To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers.

Review of operational acute malnutrition treatment records.

Twenty-one outpatient therapeutic feeding clinics in rural Malawi.

Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6–9 months of age who were being treated at the same time in the same location in the context of two different randomised clinical trials.

A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6–9 months old with acute malnutrition (seventy-four severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75·4 %) achieved nutritional recovery; in comparison, 56 (75·7 %) of those with severe acute malnutrition 6–9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81·3 %) recovered; in comparison, 241 (85·2 %) of those aged 6–9 months recovered.

In a rural Malawian population of infants u6m who had generally already stopped exclusive breast-feeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

American Indian and Alaska Native peoples (AI/AN) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/AN. Thus, our study assessed social determinants of obesity in AI/AN aged ≥ 50 years.

We conducted a cross-sectional analysis using multivariate generalised linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30·0 kg/m2). Analyses were conducted for the total study population and stratified by median county poverty level.

Indian Health Service (IHS) data for AI/AN who used IHS services in FY2013.

Totally, 27 696 AI/AN aged ≥ 50 years without diabetes.

Mean BMI was 29·8 ± 6·6 with 43 % classified as obese. Women were more likely to be obese than men, and younger ages were associated with higher obesity risk. While having Medicaid coverage was associated with lower odds of obesity, private health insurance was associated with higher odds. Living in areas with lower rates of educational attainment and longer drive times to primary care services were associated with higher odds of obesity. Those who lived in a county where a larger percentage of people had low access to a grocery store were significantly less likely to be obese.

Our findings contribute to the understanding of social determinants of obesity among older AI/AN and highlight the need to investigate AI/AN obesity, including longitudinal studies with a life course perspective to further examine social determinants of obesity in older AI/AN.

A family of nutrient-rich food (NRF) indices was validated against the mean adequacy ratio (MAR) and their associations with obesity were tested.

Cross-sectional study. NRF indices include nutrients to encourage ranging from 6–11 (protein; fibre; vitamin A, vitamin C, vitamin E and vitamin B12; Ca; Fe; K; Mg; Zn) and two nutrients to limit (saturated fat and Na), described as NRFn.2 (where n 6–11), based on reference amount of 100 g or 100 kcal using the NRF index family of algorithms. The percentage of variation in MAR (R 2) was the criteria of index performance. Logistic regression models were applied to predict the association between NRF index and obesity.

Three communities in Zhengzhou city, Henan province, China.

A total of 656 adults were recruited from Henan as the subjects.

The NRF9·2 index, based on nine beneficial nutrients and two nutrients to limit, using the algorithm based on sums and 100 kcal, had the higher R 2 values (R 2 = 0·232). The OR for overweight (defined by BMI) in the 4th quartile (Q4) v. the 1st quartile (Q1) of the NRF9·2 index was 0·61 (95 % CI = 0·37, 0·98) after multiple adjustments.

NRF9·2 index using the algorithm based on sums and 100 kcal gave the best predicted model for diet quality. NRF9·2 index score was associated with overweight defined by BMI, but it was not associated with central obesity. The NRF9·2 index is a valid tool to assess the overall diet quality among adults in Henan province of China.

To assess the associations among several anthropometric measures, as well as BMI trajectories and colorectal cancer (CRC) risk in older women.

Prospective cohort study.

Forty clinical centres in the USA.

Totally, 79 034 postmenopausal women in the Women’s Health Initiative Observational Study.

During an average of 15·8 years of follow-up, 1514 CRC cases were ascertained. Five BMI trajectories over 18–50 years of age were identified using growth mixture model. Compared with women who had a normal BMI at age 18, women with obesity at age 18 had a higher risk of CRC (HR 1·58, 95 % CI 1·02, 2·44). Compared with women who kept relatively low normal body size during adulthood, women who progressed from normal to obesity (HR 1·29, 95 % CI 1·09, 1·53) and women who progressed from overweight to obesity (HR 1·37, 95 % CI 1·13, 1·68) had higher CRC risks. A weight gain > 15 kg from age 18 to 50 (HR 1·20, 95 % CI 1·04, 1·40) and baseline waist circumference > 88 cm (HR 1·33, 95 % CI 1·19, 1·49) were associated with higher CRC risks, compared with stable weight and waist circumference ≤ 88 cm, respectively.

Women who have a normal weight in early adult life and gain substantial weight later, as well as those who are persistently heavy over adulthood, demonstrated a higher risk of developing CRC. Our study highlights the importance of maintaining a healthy body weight over the life course for reducing the risk of developing CRC in women.

Observational studies and clinical trials have shown conclusive evidence that periconceptional folic acid supplementation prevents up to 70 % of neural tube defects (NTD). The Honduran government wanted to implement a supplementation programme of folic acid but needed to assess the relative effects of two dosages of folic acid.

To determine the effect of two dosages of folic acid on blood folate levels in Honduran female factory workers aged 18 to 49 years.

This was a randomized, double-blind control supplementation trial conducted in Choloma, Honduras. A total of 140 eligible women were randomly assigned to two dosage groups and followed up for 12 weeks. One group received a daily dosage of 1 mg folic acid and the other a once weekly dosage of 5 mg. Serum folate and red blood cell folate levels were determined by radioassay at baseline, 6 weeks and 12 weeks.

Serum folate levels increased from 6·3 (se 0·2) to 14·9 (se 0·6) ng/ml (P < 0·0001) in women assigned to the 1 mg/d group and from 6·9 (se 0·3) to 10·1 (se 0·4) ng/ml (P < 0·0001) in those assigned to the 5 mg/week group. Red blood cell folate concentrations also increased significantly in both groups, albeit more slowly. Educational level, age and BMI were not associated with the changes in serum and red blood cell folate levels during the supplementation period. However, a differential effect on serum folate levels by dosage group and time was observed.

Although both folate supplementation regimens increased serum and red blood cell folate levels significantly among the women studied, blood folate levels that are considered to be protective of NTD were reached faster with the daily dosage of 1 mg folic acid.

Limited information is available on the prevalence and effect of hypertriglyceridaemic–waist (HTGW) phenotype on the risk of type 2 diabetes mellitus (T2DM) in rural populations.

In the present cross-sectional study, we investigated the prevalence of the HTGW phenotype and T2DM and the strength of their association among rural adults in China.

HTGW was defined as TAG >1·7 mmol/l and waist circumference (WC) ≥90 cm for males and ≥80 cm for females. Logistic regression analysis yielded adjusted odds ratios (aOR) relating risk of T2DM with HTGW.

Adults (n 12 345) aged 22·83–92·58 years were recruited from July to August of 2013 and July to August of 2014 from a rural area of Henan Province in China.

The prevalence of HTGW and T2DM was 23·71 % (males: 15·35 %; females: 28·88 %) and 11·79 % (males: 11·15 %; females: 12·18 %), respectively. After adjustment for sex, age, smoking, alcohol drinking, blood pressure, physical activity and diabetic family history, the risk of T2DM (aOR; 95 % CI) was increased with HTGW (v. normal TAG and WC: 3·23; CI 2·53, 4·13; males: 3·37; 2·30, 4·92; females: 3·41; 2·39, 4·85). The risk of T2DM with BMI≥28·0 kg/m2, simple enlarged WC and simple disorders of lipid metabolism showed an increasing tendency (aOR=1·31, 1·75 and 2·32).

The prevalence of HTGW and T2DM has reached an alarming level among rural Chinese people, and HTGW is a significant risk factor for T2DM.

Hispanic adults in the USA tend to have a disproportionate prevalence of metabolic syndrome (MetS) as compared to other races.

We examined whether the association between acculturation and MetS and its components are mediated by the intake of fruit in Hispanics.

Data from the National Health and Nutrition Examination Surveys 2009–2016 were used in this study.

A total of 2078 Hispanics aged ≥ 20 years were included in this analysis.

The mediating role of total fruit intake was assessed using multivariable-adjusted logistic structural equation models with the bootstrapping method by estimating indirect (IE) and direct (DE) effects from acculturation to MetS. High acculturation was associated with increased odds of MetS (adjusted OR = 1·20, 95 % CI 1·04, 1·39), central obesity (OR = 1·24, 95 % CI 1·07, 1·44) and high blood pressure (OR = 1·16, 95 % CI 1·02, 1·32) among Hispanic adults. Total fruits intake partially mediated the associations of acculturation with MetS (ORIE = 1·02, 95 % CI 1·00, 1·03) and central obesity (ORIE = 1·02, 95 % CI 1·00, 1·03), whereas fully mediated the association between acculturation and high blood pressure (ORIE = 1·03, 95 % CI 1·01, 1·06). Moreover, intake of total fruits fully mediated the acculturation–MetS association among Mexican Americans (ORIE = 1·02, 95 % CI 1·00, 1·05).

Our findings suggested that increasing fruit consumption may reduce the impact of high acculturation on MetS development in Hispanic adults. Further studies are needed to confirm these findings.

Sugar-sweetened beverages (SSB) are linked to increased metabolic risk. However, the sex differences in the relationship between SSB intake and adverse health effects remain unclear. Therefore, the present study examined the association between SSB consumption and metabolic risks among working-age males and females from Taiwanese communities.

A community-based study utilised data from a comprehensive health screening project conducted by the Public Health Bureau in Changhua County, Taiwan. Metabolic risks included waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, TAG, LDL cholesterol and fasting glucose level using serum tests.

Participants were recruited in Changhua County, Taiwan.

Between 2005 and 2014, 92 724 citizens participated in the health screening; our data analysis included 75 278 respondents between 30 and 64.

The results showed that the frequency of SSB consumption was associated with abnormal waist circumference and elevated total cholesterol, TAG, LDL and glucose in both men and women. Increased SSB consumption frequency was associated with elevated glucose and hypertension in women. Even a slight increase in SSB intake frequency was related to raising the metabolic risks. Similar patterns were evident when models included BMI; however, the associations were attenuated. In the BMI-stratified subgroup analysis, the relationship between SSB consumption and metabolic risks was more pronounced in participants without obesity.

The present study suggests that SSB consumption carries metabolic risk among working-age Taiwanese, particularly women and those without obesity. Health promotion programmes should raise awareness of the health hazards associated with SSB.

To assess the presence of nutrition declarations and nutritional quality in pre-packaged food products sold in Guatemala.

We photographed nutrition labels of pre-packaged foods. We extracted information about declaration of energy, total/saturated/trans-fats, total/added sugars and Na content (critical nutrients). We classified all products according to their degree of processing (NOVA classification) and nutritional quality (PAHO and WHO-Europe nutrient profile models).

Pre-packaged foods for sale in seven supermarkets in Guatemala City.

This study did not involve human subjects.

We assessed 3459 pre-packaged foods, including 80 % ultra-processed, 7 % processed and 13 % unprocessed/minimally processed foods or culinary ingredients. Nutritional information was available in 3021 products (87·3 %). Energy content was declared in 87·0 %; total fats in 86·1 %; saturated fats in 81·5 %; trans-fats in 48·9 %; total sugars in 70·3 %; added sugars in 0·5 % and Na/salt in 85·5 % of products. Insufficient nutrient information made impossible to assess nutritional quality in 36·6 and 17·1 % of products with the PAHO and WHO-Europe models, respectively. Using PAHO and WHO nutrient profiles, we found that 66·2 and 50 % of food products did not meet the model’s nutritional criteria.

A high proportion of pre-packaged foods with nutritional information available in Guatemalan supermarkets do not meet the nutritional criteria recommended by WHO and PAHO. Furthermore, a high proportion of products did not declare critical nutrients and many did not even provide any nutritional information. National regulations should consider making critical nutrient declarations (including trans-fats and sugars) mandatory for all products.

To estimate the prevalence and socio-economic inequalities in adequate consumption of fruits and vegetables in Peru between 2014 and 2019.

Analytical cross-sectional study. The outcome variable was adequate consumption of fruits and vegetables, defined as the consumption of five or more servings of fruits and vegetables per d (yes/no). We used concentration curves and Erreygers concentration index to describe socio-economic inequalities and a microeconometric approach to determine the contribution of each variable to inequality.

Peru.

Data from Peruvians aged 18 years or older collected by the Demographic and Family Health Survey.

The prevalence of adequate fruit and vegetable consumption did not change between 2014 (10·7 %; 95 % CI (10·0, 11·4)) and 2019 (11 %; 95 % CI (10·4, 11·7)). We found socio-economic inequalities in the adequate consumption of fruits and vegetables, with wealthier individuals having a higher prevalence of adequate consumption compared to poorer individuals in 2014 (19·2 % v. 3·5 %) and 2019 (18·6 % v. 4·7 %). The decomposition analysis found that education, urban areas and being wealthy were the main factors associated with socio-economic inequality in adequate fruit and vegetable consumption, being structural problems of society.

Despite the current regulations on healthy eating in Peru, adequate consumption of fruits and vegetables remains low, and there are socio-economic inequalities between the poorest and wealthiest individuals. Our findings suggest that more efforts are needed to increase the intake and assess the disparities in adequate fruit and vegetable consumption.

The impact of the dietary potential inflammatory effect on diabetic kidney disease (DKD) has not been adequately investigated. The present study aimed to explore the association between dietary inflammatory index (DII) and DKD in US adults.

This is a cross-sectional study.

Data from the National Health and Nutrition Examination Survey (2007–2016) were used. DII was calculated from 24-h dietary recall interviews. DKD was defined as diabetes with albuminuria, impaired glomerular filtration rate or both. Logistic regression and restricted cubic spline models were adopted to evaluate the associations.

Data from the National Health and Nutrition Examination Survey (2007–2016) were used, which can provide the information of participants.

Four thousand two-hundred and sixty-four participants were included in this study. The adjusted OR of DKD was 1·04 (95 % CI 0·81, 1·36) for quartile 2, 1·24 (95 % CI 0·97, 1·59) for quartile 3 and 1·64 (95 % CI 1·24, 2·17) for quartile 4, respectively, compared with the quartile 1 of DII. A linear dose–response pattern was observed between DII and DKD (Pnonlinearity = 0·73). In the stratified analyses, the OR for quartile 4 of DII were significant among adults with higher educational level (OR 1·83, 95 % CI 1·26, 2·66) and overweight or obese participants (OR 1·67, 95 % CI 1·23, 2·28), but not among the corresponding another subgroup. The interaction effects between DII and stratified factors on DKD were not statistically significant (all P values for interactions were >0·05).

Our findings suggest that a pro-inflammatory diet, shown by a higher DII score, is associated with increased odd of DKD.

Examine mother–son, mother–daughter, father–son and father–daughter resemblance in weight status, and potential modifying effects of socio-demographic and childcare characteristics.

Cross-sectional study.

School.

1973 school-age children and their parents from five mega-cities across China in 2017.

Pearson correlation coefficients (r) for BMI of father–son, father–daughter, mother–son and mother–daughter pairs were 0·16, 0·24, 0·26 and 0·24, respectively, while their weighted kappa coefficients (k) were 0·09, 0·14, 0·04 and 0·15, respectively. Children aged 6–9 years (r ranged from 0·30 to 0·35) had larger BMI correlation with their parents than their counterparts aged 10–14 years or 15–17 years (r ranged from 0·15 to 0·24). Children residing at home (r ranged from 0·17 to 0·27) had greater BMI correlations with their parents than children residing at school/other places. BMI correlation coefficients were significant if children were mainly cared for by their mothers (r ranged from 0·17 to 0·29) but non-significant if they were mainly cared for by others. Only children who ate the same meal as their parents ‘most times’ (r ranged from 0·17 to 0·27) or had dinner with their parents ‘at most times’ (r ranged from 0·21 to 0·27) had significant BMI correlation with their parents. Similarly, children who had dinner with their parents ‘most times’ but not ‘sometimes,’ had significant BMI correlation coefficients.

Parent–child resemblance in weight status was modest and varied by child age, gender, primary caregiver, whether having similar food or dinner with parents in China.

To investigate food insecurity and related coping strategies, and their associations with the risk of anxiety and depression, among South African households with children.

Nationally representative cross-sectional study. Tools for assessing food insecurity, coping strategies, risk of anxiety and depression were assessed from the Community Childhood Hunger Identification Project, Coping Strategies Index, Generalised Anxiety Disorder-7 and Patient Health Questionnaire-9, respectively. We used ordered logistic regression to test associations of food insecurity and coping strategies with the risk of anxiety and depression. Moderating effects of each coping strategy were tested in the associations of food insecurity with anxiety and depression.

South Africa, post COVID-19 restrictions, May–June 2022.

1,774 adults, weighted to 20,955,234 households.

Food insecurity prevalence was 23·7 % among households with children. All coping strategies were used to some extent, but relying on less preferred and less expensive foods was the most used strategy (85·5 % of food-insecure households). Moving to a higher level of food insecurity was associated with >1·6 greater odds of being in a higher risk of anxiety and depression. Sending a household member to beg for food was the strongest associated factor (OR = 1·7, P < 0·001). All coping strategies partly moderated (lessened) the associations of food insecurity with a higher risk of anxiety and depression.

Food insecurity among households with children was high following the COVID-19 pandemic. Collaborative efforts between government, private sector and civil society to eradicate food insecurity should prioritise poorer households with children, as these populations are the most vulnerable.

This study aimed to critically analyse Australia’s current and proposed policy actions to reduce added sugar consumption. Over-consumption of added sugar is a significant public health nutrition issue. The competing interests, values and beliefs among stakeholders mean they have disparate views regarding which policy actions are preferable to reduce added sugar consumption.

Semi-structured interviews using purposive, snowball sampling and policy mapping. Policy actions were classified by two frameworks: NOURISHING (e.g. behaviour change communication, food environment and food system) and the Orders of Change (e.g. first order: technical adjustments, second order: reforming the system, third order: transforming the system).

Australia.

Twenty-two stakeholders from the food industry, food regulation, government, public health groups and academia.

All proposed and existing policy actions targeted the food environment/behaviour change; most were assessed as first-order changes, and reductionist (nutrient specific) in nature. Influences on policy actions included industry power, stakeholder fragmentation, government ideology/political will and public pressure. Few stakeholders considered potential risks of policy actions, particularly of non-nutritive sweetener substitution or opportunity costs for other policies.

Most of Australia’s policy actions to reduce added sugar consumption are reductionist. Preferencing nutrient specific, first-order policy actions could reflect the influence of vested interests, a historically dominant reductionist orientation to nutrition science and policy, and the perceived difficulty of pursuing second- or third-order changes. Pursuing only first-order policy actions could lead to ‘regrettable’ substitutions and creates an opportunity cost for more comprehensive policy aimed at adjusting the broader food system.

This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age.

Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children’s BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years).

Population based.

Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old.

At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively.

Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother’s education level or age, which is important in community-based interventions.

To identify dietary patterns and prospectively evaluate their influence on the BMI Z-score of adolescents.

A longitudinal study, using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits and Adolescent Health – LONCAAFS.

To obtain data on food consumption, a 24-h recall survey was conducted; a second 24-h recall was applied to 30 % of the sample in all waves. Dietary patterns were identified by exploratory factor analysis using principal components. BMI Z-score was determined according to the recommendation of the WHO, based on the BMI for age and sex. Socio-economic data, sedentary behaviour and physical activity level were obtained. Associations between BMI Z-score and dietary patterns and between BMI Z-score and variables of interest were determined using generalised estimating equations.

Totally, 1431 adolescents were assessed in 2014, 1178 in 2015, 959 in 2016 and 773 in 2017, belonging to the public schools of João Pessoa, Northeast Brazil.

Three dietary patterns were identified throughout the study: ‘traditional’, ‘snacks’ and ‘Western’. The ‘Western’ dietary pattern was positively associated with BMI Z-score (β = 0·025; 95 % CI 0·002, 0·048), regardless of sex and physical activity level, prospectively.

A dietary pattern composed of foods with high energy density, high fat and sugars, and low fibre influences the BMI Z-score of adolescents over time.