To assess the short- and long-term effectiveness of a lottery incentive intervention to promote the purchase of healthy products in school cafeterias.

A quasi-experiment in which students’ purchases in intervention schools were analysed in a pre–post analysis and also compared with a control school in a difference-in-differences model. A hierarchical linear model assessed the mean number of promoted healthy products purchased daily per participant before (twenty-six weekdays), during (nine weekdays) and after (twenty-eight weekdays) the intervention period. Sex, age and prior purchasing behaviour served as covariates.

Convenience sample of school cafeterias using a debit-card payment method that allowed for the assessment of students’ purchasing behaviour.

Students who used the pre-paid card to buy snacks at the school cafeteria. A total of 352 students (208 in intervention schools and 144 in control school) were included in the final analyses.

The incentives programme significantly increased the purchase of promoted healthy products during (v. before) the intervention period in intervention schools (P<0·001), especially among younger children (P=0·036). Among the students who purchased the promoted healthier products during the intervention, there was an increase in total number of purchased products (healthy non-promoted, but also of less healthy products). Sex and past consumption behaviour did not influence the response to incentives in the short term. On average, no long-term effect was observed.

Long-term and negative spillover effects must be taken into consideration for a complete understanding of the effects of incentives on healthier eating.

To make a tentative assessment of the consumption of cassava in three countries in South-east Asia and the cyanogenic potential (CNp) of the crop as a possible food safety issue.

We used data from the Ministry of Health in Vietnam and Statistics Authorities in Indonesia and Philippines (mean household consumption per province) to assess cassava consumption. Conversions of units were needed to facilitate the comparison of cassava consumption between countries. The most up-to-date data available regarding both cassava consumption and the CNp of cassava grown in the respective countries were assessed.

Vietnam, Indonesia and Philippines.

Respondents from provinces in Vietnam (nineteen), Indonesia (thirty-three) and Philippines (eighty-one) were asked to complete a recall questionnaire detailing either the previous 24-h’ or the 7-d’ cassava consumption.

Among the three countries, available data indicated that the highest median cassava-consumption figures percapita were from Indonesia and the Philippines (9·01 and 7·28 g/capita per d, respectively), with Vietnam having the least (1·14 g/capita per d). Published information regarding the CNp of cassava in the three countries was limited.

While the findings of the present study are somewhat limited by a lack of available information regarding both the extent of cassava consumption and the CNp of cassava consumed in the three countries, it appears likely that cyanogen intake arising from cassava consumption among the three countries exceeds the FAO/WHO Provisional Maximum Tolerable Daily Intake, although any risk to public health appears limited to a minority of provinces in each country.

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.

Describe how dietary intake patterns of US young adults align with the EAT-Lancet Planetary Health Diet (PHD) sustainable diet goals and identify personal, behavioural, and socio-environmental correlates of sustainable intake.

Data on past-year dietary intake were captured using a FFQ. The PHD was applied to specific food groups, and a total PHD score was calculated. Linear regression models were used to identify associations between personal, behavioural and socio-environmental factors and PHD scores.

This cross-sectional analysis uses data from the second wave of EAT 2010–2018 (Eating and Activity over Time), a population-based longitudinal study recruited in Minnesota.

Ethnically/racially diverse group of participants (n 1308) with a mean age of 22·1 (sd 2·0) years.

The mean PHD score was 4·1 (sd 1·4) on a scale of 0–14, with 14 representing the most sustainable. On average, participants consumed fewer whole grains, fish, legumes, soya, and nuts than ideal for a sustainable diet, and an excess of eggs, added sugar, and meat. The PHD score was higher for participants with higher socio-economic status (SES) and greater educational attainment. Higher home availability of healthy food (β = 0·24, P < 0·001) and less frequent fast-food consumption (β = –0·26, P < 0·001) were the strongest correlates of PHD scores.

Results suggest that a high percentage of participants may not be achieving the sustainable diet goals defined by the PHD. Reductions in meat consumption and increases in plant-based foods are necessary to increase the sustainability of US young adults’ diets.

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.

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.

The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived programme outcomes.

The current study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers' market season. Directed content analysis was used to analyse the data, whereby the five domains of Freedman et al.’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively.

One urban and two rural communities in British Columbia, Canada.

Twenty-eight adults who were participating in the FMNCP.

Three themes emerged: autonomy and dignity, social connections and community building, and environmental and programmatic constraints. Firstly, the programme promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development and mitigating stigma and shame. Secondly, shopping in farmers' markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers' markets, lack of transportation and challenges with redeeming coupons.

Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies and expanding programmes may help improve participants’ experiences and outcomes of farmers' market food subsidy programmes.

To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001–2002 and 2017–2018 and in neighbouring comparison countries (without a tax).

Repeated cross-sectional surveys.

Health Behaviour in School-aged Children study, spanning five survey years (school years 2001–2002 to 2017–2018).

Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls).

Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (Pinteraction < 0·001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France or Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction = 0·15).

Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.

This study investigated the impact of recipe and single-use herb/spice packet provision on egg intake and protein intake in community-dwelling individuals aged over 55 years.

Using a randomised-controlled intervention design, 100 older adults were randomised to receive (n 53) or not receive (n 47) high-protein egg-based recipes and herb/spice packets through the post for 12 weeks, from June to December 2016. Egg intake, protein intake, adverse events, lean body mass and functional measures of lean body mass were measured at baseline, after the 12 weeks and after a further 12 weeks.

Bournemouth, UK.

Community-dwelling older adults.

Intention-to-treat data were analysed using regression, controlling for various demographic and lifestyle characteristics. Ninety-three individuals (intervention, n 50; control, n 43) completed assessments at all three time points. Egg intakes increased by end of intervention in both groups (mean: 4–5 eggs/month). After a further 12 weeks, higher egg intakes were sustained in the intervention group, while egg intakes in the control group returned to baseline levels (between-group difference: β = −0·124, P = 0·047). No differences were found in other measures (largest β = −0·106, P = 0·12).

The provision of high-protein egg-based recipes and single-use herb/spice packets over 12 weeks increased egg intakes up to 12 weeks after end of intervention. Other factors may explain increased egg intakes during the intervention, but the sustained effects most plausibly result directly from recipe provision. Limited effects in other measures suggest that the recipes may have replaced as opposed to added to existing protein intakes.

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.

To examine the effectiveness of the Produce for Better Health Foundation grocery store tour programme as a nutrition education tool for changing consumers’ intention to consume various forms of fruits and vegetables (F&V).

Cross-sectional study.

Ten grocery stores in a city in the Southeast USA.

A total of 147 grocery shoppers in Alabama, who participated in a grocery store tour, completed a retrospective pre-/post-survey using the Theory of Planned Behaviour.

Results from independent-samples t tests indicated that mean values of attitude, subjective norm and perceived control were significantly increased after store tours (P < 0·01). Participants’ intentions to consume various types of F&V (fresh, dried, canned, juice and frozen), especially dried F&V, increased significantly after store tours. Results from structural equation modelling indicated that before store tours attitude (γ = 0·48, P < 0·01) was the most significant predictor of intention to consume F&V, followed by perceived behavioural control (γ = 0·24, P = 0·02) and subjective norm (γ = 0·21, P = 0·03). After store tours, attitude (γ = 0·51, P < 0·01) and perceived behavioural control (γ = 0·44, P < 0·01) were still strong predictors of intention to consume F&V, while subjective norm became an insignificant predictor of intention.

Findings revealed positive changes in study participants’ attitude, subjective norm, perceived behavioural control and their intentions to consume various forms of F&V, which suggest potential benefits of providing grocery store tours as a tool to promote consumers’ F&V intake.

Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.

An observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.

Dutch general practice.

One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.

Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.

Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

The Three Delays Model is a conceptual model traditionally used to understand contributing factors of maternal mortality. It posits that most barriers to health services utilisation occur in relation to one of three delays: (1) Delay 1: delayed decision to seek care; (2) Delay 2: delayed arrival at health facility and (3) Delay 3: delayed provision of adequate care. We applied this model to understand why a community-based management of acute malnutrition (CMAM) services may have low coverage.

We conducted a Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) over three phases using mixed methods to estimate programme coverage and barriers to care. In this manuscript, we present findings from fifty-one semi-structured interviews with caregivers and programme staff, as well as seventy-two structured interviews among caregivers only. Recurring themes were organised and interpreted using the Three Delays Model.

Madaoua, Niger.

Totally, 123 caregivers and CMAM program staff.

Overall, eleven barriers to CMAM services were identified in this setting. Five barriers contribute to Delay 1, including lack of knowledge around malnutrition and CMAM services, as well as limited family support, variable screening services and alternative treatment options. High travel costs, far distances, poor roads and competing demands were challenges associated with accessing care (Delay 2). Finally, upon arrival to health facilities, differential caregiver experiences around quality of care contributed to Delay 3.

The Three Delays Model was a useful model to conceptualise the factors associated with CMAM uptake in this context, enabling implementing agencies to address specific barriers through targeted activities.

To introduce the concept ‘nutrition activation’ (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities.

Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes.

USA.

Adult participants (n 7825) in the 2007–2010 National Health and Nutrition Examination Survey.

Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger ‘spike’ in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d).

Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.

Measurement of mean population Na and K intakes typically uses laboratory-based assays, which can add significant logistical burden and costs. A valid field-based measurement method would be a significant advance. In the current study, we used 24 h urine samples to compare estimates of Na, K and Na:K ratio based upon assays done using the field-based Horiba twin meter v. laboratory-based methods.

The performance of the Horiba twin meter was determined by comparing field-based estimates of mean Na and K against those obtained using laboratory-based methods. The reported 95 % limits of agreement of Bland–Altman plots were calculated based on a regression approach for non-uniform differences.

The 24 h urine samples were collected as part of an ongoing study being done in rural China.

One hundred and sixty-six complete 24 h urine samples were qualified for estimating 24 h urinary Na and K excretion.

Mean Na and K excretion were estimated as 170·4 and 37·4 mmol/d, respectively, using the meter-based assays; and 193·4 and 43·8 mmol/d, respectively, using the laboratory-based assays. There was excellent relative reliability (intraclass correlation coefficient) for both Na (0·986) and K (0·986). Bland–Altman plots showed moderate-to-good agreement between the two methods.

Na and K intake estimations were moderately underestimated using assays based upon the Horiba twin meter. Compared with standard laboratory-based methods, the portable device was more practical and convenient.