents experience extreme rates of poverty, food insecurity and diet-related diseases. While many residents travel far to shop at grocery stores, there are small stores closer to home that could provide more healthy options, like fruits and vegetables (F&V). Little is known from the perspective of store owners and managers regarding the barriers and facilitators to offering F&V; the present study contributes to filling that gap.

Data were collected through structured interviews from a sampling frame of all store owners or managers in the setting (n 29).

Small stores in Navajo Nation, New Mexico, USA. Navajo Nation is predominantly rural and the largest federally recognized Native American tribe in the USA.

Sixteen managers and six owners at twenty-two stores.

When asked about the types of foods that were most commonly purchased at their stores, most participants reported snacks and drinks (82 and 68 %, respectively). Many participants reported they would like to offer more fresh F&V. However, barriers included varying perceived customer demand, limited F&V choices from distributors and (for some managers) limited authority over product selection.

Findings contribute to the discussion on engaging store owners and managers in providing quality, healthy foods close to home in low-income, rural regions.

To explore stakeholder perspectives regarding online diabetes nutrition education for American Indians and Alaska Natives (AI/AN) with type 2 diabetes (T2D).

Qualitative data were collected through focus groups and interviews. Focus group participants completed a brief demographic and internet use survey.

Focus groups and community participant interviews were conducted in diverse AI/AN communities. Interviews with nationally recognised content experts were held via teleconference.

Eight focus groups were conducted with AI/AN adults with T2D (n 29) and their family members (n 22). Community participant interviews were conducted with eleven clinicians and healthcare administrators working in Native communities. Interviews with nine content experts included clinicians and researchers serving AI/AN.

Qualitative content analysis used constant comparative method for coding and generating themes across transcripts. Descriptive statistics were computed from surveys. AI/AN adults access the internet primarily through smartphones, use the internet for many purposes and identify opportunities for online diabetes nutrition education.

Online diabetes nutrition education may be feasible in Indian Country. These findings will inform the development of an eLearning diabetes nutrition education programme for AI/AN adults with T2D.

To examine the relationship between food insecurity and child well-being indicators.

Cross-sectional survey conducted in 2344 households with children. The main exposure measure was food insecurity status, which was categorized as food secure or food insecure based on two or more food insecurity questions answered in the affirmative. Multiple logistic regression analysis was used to model the association between food insecurity status and selected child well-being indicators.

Barbados, St. Lucia and St. Vincent and the Grenadines (hereafter St. Vincent), three Eastern Caribbean countries, 2005.

A random sample of households with children was identified by the governments of Barbados, St. Lucia and St. Vincent. In-home interviews were conducted by social workers.

One-third (33 %) of households were categorized as food insecure. Food-insecure households were more likely to include a chronically ill parent (OR = 2·48; 95 % CI 1·76, 3·49), a recently divorced parent (OR = 1·92; 95 % CI 1·21, 3·05), a child requiring multiple visits to a health-care provider for a disability (OR = 3·98; 95 % CI 1·20, 13·19) or injury (OR = 1·78; 95 % CI 1·12, 2·83), a child with a learning disability (OR = 2·08; 95 % CI 1·16, 3·74) or a child with a physical disability (OR = 2·54; 95 % CI 1·22, 5·32) after adjustment for poverty and other demographic variables.

The results indicate that food-insecure households were more likely to be burdened by child disability (learning and physical), family system disruption (recent divorce and chronic illness) and child health-care needs (for disability and injury) than food-secure households. The implementation of programmes and policies to minimize food insecurity in the Eastern Caribbean may be warranted.

To describe the duration of breast-feeding between 1990 and 2013 and to estimate the association between breast-feeding duration and sociodemographic, health and pro-breast-feeding policies and programmes in Latin American countries.

This is a cross-sectional study with data from Demographic and Health Surveys programme conducted in Bolivia, Brazil, Colombia, Peru and the Dominican Republic between 1990 and 2013. The median duration of breast-feeding was estimated by survival analysis. Information on pro-breast-feeding policies and programmes was extracted from the World on Breastfeeding Trends Initiative (WBTi) tool. The association between the duration of breast-feeding and WBTi tool score was analysed by multilevel survival regression.

Nationally representative cross-sectional survey from Bolivia, Brazil, Colombia, Peru and Dominican Republic.

We included children under 24 months of age, totalling 17 318 children.

Breast-feeding duration showed a significant increase in all countries, except the Dominican Republic. Mothers with higher schooling level (HR = 1·66; 95 % CI 1·35, 2·04), higher income (HR = 1·58; 95 % CI 1·40, 1·77) and overweight (HR = 1·14; 95 % CI 1·05, 1·23) breastfed for a shorter time. Breast-feeding in the first hour of life (HR = 0·79; 95 % CI 0·74, 0·83) was associated with increase in the duration of breast-feeding. Regarding WBTi, Peru presented the lowest score and the Dominican Republic presented the highest score. WBTi score was inversely related to the duration of breast-feeding for this set of countries (HR = 1·07; 95 % CI 1·02, 1·12).

Mothers with better socio-economic conditions and overweight breastfed for a shorter time. Breast-feeding in the first hour was associated with longer duration of breast-feeding. In this set of countries, higher scores from WBTi tool did not result in longer duration of breast-feeding.

Stunting (height-for-age < −2 sd) is one of the forms of undernutrition and is frequent among children of low- and middle-income countries. But stunting perse is not a synonym of undernutrition. We investigated association between body height and indicators of energetic undernutrition at three critical thresholds for thinness used in public health: (1) BMI SDS < −2; (2) mid-upper arm circumference divided by height (MUAC (mm) × 10/height (cm) < 1·36) and (3) mean skinfold thickness (SF) < 7 mm and to question the reliability of thresholds as indicators of undernutrition.

Cross-sectional study; breakpoint analysis.

Rural and urban regions of Indonesia and Guatemala – different socio-economic status (SES).

1716 Indonesian children (6·0–13·2 years) and 3838 Guatemalan children (4·0–18·9 years) with up to 50 % stunted children.

When separating the regression of BMI, MUAC or SF, on height into distinguishable segments (breakpoint analysis), we failed to detect relevant associations between height, and BMI, MUAC or SF, even in the thinnest and shortest children. For BMI and SF, the breakpoint analysis either failed to reach statistical significance or distinguished at breakpoints above critical thresholds. For MUAC, the breakpoint analysis yielded negative associations between MUAC/h and height in thin individuals. Only in high SES Guatemalan children, SF and height appeared mildly associated with R2 = 0·017.

Currently used lower thresholds of height-for-age (stunting) do not show relevant associations with anthropometric indicators of energetic undernutrition. We recommend using the catch-up growth spurt during early re-feeding instead as immediate and sensitive indicator of past undernourishment. We discuss the primacy of education and social-economic-political-emotional circumstances as responsible factors for stunting.

Asians and Pacific Islanders have higher circulating serum ferritin (SF) compared with Caucasians but the clinical significance of this is unclear. There is a higher prevalence of metabolic syndrome (MetS) in Taiwanese Indigenous than Han Chinese. Genetically, Indigenous are related to Austronesians and account for 2 % of Taiwan's population. We tested the hypothesis that accumulation of Fe in the body contributes to the ethnic/racial disparities in MetS in Taiwan.

A population-based, cross-sectional study.

National Nutrition and Health Survey in Taiwan and Penghu Island.

A total of 2638 healthy adults aged ≥19 years. Three ethnic groups were included.

Han Chinese and Indigenous people had comparable levels of SF. Austronesia origin was independently associated with MetS (OR = 2·61, 95 % CI 2·02, 3·36). After multiple adjustments, the odds for MetS (OR = 2·49, 95 % CI 1·15, 5·28) was significantly higher among Indigenous people in the highest SF tertile compared with those in the lowest tertile. Hakka and Penghu Islanders yielded the lowest risks (OR = 1·08, 95 % CI 0·44, 2·65 and OR = 1·21, 95 % CI 0·52, 2·78, respectively). Indigenous people in the highest SF tertile had increased risk for abnormal levels of fasting glucose (OR = 2·34, 95 % CI 1·27, 4·29), TAG (OR = 1·94, 95 % CI 1·11, 3·39) and HDL-cholesterol (OR = 2·10, 95 % CI 1·18, 3·73) than those in the lowest SF tertile.

Our results raise the possibility that ethnic/racial differences in body Fe store susceptibility may contribute to racial and geographic disparities in MetS.

(i) To map how US adults value ‘choice’ in the context of obesity policy and (ii) to discuss implications for obesity prevention in children.

Semi-structured interviews (n 105) were conducted between 2006 and 2009 about causes of and solutions to childhood obesity. Quotes captured in field notes from community meetings (n 6) on childhood obesity prevention were also analysed. Each use of the word ‘choice’ and its variants was identified in these texts. Content and discourse were analysed to identify the implied values and meaning in each use.

North-eastern USA.

One hundred and five adults, some involved in childhood obesity prevention initiatives.

Three distinct frames of ‘choice’ emerged: (i) having choices (choice as freedom), (ii) making choices (choice as responsibility) and (iii) influencing choices (contextual constraints and impacts on choice). Many speakers used more than one frame over the course of an interview. Most people using the third frame seemed to share the values behind the first two frames, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a ‘social contract’.

Public debate in the USA about responsibility for and solutions to rising obesity rates often hinges on notions of ‘choice’. These frames, and the values underlying them, are not mutually exclusive. Respecting the values behind each ‘choice’ frame when crafting obesity prevention policy and employing all three in public communications about such policy may facilitate greater consensus on prevention measures.

To introduce community-specific modifications in the conventional 24 h recall method for objectively estimating maternal dietary intake and validate it with a reference method.

A modified 24 h recall method was developed with the visit of trained local girls at the subject’s home to weigh portion sizes at each mealtime over the 24 h recall period. This was validated with the reference method in which weighed records of the foods consumed were obtained and their laboratory analysis was done to obtain nutrient intakes.

Rural areas located 40–50 km from Pune City, India.

Forty-one pregnant women participated willingly.

The estimates of intake obtained from the reference method were comparable to those obtained from the modified 24 h recall method for energy (7795 (sd 1841) kJ (1863 (sd 440) kcal) v. 7615 (sd 1824) kJ (1820 (sd 436) kcal), respectively), protein (48·6 (sd 12·9) g v. 45·3 (sd 12·6) g, respectively) and fat (35·3 (sd 16·6) g v. 36·0 (sd 14·2) g, respectively). Significant correlation was observed between the estimates obtained by the two methods for energy (0·75, P < 0·001), protein (0·71, P < 0·001) and fat (0·56, P < 0·001) and differences in nutrient intake did not reveal any systematic bias. When compared with the reference method, the modified method showed >80 % sensitivity and specificity for identifying inadequate maternal energy intakes.

Simple modifications to conventional methods backed by understanding of community specifics and nutritional peculiarities are of immense importance in obtaining objective estimates of daily nutritional intakes of individuals in free-living populations. The approach would be adaptable in similar settings in other developing countries.

Relationships among race/ethnicity, individual socio-economic status (SES), neighbourhood SES and acculturation are complex. We sought to answer whether: (i) race/ethnicity, individual SES and neighbourhood SES have independent effects on women’s fruit and vegetable consumption (FVC); (ii) SES modifies the effects of race/ethnicity on FVC; and (iii) nativity modifies the effect of Latina ethnicity on FVC.

Cross-sectional surveys from the population-based Geographic Research on Wellbeing (GROW) Study were linked with census-tract level data. FVC was indicated by (i) consuming fruits and vegetables less often than daily (LOWFV) and (ii) not having fruits and vegetables in the home very often. Other variables included age, marital status, race/ethnicity, country of birth, educational attainment, family income and longitudinal neighbourhood poverty (based on latent class growth models). Weighted logistic regression models accounting for the complex sample design were constructed.

California, USA, 2012–2013.

Women (n 2669).

In adjusted models, race/ethnicity, education and income were independently associated with FVC, but not neighbourhood poverty. Women of colour, high-school graduates and women with incomes at 301–400 % of the federal poverty level were at higher odds of LOWFV compared with non-Hispanic Whites, college graduates and those with incomes >400 % of the federal poverty level. Little evidence for interactions between race/ethnicity and individual or neighbourhood SES was found; similar patterns were observed for immigrant and US-born Latinas.

Addressing the dietary needs of lower-SES communities requires multilevel interventions that simultaneously provide culturally tailored nutrition education and address the physical and economic accessibility of culturally acceptable fruits and vegetables.

To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function.

Cohort study.

The metropolitan region of Salvador, Bahia, Brazil.

The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis.

Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <−0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99).

Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

To describe which functions potential employers of public health nutritionists in Norway find important for a person trained in public health nutrition to be able to carry out. Further, to illustrate how the findings were used in the development of a curriculum for a bachelor in public health nutrition at Akershus University College.

A non-random, cross-sectional survey using a questionnaire with both pre-coded and open-ended questions.

Ninety-one establishments working in various fields more or less related to nutrition responded (response rate of 45 %).

Local offices of the Norwegian Food Safety Authority were over-represented among respondents. Functions related to communication and food and nutrition laws and regulations were most frequently rated as important by the respondents. Functions in nutrition research, project work and policy and planning were also regarded important by more than half of the respondents. The priorities of the potential employers together with the additional comments and suggestions were taken into account when a new curriculum on public health nutrition was developed.

The assessment of functions prioritised by employers of public health nutritionists gave a valuable input for developing a new curriculum in public health nutrition. It reflected the challenges of the real world that public health nutritionists will work in and therefore helped making the curriculum potentially more relevant.

Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups.

Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries.

Focus groups with adolescents and caregivers carried out by trained researchers.

Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to ‘belong’ in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time.

Interventions to improve adolescents’ diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.

Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk.

Prospective cohort study.

We followed participants in the Hordaland Health Study, Norway from 1997–1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410–414 and ICD10 codes I20–I25).

2995 men and women, aged 46–49 years.

Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90).

Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD.

To identify the association of the glucokinase gene (GCK) rs4607517 polymorphism with gestational diabetes mellitus (GDM) and determine whether sweets consumption could interact with the polymorphism on GDM in Chinese women.

We conducted a case–control study at a hospital including 1015 participants (562 GDM cases and 453 controls). We collected the data of pre-pregnancy BMI, sweets consumption and performed genotyping of the GCK rs4607517 polymorphism. Logistic regression was performed to test the association between the rs4607517 polymorphism and GDM, and the stratified analyses by sweets consumption were conducted, using an additive genetic model.

A case–control study of women at a hospital in Beijing, China.

One thousand and fifteen Chinese women.

The GCK rs4607517 A allele was significantly associated with GDM (OR 1·35, 95 % CI 1·03, 1·77; P = 0·028). Furthermore, stratified analyses showed that the A allele increased the risk of GDM only in women who had a habitual consumption of sweet foods (sweets consumption ≥ once per week) (OR 1·61, 95 % CI 1·17, 2·21; P = 0·003). Significant interaction on GDM was found between the rs4607517 A allele and sweets consumption (P = 0·004).

This study for the first time reported the interaction between the GCK rs4607517 polymorphism and sweets consumption on GDM. The results provided novel evidence for risk assessment and personalised prevention of GDM.

To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.

Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.

All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.

Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011–2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).

The proportion of products carrying claims that do not meet nutrient profiling and consumers’ tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.