To explore the relationship between ultra-processed foods (UPF) consumption and dietary, lifestyle and social determinants using pathway analysis in the baseline of the Cohort of Universities of Minas Gerais (CUME project).

Cross-sectional study, in which path analysis was used to estimate direct and indirect effects of dietary practices, sleep, time on the computer and professional status on UPF consumption.

Data were collected in 2016, through an online questionnaire composed of sociodemographic, anthropometric, lifestyle and dietary practices questions, and a FFQ.

Baseline participants from the CUME Project (n 2826), adults who graduated from Universidade Federal de Viçosa or Universidade Federal de Minas Gerais, Brazil.

Being employed (P = 0·024), the time spent on the computer (P = 0·031) and the frequency of fried food intake (P < 0·001) were positively and directly associated with UPF consumption, whereas the sleep duration (P = 0·007) and the number of meals per d (P < 0·001) were negatively and directly associated with UPF consumption. Indirect effects were observed between being employed, mediated by the sleep duration (P = 0·032) and fried food intake (P = 0·005), whereas being a student is mediated by the time on the computer (P = 0·048).

The time spent on the computer, sleep duration and fried food consumption showed direct effects on UPF consumption. They also acted as mediators on the relationship between professional status and UPF consumption. Besides, the number of meals eaten each day also was directly associated with UPF consumption.

To understand the relationship between vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) levels in a sample of Portuguese adolescents.

Cross-sectional evaluation carried out in the 2003/2004 school year. Vitamin D intake was assessed by an FFQ and 25(OH)D was measured in a fasting blood sample.

Public and private schools in Porto, Portugal.

Adolescents aged 13 years (n 521) enrolled at school (EPITeen cohort).

Both mean (sd) intake and serum 25(OH)D level were far below the recommended, 4·47 (2·49) µg/d and 16·5 (5·7) ng/ml, respectively. A significant difference in serum level was found according to season, with lower values in winter than summer (14·8 (4·6) v. 17·3 (5·9) ng/ml, P<0·001). Vitamin D intake was weakly correlated with serum 25(OH)D (r=0·056, P=0·203).

Dietary vitamin D and serum 25(OH)D levels were positively but weakly correlated and the error was higher among those with higher serum 25(OH)D concentration. Our results support the need for strategies that promote increase of the most important food sources of vitamin D to reduce the high prevalence of low vitamin D status.

The aim of the present study was to determine the interaction of and association between frequency of goitre detected by palpation, nutritional status evaluated by anthropometric indices and socio-economic status in school-aged children.

One thousand and eighteen prepubertal and pubertal children (aged 6–14 years) attending primary schools in an urban area were included in this study.

All subjects were evaluated for the presence of goitre and nutritional status. Thyroid size was assessed using the World Health Organization's (WHO) palpation system (1960). Severity of protein–energy malnutrition (PEM) was based on WHO criteria. Children were grouped into four categories of socio-economic status.

Eight per cent of children were detected to have goitre by palpation. Body mass index and weight-for-height were significantly lower in children who had palpable goitre than in children who did not have goitre (P < 0.05). Frequencies of having palpable goitre and being stunted and underweight were especially higher in children with very low socio-economic status (P = 0.016, 0.01 and 0.01, respectively). Frequency of being stunted, underweight and wasted in children with palpable goitre did not change significantly according to socio-economic status (P>0.05). In logistic regression analyses, the most important factor in detection of palpable goitre was socio-economic status (B = 0.517, P = 0.004). Fathers' education and occupation were found to be most significant (P = 0.031 and 0.020, respectively).

Children detected to have palpable goitre were thinner. However, nutritional disorders were not more frequent among children with palpable goitre compared with children without goitre. Goitre and nutritional deficiencies were more common in children with lower socio-economic status but the frequency of nutritional disorders in children with palpable goitre did not change according to socio-economic status.

This study evaluated a simple environmental intervention called ‘Water Schools’ in Lower Austria providing free refillable water bottles and educational material.

Non-randomised controlled cluster trial with three measurements: at baseline (T0), after the intervention at 9 months (T1) and after 1-year follow-up (T2).

Half-day elementary schools in Lower Austria (Austria).

Third-grade pupils from twenty-two schools in the intervention group (IG) and thirty-two schools in the control group (CG) participated in the study. Data were analysed for 569 to 598 pupils in the IG and for 545 to 613 in the CG, depending on the time of measurement.

The consumption of tap water increased in the IG from baseline to T1 and then decreased again at T2, but this was similar in the CG (no statistically significant difference in the time trend between the IG and CG). Similar results were seen for tap water consumption in the mornings. The proportion of children who only drank tap water on school mornings increased significantly from baseline to T1 in the IG compared to the CG (P = 0·020). No difference in the changes over time occurred between the groups for the proportion of pupils drinking approximately one bottle of tap water during school mornings.

Not only the children in the IG but also those in the CG drank more tap water after 1 school year than at the beginning. The measurement of drinking habits in the CG may have been intervention enough to bring about changes or to initiate projects.

To examine the association between the place of residence and receiving free samples and advice to feed the baby with infant formula.

A cross-sectional study.

The current study covered twelve counties/districts in China.

5112 mothers with infants aged 0–5·9 months.

About 16 % of the mothers received free samples of infant formula. During pregnancy, this likelihood was higher among mothers in small and medium cities (OR: 1·96; 95 % CI 1·14, 3·38) and non-poor rural counties (OR: 4·65; 95 % CI 1·65, 13·14) compared with mothers in big cities. During the hospital stay, it was lower in big cities. After discharge, it was lower in poor rural counties (OR: 0·14; 95 % CI 0·05, 0·41). About 26 % of the mothers were advised to feed their infants with infant formula. The likelihood of receiving advice to feed the baby with infant formula from hospitals was lower in non-poor (OR: 0·37; 95 % CI 0·21, 0·66) and poor rural counties (OR: 0·35; 95 % CI 0·13, 0·91) than in big cities. Mothers in non-poor rural counties were less likely to receive advice from traditional mass media (OR: 0·17; 95 % CI 0·06, 0·48), while mothers in small and medium cities were more likely to receive advice from modern mass media (OR: 1·84; 95 % CI 1·20, 2·80) compared with mothers in big cities.

The promotion strategy of infant formula varies from different places of residence in China. The study suggests the need to strengthen enforcement of relevant regulations, especially within health facilities and through modern mass media.

Breast-feeding is an unequalled way of providing optimal food for infants’ healthy growth and development and the WHO recommends that infants should be exclusively breast-fed for the first 6 months of life. For mothers who are unable to breast-feed or who decide not to, infant formulas are the safest alternative. Despite recommendations, it is possible that parents make potentially harmful nutritional choices for their children because of cultural beliefs or misinformation on infant nutrition. We describe a possible health risk of not breast-feeding, highlighting a potentially dangerous dietetic practice.

We report the case of a newborn who was fed with undiluted goat’s milk because her mother could not breast-feed and was not aware of infant formulas.

The dietary mistake was detected because of a positive expanded newborn screening result, characterized by severe hypertyrosinaemia with high methionine and phenylalanine levels, a pattern suggestive of severe liver impairment. The pattern of plasma amino acids was related to a goat’s milk diet, because of its very different composition compared with human milk and infant formula.

Our experience demonstrates that, when breast-feeding is not possible or is not exclusive, infants may be at risk of dangerous nutritional practices, including diets with very high protein content, such as a goat’s milk diet. Families of not breast-fed infants may need appropriate advice on safe alternatives for infant nutrition to avoid the risks of inappropriate diets.

To describe the results of a nutritional intervention programme among Japanese-Brazilians according to gender.

A non-controlled experimental study.

The research included three points of clinical, nutritional and physical activity evaluation: at baseline (in 2005), after the first year and at the end of the second year (in 2007). The paired Student t test and multiple linear regression analysis were used to evaluate changes in the subjects’ profile (clinical, nutritional and physical activity variables).

Japanese-Brazilians (n 575) of both genders, aged over 30 years.

We verified statistically significant reductions in body weight (0·9 kg), waist circumference (2·9 cm), blood pressure, fasting blood glucose (>3 mg/dl) and total cholesterol (>20 mg/dl) and its fractions, in both genders. We also found reductions in intake of energy (among men), protein (among women) and fat (both genders) and increases in intake of total fibre (among women) and carbohydrate (among men).

The intervention programme indicated meaningful benefits for the intervention subjects, with changes in their habits that led to a ‘healthier’ lifestyle positively impacting their nutritional and metabolic profile.

Nutritional information panels are required on all packaged food products in the USA, yet are perceived as difficult to use by consumers. Nutritional symbols have been developed by various groups to assist consumers in making healthier food purchases. Different nutritional criteria are used depending on the authorizing body of these symbols. The present study assesses the nutrient profile of baby and toddler foods in light of their accompanying nutritional symbols.

Kruskal–Wallis and χ2 tests were used to assess differences in the nutritional content of products based on the presence and issuing body of nutritional symbols.

Nine grocery, drug and department stores in Philadelphia, PA, USA.

Two hundred and forty packaged baby and toddler foods.

Products whose nutritional symbol was issued by government/health professionals contained significantly more Ca (P = 0·002), fibre (P = 0·001), protein (P = 0·005), vitamin A (P = 0·011), vitamin C (P < 0·001) and Zn (P < 0·001) and less sugar (P = 0·004) per serving than products without a nutritional symbol and products whose nutritional symbol was issued by the manufacturer.

Products with a nutritional symbol issued by government/health professionals were healthier than foods with nutritional symbols issued by the manufacturer directly and foods with no nutritional symbols.

To explore if the secular trend in height is contributing to delay overweight rise among Brazilian adolescents.

Changes in BMI mean over time were fitted using linear regression including as independent variables survey year, height, survey-specific income quintiles, age and an interaction term of height × survey year. Overweight was defined as BMI≥25·0 kg/m2. Changes in overweight prevalence over time were fitted using Poisson regression.

Four national household surveys: 1974/5, 1989, 2002/3 and 2008/9.

Brazilian adolescents.

Mean values of height and BMI increased over the period, for both sexes and in all age ranges, except for girls aged 14–19 years from 1989 to 2002/3. The highest average increment and mean rate of height were between 1989 and 2002/3 and in 10–15-year-olds. The annual increment of height decreased from 2002/3 to 2008/9 in parallel with the increment in BMI rate. After fitting the regression model, the height × survey year interaction and per capita income were strong vectors to increase BMI mean. Changes in increment rate of height played a protective role against overweight in the last two periods for both sexes, mainly for girls. The period from 1989 to 2002/3 was the strongest vector associated with overweight in boys and the association decreased to the next period, from 2002/3 to 2008/9.

BMI and height of adolescents have increased in a wavering and alternate way throughout four decades in Brazil. The rate of height increment has played a protective role against overweight in adolescents.

To study the clinico-immunological, nutritional and growth characteristics of HIV-infected children and the impact of antiretroviral therapy (ART) on these parameters.

Retrospective study.

Out-patient department of a paediatric ART centre, Delhi, India.

HIV-positive children registered at the paediatric ART centre of the hospital were enrolled (n 130). Anthropometric measurements were used to classify children into the type of malnutrition according to definitions of the WHO and US Centers for Disease Control and Prevention. Clinical and immunological status of the children was recorded as per WHO guidelines. First-line ART was started based on guidelines of the National AIDS Control Organization. Nutritional status and clinico-immunological characteristics were followed up annually in children receiving ART.

Of children ≤5 years of age (n 54), stunting was noted in 42·5 % contrary to wasting seen in only 12·9 %. In children >5 years of age (n 76), short stature (40·7 %) and underweight (39·4 %) were seen in almost equal proportions. Asymptomatic presentation was noted in 60·0 %. Following ART, a reduction in wasting was noted in 75·0 % of children ≤5 years of age, whereas only 44·4 % of underweight children >5 years of age showed an improvement after therapy. Stunting and short stature continued to persist in all in children (≤5 years and >5 years, respectively). Clinico-immunologically, 67·5 % improved in clinical status and 62·5 % showed immunological improvement.

ART improves the acute parameters of nutritional status like wasting. It also improves the clinical outcome and restores the immune system. At present first-line ART is effective in HIV-positive children.

To evaluate the relationship between neighbourhood food environment perceptions and obesity among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) or Expanded Food and Nutrition Education Program (EFNEP) participants.

A cross-sectional study conducted during SNAP-Ed or EFNEP programme participation in six states in the Midwest US between May 2016 and November 2017.

Community centres, food pantries and other SNAP-Ed or EFNEP recruitment locations.

Convenience sample of 1743 low-income, adult nutrition education programme participants.

Controlling for participant location and other demographic variables, those who perceived that a large selection of fruits and vegetables were available to them were 22 % less likely to be obese (adjusted odds ratio 0·78, 95 % CI 0·63, 0·97). In addition, participants who perceived the distance to the grocery store where they purchased most of their groceries to be greater than 5 miles were 1·36 times more likely to be overweight or obese than those who travelled shorter distances for their groceries.

SNAP-Ed or EFNEP participants’ weight status may be associated with their perceptions of their neighbourhood food environments. Programmes incorporating nutrition education and food access initiatives should attempt to better understand participant perceptions in order to address barriers in their efforts and to ensure that healthy food is accessible to low-income residents.

The current study aimed to identify features to include in online grocery stores to support healthful food purchasing by those striving to lose weight.

A Value Proposition Design approach was used to gain shopper insights, devise potential online grocery store features and obtain feedback on these features.

Telephone interviews were conducted to gain insight into shoppers’ needs and perceptions. Results were used by the research team to identify potential online grocery shopping features that may support healthful purchase decisions, and interviews were conducted with a different sample of shoppers to gather feedback on features.

Insight (n 25) and feedback (n 25) interviews were conducted with convenience samples of adults trying to lose weight.

Participants were primarily female, white, college educated and with obesity or overweight. Online grocery features devised by the research team based on findings from the insight interviews included (1) shopping cart nutrition rating tool; (2) healthy meal planning tool; (3) interactive healthy eating inspiration aisle and (4) healthy shopping preference settings option. Findings from the feedback interviews indicated that the healthy meal planning tool, healthy shopping preference settings option and shopping cart nutrition rating tool features were positively rated by most participants.

There are multiple features grocers should consider including in their online stores to attract and support customers striving to eat healthy for weight loss.

The focus of interventions for adults living with HIV (ALH) in Nigeria has been mostly on prevention and provision of antiretroviral therapy (ART) with little consideration to nutrition-related matters. Therefore, the present study aimed to improve the quality of life (QoL) and anthropometric status of ALH in Abeokuta, Nigeria.

A quasi-experimental design where 200 conveniently selected participants were stratified by gender and duration on ART. The intervention group (n 100) received the nutrition education programme (NEP) for 12 weeks. The control group received a brochure on nutrition guidelines for ALH. Socio-biographical information, QoL and anthropometric status were assessed using previously validated questionnaires and standard techniques at baseline, week 12 and week 24. Generalised least squares (GLS) regression analysis was used for group comparisons. Anthropometric status was summarised by gender.

Two tertiary hospitals in Abeokuta, Nigeria.

ALH.

The NEP led to significant improvement in the physical functioning (week 12 and 24: P < 0·01), role limitation due to physical health (week 12: P = 0·01; week 24: P = 0·002) and pain (week 12: P = 0·01) constructs of the QoL of the intervention group compared with the control group. There was no significant difference (P = 0·07) between the mean weights of the two groups at baseline.

There was a significant improvement at week 12 and week 24 in the QoL of the intervention participants. The results indicated that a tailored NEP could make a positive contribution to the management of ALH.

BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting.

To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1325 Guatemalan adults (44 % stunted: ≤150 cm women; ≤162 cm men).

Cardio-metabolic risk factors were systolic/diastolic blood pressure ≥130/≥85 mmHg, glucose ≥5·5 mmol/l, TAG ≥1·7 mmol/l, ratio of total cholesterol to HDL-cholesterol ≥5·0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used.

Areas under the ROC curve were in the range of 0·59–0·77 for BMI and 0·59–0·78 for WC among men and 0·66–0·72 and 0·64–0·72 among women, respectively. Optimal cut-off points for BMI were 24·7–26·1 kg/m2 among men (24·5–26·1 kg/m2 stunted; 24·8–26·3 kg/m2 non-stunted) and 26·5–27·6 kg/m2 among women (26·3–27·8 kg/m2 stunted; 26·6–27·9 kg/m2 non-stunted). Optimal cut-off points for WC were 87·3–91·1 cm among men (85·3–89·4 cm stunted; 88·5–93·3 cm non-stunted) and 91·3–95·3 cm among women (90·9–94·4 cm stunted; 91·8–95·6 cm non-stunted).

Optimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.

To gain an in-depth understanding of infant and young child feeding practices, accompanying beliefs and their sociocultural context in the Karen and Lua ethnic communities of northern Thailand.

A two-day workshop and thirty in-depth interviews were undertaken in June 2014. Dialogue occurred with the assistance of translators and was recorded, transcribed and translated. A detailed thematic analysis was undertaken.

Northern Thai indigenous communities in which one-third of the children under 5 years of age are stunted.

People with various roles in the local health system and twenty-six villagers who cared for infants and young children.

Predominant breast-feeding was said to occur for 1 to 3 months but was not exclusive due to early introduction of water and/or rice. Exclusive breast-feeding for 6 months was impeded by the need for mothers to return to farming work, with the early introduction of solids enabling infants to be cared for by other family members. Low variety in complementary foods was typical during infancy, with few local foods having appropriate texture and special preparation of foods rarely described. A pervasive underlying issue is women’s responsibility to labour and lack of time to care for their young children. Poverty and food insecurity also featured in participants’ accounts.

In combination, women’s limited time to care, poverty and food insecurity are perpetuating poor nutrition of children in early life. Agricultural solutions that are being explored should also attend to the burden of work for women.

To evaluate the effectiveness of a nutritional intervention to promote fruit and vegetable (FV) intake.

A randomised controlled community trial was conducted to evaluate the effectiveness of a 7-month nutritional intervention and to promote FV intake, separately and together. All participants attended physical exercise sessions. The intervention was based on the transtheoretical model and Paulo Freire’s pedagogy. The interventions included group educational sessions, motivational cards and informational materials. The primary outcome was a change in FV intake (g/d), and secondary outcomes included stages of change, self-efficacy, decisional balance and knowledge on FV. All data were collected face-to-face; and FV intake was assessed using a validated brief questionnaire.

Health promotion services of Brazilian Primary Health Care.

3414 users of Brazilian Primary Health Care (1931 in the control group and 1483 in the intervention group (IG)).

At baseline, the average daily FV intake was 370·4 g/d (95 % CI 364·2, 376·6). The increase in FV intake (23·4 g/d; 95 % CI 6·7, 40·0) and fruit intake (+17·3 g/d; 95 % CI 5·1, 29·4; P = 0·01) was greater in the IG among participants in the lowest baseline intake. Participants in the IG also showed progression in the stages of change (P < 0·001), increased self-efficacy (P < 0·001) and improved knowledge of FV crops (P < 0·001).

The nutritional intervention was effective in increasing FV intake and fruits intake among individuals with a lower intake at baseline and in maintaining FV intake among those who reported consuming FV as recommended (400 g/d).