In 2012, the US government overhauled school nutrition standards, but few studies have evaluated the effects of these standards at the national level. The current study examines the impact of the updated school nutrition standards on dietary and health outcomes of schoolchildren in a nationally representative data set.

Difference-in-differences. We compared weekday fruit and vegetable intake between students with daily school lunch participation and students without school lunch participation before and after implementation of updated school nutrition standards using a multivariable linear regression model. Secondary outcomes included weekday solid fat and added sugar (SoFAS) intake and overweight and obesity prevalence. We adjusted analyses for demographic and family socio-economic factors.

USA.

K-12 students, aged 6–20 years (n 9172), from the National Health and Nutrition Examination Survey, 2005–2016.

Implementation of updated school nutrition standards was not associated with a change in weekday fruit and vegetable intake (β = 0·02 cups, 95 % CI −0·23, 0·26) for students with daily school lunch participation. However, implementation of the policy was associated with a 1·5 percentage point (95 % CI −3·0, −0·1) decline in weekday SoFAS intake and a 6·1 percentage point (95 % CI −12·1, −0·1) decline in overweight and obesity prevalence.

Changes to US school nutrition standards were associated with reductions in the consumption of SoFAS as well as a decrease in overweight and obesity in children who eat school lunch. However, we did not detect a change in weekday intake of fruits and vegetables associated with the policy change.

Food insecurity (FI) is a challenge to policy makers worldwide, who need to understand which polices and programmes are effective at overcoming FI. The present study aimed to examine the impact of family income and conditional cash transfers on changes in household FI status in a highly vulnerable municipality in Northeast Brazil.

A population-based longitudinal cohort study among families in a municipality in the semi-arid area in Northeast Brazil (2011 and 2014). FI was estimated with the Brazilian Household Food Insecurity Measurement Scale (EBIA). The effects of family income and cash transfer on changes in FI were estimated using logistic regression models and the population-attributable risk fraction.

Households in Cuité, Paraíba, Brazil.

Household respondents interviewed in 2011 (n 358) and 2014 (n 326).

There was a reduction in FI prevalence of 17·5 % across time; 24·5 % of families who were food insecure in 2011 became food secure in 2014. After adjustment, families that did not experience an increase in their total household income or a reduction in the cash transfer amount were at increased risk of persistent FI across time. If the cash transfer programme had not been in place, about 10 % of the families that switched from food insecure to food secure across time would have remained in FI instead.

The decrease of FI occurred in an area of extreme climatic and social vulnerability. These changes were more related to the cash transfer than the increase in family income over time.

Extensive marketing of ‘toddler milks’ (sugar-sweetened milk-based drinks for toddlers) promotes unsubstantiated product benefits and raises concerns about consumption by young children. The present study documents trends in US toddler milk sales and assesses relationships with brand and category marketing.

We report annual US toddler milk and infant formula sales and marketing from 2006 to 2015. Sales response models estimate associations between marketing (television advertising spending, product price, number of retail displays) and volume sales of toddler milks by brand and category.

US Nielsen retail scanner sales and advertising spending data from 2006 to 2015.

Researchers analysed all Universal Product Codes (n 117·4 million) sold by seven infant formula and eight toddler milk brands from 2006 to 2015.

Advertising spending on toddler milks increased fourfold during this 10-year period and volume sales increased 2·6 times. In contrast, advertising spending and volume sales of infant formulas declined. Toddler milk volume sales were positively associated with television advertising and retail displays, and negatively associated with price, at both the brand and category levels.

Aggressive marketing of toddler milks has likely contributed to rapid sales increases in the USA. However, these sugar-sweetened drinks are not recommended for toddler consumption. Health-care providers, professional organizations and public health campaigns should provide clear guidance and educate parents to reduce toddler milk consumption and address misperceptions about their benefits. These findings also support the need to regulate marketing of toddler milks in countries that prohibit infant formula marketing to consumers.

To evaluate the impact of a preschool-based nutrition education programme consisting of twelve ‘hands on’ nutrition education lessons delivered during the school year on young children’s willingness to consume fruits and vegetables.

Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015–2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group.

Centre-based preschool programmes serving low-income families in the Denver metro area.

Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015–2016 school year (n 308) and children enrolled in comparison classrooms (n 215).

Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups.

An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.

We evaluate the extent to which Coca-Cola tried to influence research in the Global Energy Balance Network, as revealed by correspondence between the company and leading public health academics obtained through Freedom-of-Information (FOI) requests.

US state FOI requests were made in the years 2015–2016 by US Right to Know, a non-profit consumer and public health group, obtaining 18 030 pages of emails covering correspondence between The Coca-Cola Company and public health academics at West Virginia University and University of Colorado, leading institutions of the Global Energy Balance Network. We performed a narrative, thematic content analysis of 18 036 pages of Coca-Cola Company’s emails, coded between May and December 2016, against a taxonomy of political influence strategies.

Emails identified two main strategies, regarding information and messaging and constituency building, associated with a series of practices and mechanisms that could influence public health nutrition. Despite publications claiming independence, we found evidence that Coca-Cola made significant efforts to divert attention from its role as a funding source through diversifying funding partners and, in some cases, withholding information on the funding involved. We also found documentation that Coca-Cola supported a network of academics, as an ‘email family’ that promoted messages associated with its public relations strategy, and sought to support those academics in advancing their careers and building their affiliated public health and medical institutions.

Coca-Cola sought to obscure its relationship with researchers, minimise the public perception of its role and use these researchers to promote industry-friendly messaging. More robust approaches for managing conflicts of interest are needed to address diffuse and obscured patterns of industry influence.

Governments worldwide have been implementing interventions aimed at improving citizens’ dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population.

Online survey to assess which interventions are the most salient and receive greater public support.

Portugal.

1010 (76·7 % female, MAge 36·33, sd 13·22).

Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex).

By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain.

To investigate the cross-sectional associations of dietary carbohydrate and fatty acid intakes with cognition in mid-childhood.

Dietary carbohydrate and fatty acid intakes were assessed using 4-d food records, and cognition was evaluated using the Raven’s Coloured Progressive Matrices (RCPM) score. The cross-sectional associations of dietary carbohydrate and fatty acid intakes with cognition were investigated using linear regression analyses adjusted for age, sex, body fat percentage, household income, parental education and daily energy intake.

The baseline examinations of the Physical Activity and Nutrition in Children study.

A population-based sample of 487 children (250 boys, 237 girls) aged 6–8 years living in the city of Kuopio, Finland.

A higher dietary intake of fructose (standardised regression coefficient, β = 0·24, P < 0·001), total fibre (β = 0·16, P = 0·02) and soluble fibre (β = 0·15, P = 0·02) was associated with a higher RCPM score in boys. Other dietary carbohydrates and fatty acids, including total carbohydrates, glucose, sucrose, starch, insoluble fibre, total fat, SFAs, MUFAs, PUFAs, palmitic acid (C16), stearic acid (C18), linoleic acid (C18:2), α-linoleic acid (C18:3), arachidonic acid (C20:4), EPA (C20:5n-3) and DHA (C22:6n-6), were not associated with the RCPM score in boys. Dietary carbohydrates or fatty acids were not associated with the RCPM score in girls.

Higher dietary fructose and fibre intakes were associated with better cognition in boys, but not in girls. Dietary fatty acids were not related to cognition in boys or in girls.

Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers’ influential role in their children’s eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers’ perspectives and practices related to child’s feeding practices and their preschool-aged children’s eating.

Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches.

Massachusetts.

Twenty-one Brazilian immigrant fathers who had at least one child aged 2–5 years.

Results revealed fathers’ awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children’s healthy eating. Nearly all fathers reported wanting to learn more and to do ‘what’s right’ for their children.

The current study provides new information about Brazilian immigrant fathers’ views about factors influencing their children’s healthy eating behaviours and paternal feeding practices. Future research should quantify fathers’ feeding styles and practices and solicit fathers’ input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.

To describe the development of Fiji’s fruit and vegetable fiscal policies between 2010 and 2014 and explore the impact they have had on import volumes.

Qualitative case study and in-depth analysis of policy process. Policy impact was assessed using publicly available import volume data and prices of food products.

Fiji.

Senior government policy makers, non-communicable disease officers from the Ministry of Health and Medical Services (MoHMS) and supermarket managers.

In 2011, the Fijian Government introduced an import excise of 10 % on vegetables and reduced the import fiscal duty on fruit that was also grown in Fiji by 10 %. The import tax on vegetables was removed in 2012 in response to a MoHMS request. Policy makers from several sectors supported the MoHMS request, recognized their leadership and acknowledged the importance of collaboration in achieving the removal of the excise. Tariff reductions appear to have contributed to increases in the volume of vegetables (varieties not grown in Fiji) and fruit (varieties grown in Fiji) imported, but it is not clear if this increased population consumption.

Reductions in import duties appear to have contributed to increases in volumes of vegetables and fruit imported into Fiji. This case study has demonstrated that governments can use fiscal policy to meet the needs of a range of sectors including health, agriculture and tourism.

Mandatory menu energy-labelling policy in restaurants has received increasing attention worldwide as a useful tool for promoting balanced energy intake and encouraging healthier food selection to reduce obesity prevalence. Therefore, we aimed to evaluate the knowledge, views and observations of the public and restaurant owners towards the mandatory menu energy-labelling policy (introduced in August 2018) in restaurants in Saudi Arabia.

In February 2019, we conducted a cross-sectional study using an electronic questionnaire.

Saudi Arabia.

Saudi individuals (n 1228) aged 18–80 years and forty-one restaurant owners.

Most participants identified the correct daily energetic requirements for moderately active men (51 %) and women (69 %), but not for inactive adults (36 %). Although 40 % reported adequate knowledge to select low-energetic meals and 55 % perceived the policy as useful, 51 % reported they would be less likely to eat at restaurants displaying energy. Most participants (76 %) mentioned they would choose lower-energetic meals, and 79 % would feel guilty after consuming high-energetic meals. Moreover, 62 % of participants reported that the new labelling policy affected their food selections, prompting them to order different food items, eat less, change restaurants or eat at restaurants less frequently. Among restaurant owners, half were aware of the reason for the implementation of this policy and supported this measure. However, they did not consider modifying recipes to reduce energy. Sales of low- and high-energetic meals increased and decreased in 44 % and 39 % of restaurants, respectively.

This policy may be an effective public health tool for promoting balanced energy intake and encouraging healthier food selection in Saudi Arabia.

Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.

In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.

An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.

This study describes current market customers at twelve market sites serving low-income seniors.

Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers.

MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.