To understand the different Na menu labelling approaches that have been considered by state and local policymakers in the USA and to summarise the evidence on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers.

Proposed and enacted Na menu labelling laws at the state and local levels were reviewed using legal databases and an online search, and a narrative review of peer-reviewed literature was conducted on the relationship between Na menu labelling and Na content of menu items offered by restaurants or purchased by consumers.

Local and state jurisdictions in the USA

Not applicable.

Between 2000 and 2020, thirty-eight laws – eleven at the local level and twenty-seven at the state level – were proposed to require Na labelling of restaurant menu items. By 2020, eight laws were enacted requiring chain restaurants to label the Na content of menu items. Five studies were identified that evaluated the impact of Na menu labelling on Na content of menu items offered by restaurants or purchased by consumers in the USA. The studies had mixed results: two studies showed a statistically significant association between Na menu labelling and reduced Na content of menu items; three showed no effects.

Data suggest that Na menu labelling may reduce Na in restaurant menu items, but further rigorous research evaluating Na menu labelling effects on Na content of menu items, as well as on the Na content in menu items purchased by consumers, is needed.

To investigate whether maternal/caregiver’s age, infant age (0–6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia.

A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle–Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done.

All observational studies conducted in Ethiopia.

Mothers of children aged less than 2 years.

A total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver’s age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver’s age (OR=1·09; 95 % CI 0·84, 1·41).

There was no association between maternal/caregiver’s age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.

A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.

A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.

Fifty-eight households, with at least one child living in the home.

During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.

At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

To determine the prevalence of high weight at different characteristics, understand the perceptions and behaviours towards high body weight, and determine potential influencing factors of body weight misperception among high-weight adults in Jilin Province.

A cross-sectional survey with complex sampling design was conducted. We described the prevalence and perception of high body weight.

Northeast China in 2012.

Adults (n 20 552) aged 18–79 years.

Of overweight individuals, 37·4 % considered themselves as ‘normal weight’, 4·8 % reported themselves as being ‘very thin’ and only 53·1 % were aware of their own weight being ‘overweight’. About 1·8 % of both male and female obese individuals perceived themselves as ‘very thin’. Only 29·1 % of obese people thought of themselves as ‘too fat’. Nearly 30·0 % of centrally obese men and women perceived that their waist circumference was about right and they were of ‘normal weight’; 5·7 % of the centrally obese even perceived themselves as being ‘very thin’. Only 51·8 and 12·5 % of centrally obese individuals reported themselves to be ‘overweight’ or ‘too fat’. Body weight misperception was more common in rural residents (OR; 95 % CI: 1·340; 1·191, 1·509). The prevalence of body weight misperception increased with age (middle age: 1·826; 1·605, 2·078; old people: 3·101; 2·648, 3·632) and declined with increased education level (junior middle school: 0·628; 0·545, 0·723; senior middle school: 0·498; 0·426, 0·583; undergraduate and above: 0·395; 0·320, 0·487).

Body weight misperception was common among adults from Jilin Province.

To assess the knowledge, opinions and expectations of persons with and without obesity concerning personalised genotype-based nutrition.

Questions about nutrition, weight management and personalised genotype-based dietary recommendations were asked via standardised telephone-based interviews. Sociodemographic and anthropometric data were collected. The data were statistically weighted by age, gender, education, domicile and BMI.

Germany.

Representative sample of the German population (n 1003) randomly sampled via a scientific Random Digit dial method plus 354 adults with a BMI ≥ 30·0 kg/m2 to enlarge the sample.

Data of 1357 participants were analysed (51·1 % female, age: 50·5 ± 18·5 years, 15·9 % adults with a BMI ≥ 30·0 kg/m2). About 42 % or 19 % of the survey participants stated to know the terms personalised dietary recommendation or genotype-based dietary recommendation, respectively. Of those, 15·8 % indicated to have an experience with a personalised or genotype-based dietary recommendation. Almost 70 % of the survey participants believed that a genotype-based dietary recommendation is a reasonable measure for weight management. About 55 % of the survey participants pointed out that a genotype-based dietary recommendation is an effective concept in general. One-third of the survey participants (34·6 %) indicated to conceive the usage of a genotype-based dietary recommendation.

Most of the survey participants did not know the term personalised or genotype-based dietary recommendation. One-third of the study participants are interested to use a genotype-based dietary recommendation. Therefore, more education of the public is necessary to properly help people making informed and serious decisions and assessing commercially available direct-to-consumer genetic tests.

The aim of the study was to describe who ate 5 or more portions of fruit and vegetables per day (‘compliers’) in 1986–1987 and in 2000–2001.

We used data from the Dietary and Nutritional Surveys of British Adults. Each is a nationally representative dietary survey using 7 d weighed food records for men and women, aged 16–64 years, living in private households in Great Britain in 1986–1987 and in 2000–2001.

Great Britain.

Data were analysed for 2197 adults in 1986–1987 and 1724 adults in 2000–2001.

In 1986–1987 12·7 % were classified as ‘compliers’ compared with 16·5 % in 2000–2001. Manual social classes, younger participants and people on benefits or outside paid employment were less likely to be ‘compliers’. Being divorced, widowed or separated was negatively related to being a ‘complier’, as was being in a household with dependant children or a lone parent with dependant children. Between 1986–1987 and 2000–2001 improvements were seen across social class groups and differences between men and women and between regions were reduced.

Only 12·7 % participants in the Dietary and Nutritional Surveys of British Adults were classified as ‘compliers’ in 1986–1987 compared with 16·5 % in 2000–2001. There have been some important changes in the distribution of ‘compliers’, but the low levels overall support the need for a reinvigorated policy drive to improve compliance with fruit and vegetable goals.

To relate empirically derived dietary patterns identified using the Treelet Transform (TT) to risk of stroke.

A prospective cohort study using the Danish Diet, Cancer and Health cohort. Dietary information was obtained in 1993–1997 using a validated semi-quantitative FFQ. Incident stroke diagnoses, obtained from the Danish National Patient Register, were verified by record review. Dietary patterns were generated using TT, and participants were categorised into quintiles based on their adherence to each pattern. Sex-specific Cox proportional hazard models estimated associations between dietary patterns and stroke.

Denmark.

55 061 men and women aged 50–64 years at the time of enrolment.

Three dietary patterns explaining 15·4 % of the total variance were identified: a Prudent pattern, a Western pattern and a Wine & Snacks pattern. During a follow-up time of 10 years, 1513 cases occurred. Comparing the highest to lowest quintiles of intake, adherence to a Prudent pattern was inversely associated with stroke (HRmen 0·74, 95 % CI 0·60, 0·91; HRwomen 0·82, 95 % CI 0·62, 1·08), while adherence to a Western pattern was associated with greater risk (HRmen 1·61, 95 % CI 1·23, 2·10; HRwomen 2·01, 95 % CI 1·48, 2·72). No association was found for a Wine & Snacks pattern for women, but a weak inverse association was found for men (HR 0·81, 95 % CI 0·67, 0·99).

The results of this study are broadly in line with current recommendations for a healthy diet to prevent stroke.

The present study investigates whether public organic food procurement policies have the potential to induce changes in the school food service environment.

A comparative cross-national survey was conducted in public primary and/or secondary schools in Finland, Germany and Italy. The school food coordinators completed a web-based questionnaire on their attitudes, intentions and actions towards organic school food provision.

In Germany, 122 out of 2050 schools in the state of Hesse responded. In Finland, 250 out of 998 schools across the country responded. In Italy, 215 out of 940 schools from eight provinces responded.

School food coordinators in the sample of schools in the three countries.

The German and Finnish school food coordinators separately most agreed with the promotion of healthy eating habits (P < 0·001) and organic food (P < 0·001) by schools. The Finnish schools were most likely to adopt a food and nutrition policy (P < 0·001), a health-promoting school policy according to WHO principles (P < 0·001), to have a playground (P < 0·001), to involve physical activity themes in teaching (P = 0·012) and to have a canteen (P < 0·001). The Italian schools were most likely to involve the food and nutrition policy in pedagogical activities (P = 0·004), to serve nutritional school meals (P < 0·001) and to recommend children to eat healthily (P < 0·001). In the three countries, the non-organic schools were less likely to adopt a food and nutrition policy (P < 0·001), a WHO health-promoting policy (P < 0·001) and have a canteen (P = 0·017) than the organic schools.

The study suggests that there is a gap in the effects of public organic food procurement policy on building a healthier school food environment.

To investigate the determinants of mild-to-moderate malnutrition in preschoolers.

Cross-sectional study conducted in October and November 1996, with a representative sample of 1740 children less than 5 years old from the city of Salvador, situated in the Brazilian Northeastern region. Socio-economic and dietary data were collected through a structured questionnaire. Anthropometric measures were performed in duplicate and data analysis was based upon the hierarchical model approach. Logistic regression analysis was used to estimate the prevalence ratio and to identify the determinants of mild-to-moderate deficits in weight-for-age and height-for-age Z-scores.

Family monthly income under US$67.00 per capita and family headed by a woman were the main basic determinants of mild-to-moderate weight-for-age and height-for-age deficits in the studied children. Household agglomeration, an underlying determinant, was associated with weight-for-age and height-for-age deficits. Among the immediate determinants, age above 6 months and dietary caloric availability in the lowest tertile (<930 kcal day−1) were also associated with weight-for-age deficits. In addition to these, hospitalisation in the 12 months preceding the interview was shown to be a predictor of mild-to-moderate weight-for-age and height-for-age deficits.

Adverse social and economic factors interact with family environmental factors to define food consumption and morbidity patterns that culminate in a high prevalence of mild-to-moderate malnutrition. The strengthening and restructuring of nutrition and healthcare actions, the definition of public policies that improve family income, and the adequate insertion of women in the labour market are possible strategies to reduce mild-to-moderate malnutrition and to sustain the decline already observed in severe malnutrition.

To explore the association between behavioural characteristics with the prevalence of abdominal obesity (AO) among a population of Southern Brazilian shift working women.

A cross-sectional study was conducted. AO was estimated using waist circumference (WC), and it was used to classify women as having AO (WC ≥ 88 cm). Prevalence ratios were estimated using Poisson regression with robust variance.

A large plastic utensils company in Southern Brazil.

450 female shift workers.

The prevalence of the AO in the women shift workers was 44·5 % (95 % CI 40·0, 49·2 %). In night shift workers, the prevalence of AO was 56·1 % compared with 40·9 % among hybrid shift workers. After adjustments for covariates, women who were current smokers had a decrease in the prevalence of AO compared with those who never smoked. Women who had three or fewer meals per day had a 46 % increase in the AO prevalence compared with those eating more frequent meals. Night shift work was associated with increase in AO prevalence compared with hybrid shift (PR 1·33; 95 % CI: 1·08, 1·64).

Our findings indicate that behavioural characteristics are associated with a high prevalence of AO in female shift workers, thus suggesting that behavioural modifications among women working shifts, such as increase in meal frequency and physical activity, may reduce AO.

To receive stakeholders’ feedback on the new structure of the Nutritional Disorders section of the International Classification of Diseases, 11th Revision (ICD-11).

A twenty-five-item survey questionnaire on the ICD-11 Nutritional Disorders section was developed and sent out via email. The international online survey investigated participants’ current use of the ICD and their opinion of the new structure being proposed for ICD-11. The LimeSurvey® software was used to conduct the survey. Summary statistical analyses were performed using the survey tool.

Worldwide.

Individuals subscribed to the mailing list of the WHO Department of Nutrition for Health and Development.

Seventy-two participants currently using the ICD, mainly nutritionists, public health professionals and medical doctors, completed the questionnaire (response rate 16 %). Most participants (n 69) reported the proposed new structure will be a useful improvement over ICD-10 and 78 % (n 56) considered that all nutritional disorders encountered in their work were represented. Overall, participants expressed satisfaction with the comprehensiveness, clarity and life cycle approach. Areas identified for improvement before ICD-11 is finalized included adding some missing disorders, more clarity on the transition to new terminology, links to other classifications and actions to address the disorders.

The Nutritional Disorders section being proposed for ICD-11 offers significant improvements compared with ICD-10. The new taxonomy and inclusion of currently missing entities is expected to enhance the classification and health-care professionals’ accurate coding of the full range of nutritional disorders throughout the life cycle.

To evaluate the awareness and knowledge about weight status and its management.

A 1 d cross-sectional survey. Basic anthropometric assessments (weight, height, BMI and waist circumference) and a self-administered questionnaire were considered.

Nineteen Clinical Nutrition or Endocrinology and Metabolic Disorders Units or Dietetics Services in the Italian region of Lombardy.

All adults attending the ‘Obesity Day’ initiative.

A total of 914 participants (605 female and 309 male) were recruited. Although most of the participants (83·5 %) considered obesity to be a disease, 38·5 % were likely to misperceive their weight status. In particular, 38·8 % of normal-weight adults believed themselves to be overweight, whereas 71·1 % and 37·5 % of classes I and II/III obese adults classified themselves as being overweight and mildly obese, respectively. However, most of the overweight (90·2 %), mildly (96·8 %) and moderately/severely obese adults (99·1 %) recognized the need to lose weight. In all, 37·8 % of the sample underestimated the role of physical activity in weight management. Interestingly, only 17·2 % of dieters (previous or current) declared being advised by their doctor to lose weight. Multivariate models revealed that higher age, low education and higher BMI were important determinants of poor weight control and management. In addition, previous dieting appeared not to provide better knowledge, whereas the role of physical activity was recognized mainly by those practising it.

The present study suggests that in Italy knowledge about weight management should be improved not only in the general population but also among health-care professionals. To confirm this finding, there is now the rationale for a nationally representative survey. New educational programmes can be designed on the basis of the information collected.

Iodine deficiency still remains a major public health concern worldwide despite global progress in its elimination. The aims of the present study were to evaluate dietary iodine status in the mother and one adult member of each family and the association between mothers’ knowledge, attitude and behaviour and the dietary iodine status of adult family members in Tehran.

In this cross-sectional study, 24 h urinary iodine and Na concentrations and the iodine content of household salt were measured. Mothers’ knowledge, attitude and behaviour were assessed using a questionnaire administered in face-to-face interviews.

Health-care centres from four distinct areas of Tehran.

Mother–adult family member pairs aged ≥19 years (n 290), enrolled through randomized cluster sampling.

In mothers and adult family members, median 24 h urinary iodine concentration was 73 (interquartile range (IQR) 36–141) µg/l and 70 (IQR 34–131) µg/l, dietary iodine intake was 143 (IQR 28–249) µg/d and 130 (IQR 26–250) µg/d and dietary salt intake was 8·0 (IQR 5·9–10·2) g/d and 7·5 (IQR 5·3–10·0) g/d, respectively. Significant correlations were observed between mothers’ attitude and behaviour and the 24 h urinary iodine concentration, dietary iodine intake and iodine content of salt of adult family members. In multiple analysis, lower quartiles of salt iodine content and salt intake and inappropriate behaviour scores in mothers increased the risk of urinary iodine concentration <100 µg/l in adult family members.

The present study showed that mothers’ behaviour, but not knowledge and attitude, was among major contributors to the suboptimal dietary iodine status observed in adult family members.

To examine changes in the age-specific prevalence of overweight and obesity in Japanese children between 2000 and 2005 and compare Japanese centile curves with international ones.

A large, Japanese, representative cross-sectional growth study.

Japan.

Japanese children aged 5–17 years, including 669 986 subjects in 2000, 670 143 in 2001, 668 760 in 2002, 670 785 in 2003, 669 120 in 2004 and 668 234 in 2005.

BMI (weight/height2).

The prevalence of overweight and obesity in children aged 5–17 years decreased from 2000 to 2005 in both males and females, according to the definitions of the Centers for Disease Control and Prevention and the International Obesity Taskforce. For each year, the centile curves were drawn so that at age 17 years they passed through respectively 24·46 kg/m2 and 24·70 kg/m2 for males, and 29·41 kg/m2 and 29·69 kg/m2 for females, which are the BMI values at age 17 years from the international reference curves.

The study results indicate that centile curves can change according to the time of observation, thus suggesting that international reference curves therefore need to be regularly revised while including more data from a larger range of countries.

We investigated the association of dietary Mg intake with insulin resistance and markers of endothelial function among Iranian women.

A cross-sectional study.

Usual dietary intakes were assessed using a validated FFQ. Dietary Mg intake was calculated by summing up the amount of Mg in all foods. A fasting blood sample was taken to measure serum concentrations of glycemic indices (fasting plasma glucose and insulin) and endothelial function markers (E-selectin, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1). Insulin resistance and sensitivity were estimated using the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), Homeostasis Model Assessment β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI).

Iranian female nurses (n 345) selected by a multistage cluster random sampling method.

The Mg intake across energy-adjusted quartiles was 205 (se 7), 221·4 (se 8), 254·3 (se 7) and 355·2 (se 9) mg/d, respectively. After adjustments for potential confounders, QUICKI level was significantly different across quartiles of Mg intake (Q1: 0·34 (se 0·02), Q2: 0·36 (se 0·01), Q3: 0·40 (se 0·01), and Q4: 0·39 (se 0·02), P = 0·02); however, this association disappeared after considering markers of endothelial function, indicating that this relation might be mediated through endothelial dysfunction. After controlling for all potential confounders, Mg intake was inversely, but not significantly, associated with serum concentrations of sICAM (Q1: 239 (se 17), Q2: 214 (se 12), Q3: 196 (se 12), and Q4: 195 (se 17), P = 0·29). There was no other significant association between dietary Mg intake and other indicators of glucose homoeostasis or endothelial markers.

Higher dietary Mg intake was associated with better insulin sensitivity in Iranian females. This linkage was mediated through reduced endothelial dysfunction.

To study the association of fish and fish-liver oil consumption across the lifespan with CHD later in life among Icelandic women, with special emphasis on the effects of consumption in adolescence.

Prevalence association study. Logistic regression was used to estimate odds ratios and 95 % confidence intervals of CHD according to fish or fish-liver oil exposure. Models were adjusted for age, education, concurrent diet and other known risk factors.

The study was nested within the AGES-Reykjavik Study, conducted in Reykjavik, Iceland.

Participants were 3326 women aged 66–96 years, with available information on CHD status at entry to the study and information on fish and fish-liver oil consumption during midlife and adolescence. Dietary habits were assessed retrospectively using a validated FFQ.

CHD was identified in 234 (7·9 %) women. Compared with women with no intake of fish-liver oil in adolescence or midlife, women who consumed fish-liver oil at least three times weekly in adolescence or in midlife had a decreased risk of CHD (OR=0·62; 95 % CI 0·45, 0·85 and OR=0·68; 95 % CI 0·50, 0·94, respectively). No associations were observed between fish intake (>2 portions/week v. ≤2 portions/week) in adolescence or midlife and CHD in this population with high fish intake.

Fish-liver oil consumption, from early life, may reduce the risk of CHD in older women. Lifelong nutrition may be of importance in the prevention of CHD in older women.

We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children.

Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks’ gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4–6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children’s percentage body fat with maternal and child factors by regression analysis.

Eastern Region, Ghana.

Children 4–6 years of age.

The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (−0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (−0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001).

In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available.

To assess and compare the (macro-)nutritional composition of red meat (RM) and poultry meat (PM) products with the emerging category of meat substitutes.

We use information on nutritional values per 100 g to estimate the differences in the nutritional composition between RM, PM, vegan meat substitute (VMS) and non-vegan meat substitute (NVMS) and derive six unique meat product clusters to enhance the comparability.

Meat markets from five major European countries: France, Germany, UK, Italy and Spain.

Product innovation data for 19 941 products from Mintel’s Global New Product Database from 2010 to 2020.

Most of the innovations in the sample are RM products (55 %), followed by poultry (30 %), VMS (11 %) and NVMS (5 %). RM products exhibit a significantly higher energy content in kcal/100 g as well as fat, saturated fat, protein and salt all in g/100 g than the meatless alternatives, while the latter contain significantly more carbohydrates and fibre than either poultry or RM. However, results differ to a certain degree when products are grouped into more homogeneous clusters like sausages, cold cuts and burgers. This indicates that general conclusions regarding the health effects of substituting meat with plant-based alternatives should only be drawn in relation to comparable products.

Meat substitutes, both vegan and non-vegan, are rated as ultra-processed foods. However, compared with RM products, they and also poultry products both can provide a diet that contains fewer nutrients-to-limit, like salt and saturated fats.