Food production accounts for one third of global greenhouse gas emissions(1). Similarly, the demand on the food system depends in part on people’s food choices. Thus, several studies have estimated the environmental impact of dietary patterns based on food consumption data from developed countries(2,3). This has led to literature reviews comparing the evidence for the impact of different diets on the environment and health status(4,5). However, similar analyses from developing countries are scarce. In this context, this systematic review sought to analyse and compare the available literature on the environmental impact of the diet of Latin American populations.

A systematic review was conducted using the ©2024 Covidence online software. Searches were conducted in Medline, Embase, Web of Science and Scopus databases. Inclusion criteria were studies measuring different markers of environmental impact such as carbon, water or ecological footprint related to food consumption in Latin American countries. We narratively synthesized the evidence by country, environmental markers, socio-demographic factors and dietary intake reported by each country.

Out of 3007 papers, 30 were included in this review. Eight Latin American countries have reported the environmental impact of diet, with the majority coming from Brazil (n = 8), followed by Mexico (n = 6), Argentina (n = 3), Chile (n = 3), and Peru (n = 2) while only study was available for Colombia, Costa Rica and Guatemala. Water and carbon footprint were the most commonly used measures of the environmental impact of people’s diets. The average (IC 95%) carbon footprint reported were 2.3 (2,1; 2,3); 2.6 (2.6; 4.4); 3.4 (2.4; 4.7); 4.5 (4.4; 4.6) and 8.3 (4.5; 12.4) KgCO2eq/person/day in Guatemala, Peru, Chile, Brazil and Argentina, respectively. In general, men, middle-aged adults and people with higher educational and socio-economic levels were positively associated with a higher diet-related environmental footprint. In addition, beef and vegetables were the foods with the highest and lowest environmental impact attribution, respectively.

Our review reveals a significant lack of research on the environmental impact of diet in Latin American populations. This underlines the need to establish a regional database documenting the environmental footprint of commonly consumed foods in Latin America. This would allow for the development of studies to provide evidence to promote public policies to achieve more sustainable diets in the region.

While the impact of high meat consumption on the environment(1) and health(2) have been studied for decades, public knowledge of these issues is less well understood. The aim of this study was to assess the awareness and knowledge of the environmental impact of food choices among the public, as well as people’s willingness to reduce their consumption of meat. We sought to repeat the study conducted by Macdiarmid et al.(3),which found limited knowledge of the link between meat and the environment, and a general unwillingness to change, to understand if public knowledge of and perceptions around sustainable diets have changed in the decade since the original study was conducted.

Nine in-person focus groups were conducted between March and August 2023. Adult participants (≥18 years old) were recruited in Scotland from populations matching the original study(3) based on a balanced urban vs rural, locations and high vs low socio-economic status (SES) areas. Data was coded and analysed using a thematic approach.

Most participants (n=60, ranging from 5-11 participants per group) believed that food choice impacts the environment and human health. Views diverged between the sociodemographic groups with urban/higher SES groups generally more knowledgeable of the impact of meat on the environment and rural/lower SES participants typically less aware. Willingness to reduce meat consumption was also split by SES and motivations were different. Higher SES groups were more willing to reduce meat consumption, and in some cases reported having already started to do so, than lower SES groups. The former groups discussed ethical, health and environmental reasons whereas the latter groups were more sensitive to the price of alternatives. Meat, variously defined, but generally ruminant meat, was considered an important part of a ‘balanced’ diet and most participants were reluctant to remove it entirely.

Although the language of dietary sustainability was not uniformly recognised or understood, there was greater understanding of the underlying concepts in 2023 compared to 2013. The environmental impacts of food choices were more often couched in terms of the physical environment (e.g., packaging) than climatic impacts (i.e., greenhouse gas emissions). There was a strong sense that local (i.e., Scottish) production was more ‘sustainable’ than imported food and there was broad willingness to reduce, but not remove, meat consumption in principle.

There are potential health and environmental benefits to reducing meat consumption among populations where consumption is high(1). However, meat is a staple part of the diet for many, and large-scale dietary shift is difficult to achieve. We sought to investigate current attitudes to meat and plant-based foods, intentions reduce meat consumption over the next three months, and potential policies and interventions current meat eaters believed could help them to eat less meat and more plant-based foods.

We conducted an online survey (n = 1590) of people living in Scotland, stratified by age, gender, ethnicity, and educational attainment. Of this sample, 95% (n = 1504) described their diet as either omnivorous (84%) or flexitarian (11%). In addition to questions about intentions to reduce meat we presented statements framed around the COM-B model of behaviour(2) to measure people’s perceptions of their Capacity, Opportunities and Motivation to change Behaviour, in this case reducing meat consumption. Latent Class Analysis (LCA) was conducted using these COM-B statements in order to identify disparate segments of the population based on underlying attitudes and beliefs. Current meat eaters were also asked to rank 25 different potential policies or interventions that have been identified in previous work(3,4), using a best-worst scaling method where they were asked to choose the option they believed would be most effective for them personally, and the one which would be least effective, from a choice of four interventions. This was repeated ten times for each respondent, with a ranking then calculated using a conditional logit model.

Considering only meat eaters, sociodemographic variables such as age (Cramer’s V=0.1, p<0.001), gender (V=0.09, p = 0.03) and education (V=0.09, p<0.001) were weak predictors of intentions to reduce meat. The LCA, based on responses to the COM-B statements, revealed four distinct groups. One group (14% of the sample) appeared unwilling to reduce consumption, one was more ambivalent (25%), another group was broadly willing (45%), and the last reported to be actively reducing consumption (14%). Regarding the perceived utility of potential policy and intervention options, there were broad similarities among the four population groups, with options related to the cost and improvement of current vegetarian options (taste and availability) considered most impactful for all. In contrast, interventions that sought to provide information and educate (e.g., leaflets or celebrity endorsement) were considered least likely to facilitate change by all four groups.

There is a willingness to reduce meat consumption among a majority (59%) of the population, and there appear to be concrete policy and intervention options that could target them. There are also potentially more targetted policy options, which could target those who currently consume more meat and are less likely to consider eating less.

Zambia is experiencing a nutrition transition, owing to fast changing food environment(1). Some of the policy strategies in Zambia are perceived by stakeholders as not feasible, or effective due to gaps in contextualization(2). The study aimed to explore the policy makers’ perception of the food environment and map the current and potential policy strategies to address the transformations.

18 key informant interviews (KII) were conducted with policy makers in Zambia during February and March 2024. Interview guide was constructed based on a food environment framework comprising four dimensions including availability, accessibility, marketing, and desirability(3). For each dimension, questions were asked on 1) perception of the food environment transformations, 2) existing policy strategies, and 3) potential policy strategies(4). Ethical approval was granted by Universities of Leeds and Zambia.

Preliminary findings (from 5/18 KII), summarised according to the themes of food environment framework.

Availability: dietary shift towards consumption of unhealthy foods due to; 1) decreasing diversity of indigenous foods coupled with increasing cheap energy dense low nutrient foods, 2) mushrooming fast food chains including in school neighbourhoods, and 3) certain policy strategies (Vit A sugar fortification). Existing policy strategies: nutrition education based on food based dietary guidelines, capacity building in the context of obesity prevention and management (courses under development). Apart from sugar sweetened beverages tax, limited strategies targeted at physical food environment. Potential strategies: 1) public-private partnerships to agree on improved reformulations and labelling, 2) incentives to industries making reformulations, 3) restriction of unhealthy foods in school environments, and 4) promoting picking-up trend of local restaurants offering indigenous healthier menus.

Accessibility: wet markets still the main source especially for vegetables and fruits. Supermarkets have picked up, but mostly offer unhealthy options, often displayed in prominent locations. Vegetables and fruits offer is small and mainly exotic. Existing strategies: no policy to guide supermarkets operations/marketing strategies. Potential strategies include 1) public-private sector dialogues to come up with guidelines for supermarkets, e.g. on placements – capitalise on experience from breast milk substitutes, alcohol, and tobacco regulations, 2) making wet markets attractive through infrastructure improvements and enforcement of food safety standards.

Marketing; aggressive advertising mostly for unhealthier foods through social media and billboards in prominent locations. Existing strategies: no specific regulation. Potential strategies include advocating for regulations prohibiting advertising in key locations like school neighbourhoods.

Desirability: fashionable to eat fast foods especially the youth. Existing strategies: Nutrition education. Potential strategy; utilising multisectoral and stakeholder actors like the church and cultural institutions.

Current policy landscape and perception among policy makers is hinged on bottom-up approaches, that is improved consumer awareness to force the industry into fundamental changes. However, a combination with top-down approaches, e.g. regulatory strategies to unhealthier foods (reformulation and marketing) is key.

Blue water is sourced from rivers, lakes, and reservoirs and is used for drinking water, growing crops, and food production(1). Approximately 75% of blue water use (BWU) comes from food systems(2). Dietary change is necessary to meet net zero BWU sustainability goals by 2050(3). While there is some information on diet-associated BWU for the Republic of Ireland (ROI)(4), BWU across the Island of Ireland is unknown. This study aimed to quantify the environmental impact of BWU of daily diets across adults aged 18-64 on the Island of Ireland, to determine population characteristics, nutrient intakes and key food sources influencing emissions.

The Northern Ireland sub cohort of the UK National Dietary Nutrition Survey (2016-2019)(5)and the Irish National Adult Nutrition Survey (2008-2010)(6) were analysed. Information on food and nutrient intakes was extracted from four-day food diaries for a total of 1,484 adults aged 18-64 years. BWU values were assigned for each food(7) and the population was grouped into tertiles of low (T1), medium (T2), and high (T3) BWU. Differences in population characteristics, key nutrients (%TE or per 10MJ) and contributing food sources were examined across these tertiles. Statistical analysis was performed using chi-square and one-way ANOVA with covariates (age, BMI, Sex, Survey type and social class) and correcting for multiple comparisons as appropriate (P<0.001).

BWU for the Island of Ireland was 481.9±440.4 L/day, 524.7±448.0 L/day for Northern Ireland and 474.9±438.6 L/day for the ROI and 100% of the population did not exceed the BWU planetary boundary of ≤786 L/day(8). Males had a higher contribution to the total BWU than females on the Island of Ireland (513.3±482.2 L/day vs 453.2±385.8 L/day). ‘Tea, coffee and water’ (76%), ‘rice and rice dishes’ (4%) and ‘fruit and fruit juice’ (2.5%) were the greatest contributors to BWU. When tertile analysis was performed, BWU from ‘tea, coffee and water’ was significantly higher for T3 at 837±468.8 L/day versus T1 (57±50.9 L/Day), this was similar for ‘rice and rice dishes’, where BWU in T3 was 26.3±44.0 L/Day versus T1 (13.3±25.2 L/Day). When nutritional analysis was performed, differences (P<0.001) across tertiles of BWU were observed for energy (11% increase between tertile 1 and 3), magnesium (12% increase across tertiles) and potassium (8% increase across tertiles).

Overall, a shift to more sustainable diets is needed to prevent BWU boundaries being exceeded in the future. By filling a literature gap on the environmental impact of the Northern Irish diet, this study complements previous research on the ROI, offering a comprehensive view of the BWU footprint and providing a basis for the development of strategies to improve diet-related BWU on the Island of Ireland.

Despite dietary guidance in over 90 countries and resources like the UK’s Eatwell guide, most individuals do not adhere to or achieve dietary aims(1,2). Specifically in the UK, population intakes of free sugars remain above the <5% recommendation, at around ∼10% of total energy intakes(3). To improve adherence to messages such as ‘reducing free sugars’, it may be helpful to identify barriers and facilitators to adherence whilst individuals attempt to modify their dietary patterns.

Participants were randomly selected from a randomised controlled trial investigating the effects of three different types of advice to reduce free sugars vs control on reducing free sugar intakes(4). A semi-structured interview explored barriers and facilitators to dietary adherence. Covariate adaptive randomisation ensured equal interviews at all timepoints across the 12-week study period and from participants in each trial arm. Data were analysed using framework analysis(5).

Sixty-two interviews were conducted across a 12-month period between 2021-2022. Seven themes for barriers and facilitators to recommendation adherence, encompassing 14 subthemes, were identified: 1) Proof and impact; 2) Realities of life; 3) Personal balance and empowerment; 4) Habitual approach; 5) Is it possible?; 6) Extensive awareness and viewpoint; and 7) Power of knowledge. Emergent themes sit within a context where individuals were challenged to reduce their intakes of free sugars and/or accurately record dietary intakes, thus they relate specifically to a dietary recording and free sugar reducing scenario. Participant interviews detected both internal and external environmental factors contributing to approaches to change. These factors were interrelated to self and community awareness, describing how individuals may utilise knowledge and understanding. Intervention participants reported all themes more than control participants; excepting the sub theme ‘limited impact.’ There were no observable reporting differences between the three intervention groups. Over the 12 -week study period, the positive sub-theme ‘enables’ within the theme ‘power of knowledge’ was more prominent at intervention delivery (week-1) than week-12. Additionally sub themes ‘active’ and ‘empower’ were reported more in those with higher adherence scores. These results suggest that dietary recommendations may need to be adapted to incorporate the stage at which dietary behavioural change takes place, with some focus also on maintenance as well as change. Overall, participant reports revealed that dietary advice needs to be appropriate for the person receiving it, easily understood, applicable, and actively engaging.

Our findings, when considered with the wider literature, may help us to better understand attempts to make dietary changes based on dietary advice, and support an individualised approach to dietary management. This greater understanding will help future advice to reduce free sugar intakes, including policy and public health initiatives.

Low socioeconomic status (SES) is associated with an increased risk of overweight and obesity, consequently elevating the likelihood of non-communicable diseases such as cardiovascular disease and type II diabetes(1). Although dietary interventions offer a promising solution to address this issue, engaging low-SES groups is challenging; uptake and adherence tends to be suboptimal(2,3). The aim of this review was to understand current levels of uptake and adherence and to identify the drivers of optimal uptake and adherence in community-based dietary interventions for populations with low socioeconomic status.

A systematic review of studies published prior to December 12, 2022, identified 114 relevant records. Full text screening, data extraction and coding was conducted by two independent reviewers. A thematic analysis and narrative synthesis was carried out to explore factors associated with uptake and adherence, alongside a basic descriptive analysis of current uptake and adherence rates.

Of the 114 included records, 88 reported uptake and 110 reported adherence. On average, uptake stood at 80%, indicating a 20% shortfall and potential compromise to validity. Adherence averaged 72%, with only 36 records meeting the recommended threshold of 80%(4). Thematic analysis revealed barriers and facilitators to engagement. Participants faced various challenges hindering engagement, including logistical obstacles such as transportation issues and scheduling conflicts, alongside socioeconomic constraints like low income and competing life stressors. Lack of personal motivation and family resistance further impeded participation, reflecting the influence of social norms. Environmental barriers, including the availability of fast food and program fidelity challenges, also contributed to lower program uptake. Social support and community engagement played a pivotal role in enhancing intervention participation, fostering supportive networks and shared knowledge among participants. Practical support and accessibility measures, such as logistical assistance and intervention adaptability, facilitated retention by reducing barriers to engagement. Tailored interventions, incorporating cultural competence and personalized approaches, effectively addressed participants’ specific needs and preferences. Additionally, motivational strategies, including goal setting and positive reinforcement, encouraged sustained engagement by boosting participants’ self-efficacy and commitment to healthy behaviours.

The observed uptake and adherence rates highlight the persistent challenge of participant engagement and retention in dietary interventions among low-income populations. Interventions addressing logistical, socioeconomic, and motivational barriers, along with tailored and culturally competent interventions, are key for improving engagement and retention in future interventions, thereby enhancing their effectiveness in combating diet-related health disparities.

People from south Asian heritage are underrepresented in health research globally(1). They have a lower threshold for obesity and are at a higher risk of type 2 diabetes mellitus (T2DM) compared to the White population(2). While south Asian women are often more included in research, there is a gap in understanding men’s perceptions and knowledge regarding obesity and T2DM, as well as barriers to adhering to dietary and physical activity recommendations. Understanding these barriers will help design appropriate interventions to tackle the unique challenge of T2DM in this community. The aim of this survey was to explore perceptions and knowledge regarding obesity and T2DM, as well as barriers to adopting a healthy lifestyle amongst Indian adult men (>18 years) living in the UK.

An online survey was distributed in English language. Survey questions were based on the Health belied model (HBM). Participants rated statements on their perceptions and knowledge of obesity and T2DM as well as lifestyle barriers. Ordinal logistic regression was used to assess the impact of place of birth and educational level on the outcomes.

A total of 102 Indian men completed this survey. While most respondents are aware of the risks associated with obesity and T2DM and recognised the significance of diet and physical activity in lowering these risks, 27.5% of respondents did not believe in their effectiveness. Additionally, 24% perceived T2DM as difficult to control once it is diagnosed. Interestingly, 46.1% of participants do not think that their ethnicity puts them at a higher risk of T2DM. Perceived barriers to following a healthy diet and physical activity regimen were cultural and traditional dietary preferences (18.6%), lack of motivation and willpower (18%), lack of knowledge about healthy diet (17.6%) and limited access to healthy food options (16.4%). Furthermore, 57.8% of respondents do not feel that they have enough support to help them reduce obesity and T2DM risk. When asked about the most effective measure to reduce the risk of obesity and T2DM, 64.7% responded “regular visits to the GP”. Additional respondents emphasized the importance of education, access to information regarding healthier options to traditional Indian foods as well as routine medical assessment. Birthplace (British-born vs. non-British-born) and educational level did not seem to impact perceptions and knowledge, but this outcome may be limited by the small sample size.

This small-scale survey highlights the importance of education in understanding obesity and diabetes risk, although it may not be the primary barrier for the lack of adherence to a healthy lifestyle. Rather, developing culturally specific health interventions and increased support can help overcome barriers and improve men’s health in this population. Larger scale surveys may be able to corroborate these findings.

Obesity is a complex condition which is significantly impacted by an individual’s biology, environment and behavioural factors. Excess energy dense (ED)(kJ/g) food intake (1), higher eating rate (2), increased eating frequency (3) and eating later in the day (4) have all been linked with obesity, but findings are mixed and require clarification using robust and objective measures of food intake behaviour. The aim of this research was to investigate associations between these eating behaviours and energy intake (EI) within a controlled residential setting in 65 participants (BMI 36.4 ±11.0 (range 17.6-65.2); 9 optimal weight, 15 overweight and 41 with obesity/severe obesity; age 44.3±12.7 years (range 18.6-67.6 years), 44F,21M).

As part of baseline measurements for a larger study (5) participants were assessed for 36hrs (twonights) within the Human Intervention Studies Unit at Ulster University, UK, and had ad lib access to a personalised menu (n 54 foods) representing a range of low/high fat macronutrient mix food groups with varying carbohydrate and protein content (6). Food intake and eating behaviour were measured covertly and validated by CCTV. Study outcomes were 24-hour EI (MJ), ED (kJ/g), % nutrient contribution to total EI, as well as parameters of eating including: size (g, kJ) speed (g/min; kJ/min;), number (n) and duration (mins) of eating occasions (defined as consumption of at least 210kJ separated by ≥5 minutes) and the timing of eating (epochs: 7-11am, 11:01-3pm, 3:01-7pm, 7:01-11pm). On the final morning, blood samples were collected before and 90mins after a standardised breakfast for the analysis of glicentin, a proglucagon-derived peptide. Associations between total EI and measures of eating behaviour were assessed using Spearman’s Rank

Correlation analysis showed weak positive associations between total EI and fasting glicentin (r = 0.296, p = 0.024), ED (r = 0.364, p = 0.004), and moderate associations with number (r = 0.419, p = 0.001) and size of eating occasions (r = 0.415, p = 0.005) as well as total weight of food consumed (r= 0.634, p<0.001). Of note, there was also a positive association between EI/eating occasion and a faster eating rate as expressed by [kJ/min (r = 0.519; p<0.001)] but not g/min (r = 0.276, p = 0.07). There was also a stronger relationship between EI and lean mass (r = 0.450, p<0.001) than bodyweight (r = 0.291, p = 0.023).

These findings suggest that food portion size and increased eating frequency may be a more important drivers of EI than dietary ED, and that the rate of eating higher ED foods may be linked to consuming a higher energy meal. These findings are skewed towards individuals with obesity but if confirmed highlight a need for weight management programmes to strengthen strategies to improve portion control and to limit grazing behaviours. There is also a need for robust randomised controlled trials to determine if eating slower reduces overall EI.

The World Health Organization (WHO) currently recommends reducing free sugar intakes for health benefits(1). Appropriate strategies to achieve these recommendations for the general public, however, remain unclear. While the WHO target is based on nutrients(1), food-based guidelines are currently recommended for public health(2), and practical advice in the form of food substitutions may facilitate dietary change(1,2).

Recommendations for reducing free sugar intakes based on nutrients (N, N = 61), nutrients and foods (NF, N = 60), and nutrients, foods, and food substitutions (NFS, N = 63) were recently investigated in a large randomized controlled trial(3). As a percentage of total energy intake (TEI), free sugar intakes reduced over 12 weeks following all three types of dietary advice, resulting in mean (s.e.) reductions of: Group N: 2.5 (0.8) %TEI; Group NF: 3.3 (0.8) %TEI; and Group NFS: 3.1 (0.7) %TEI; compared with no change (1.2 (0.8) %TEI) in the control group (N = 58). Few differences between the three different types of advice however, were found. The pilot study presented here aimed to extend this original study through the additional investigation of three different types of dietary advice based on food substitutions.

For this pilot study, a total of 72 UK adults with >5%TEI from free sugars at baseline, were randomized to receive dietary advice to reduce free sugar intakes by: a) replacing sweet high-sugar foods with sweet-tasting low-sugar alternatives, e.g. fruit and low-calorie sweeteners (Group ST, N = 24); b) replacing sweet high-sugar foods with non-sweet-tasting low-sugar alternatives, e.g. herbs, spices and nuts (Group T, N = 24); and c) replacing sweet high-sugar foods with plain lowsugar alternatives, e.g. plain rice-cakes (Group NT, N = 24). The advice was based on current NHS guidance and provided once. Participants were then followed for 4 (and 12) weeks, and betweengroup differences were investigated.

Free sugar intakes reduced in all three groups over 4 weeks (F(1,69) = 26.17, p<0.01), with effect sizes comparable to those in the original study (mean (s.e.)): Group ST: 2.4 (1.2) %TEI; Group T: 3.8 (1.3) %TEI; Group NT: 3.3 (1.2) %TEI. No differences were found between groups (F(2,69) = 0.56, p = 0.61). Similar results were also found in a subset of participants who continued in the study for 12 weeks (N = 29) (F(1,26) = 12.38, p<0.01; group x time interaction F(2,26) = 1.07, p = 0.39) (mean (s.e.)): Group ST: 2.3 (0.7) %TEI; Group T: 5.2 (1.3) %TEI; Group NT: 2.3 (1.2) %TEI.

Our findings confirm those of the original study – that the provision of dietary advice to reduce free sugar intakes can result in reduced free sugar intakes in willing volunteers, but the exact nature of the advice provided seems less important.

In Myanmar, exclusive breastfeeding amongst infants under six months is only 51%, although overall breastfeeding rate is almost universal at 98%. Only 16% of children aged 6 – 23 months meet the minimum acceptable dietary standards. In addition, 58% of children aged 6 – 59 months and 47% of women aged 15 – 45 years are anaemic(1). A Facebook page named “Dohmeetharsulay” was launched by a team of Burmese nutritionists and nurses (who also served as page administrators), in June 2019, aiming to contribute to closing the maternal and child nutrition promotion gap. A military coup happened on 1st February 2021 during the COVID-19 pandemic(2) causing unrest, armed conflicts, and increasing the strain on the country’s health system. The military junta then imposed internet and media restrictions, including banning the use of Facebook(3). The aim of this study is to explore the important role of using social media in nutrition education in a challenging context by measuring engagement with the programme.

Meta, previously known as Facebook, provides automatically calculated social media insight data on indicators such as page’s reach, audience demography and posts performance. Data for a three-year period, from 1 March 2021 (which is one month after the coup) to 29 February 2024, was reviewed and analysed numerically by the administrator team led by the main author (who is a nutritionist), to understand the page’s reach and overall performance in achieving its objective of promoting nutrition.

The Dohmeetharsulay page had 2.6 million reaches, during the study period; with only 121,171 from paid promotion. The page had 45,300 lifetime followers (82.6% women and 17.4% men). Myanmar was the top country represented by 86.5% of total followers followed by Thailand (5.8%), Malaysia (1.7%), Singapore (1.1%), United States (0.7%), India (0.5%), Japan (0.4%), China (0.3%), Indonesia (0.3%) and Nigeria (0.3%). The contents received 172,500 engagements including reactions, comments, shares and clicks on the posts.

Several authors have suggested that the use of social media has potential to improve positive health and nutrition behaviours, especially in hard-to-reach groups(4). Dohmeetharsuly is the only social media page dedicated to promoting evidence-based nutrition knowledge in the Burmese language, without any commercial influence. Despite the challenges and restrictions under the dictatorship, the data indicated that the page continued to communicate nutrition messages to the intended audience. Although further investigations are needed, it can be assumed that educational messages from the page have been benefiting families who have migrated or are displaced from Myanmar, in addition to the families inside Myanmar. Thus, the use of social media has an important role in providing nutrition education for families especially in places like Myanmar where reach of traditional health communication is limited due to conflict.

The triple burden of malnutrition (TBM) is a growing public health issue worldwide. This study examined the prevalence and association between undernutrition, overnutrition and micronutrient deficiencies (MNDs), and the key demographic and socioeconomic determinants, among Vietnamese children, using the nationally representative General Nutrition Survey (GNS) 2020(1).

The GNS 2020 was reviewed and approved by the Ethical Committee of the National Institute of Nutrition, Vietnam. Written informed consent was obtained from each participant and/or their parents prior to data collection. Data on anthropometric parameters, micronutrients biomarkers, demographic and socioeconomic indicators for 7,289 children aged 6 months to 9 years old were analysed(1). All analyses were weighted and accounted for complex survey design using svyset commands in STATA. Age-specific and region-specific prevalence of malnutrition were examined. Determinants of malnutrition were assessed using bivariate and multivariate logistic regressions, crude or adjusted odds ratio (OR/AOR) and respective 95% confidence intervals (CI) were reported.

Overall, the prevalence of stunting, underweight and wasting/thinness of children was 12.7%, 10.5%, and 4.7%, respectively, in 2020. This finding underscores that child stunting reduction in Vietnam is on track towards the target of 40% reduction by 2025 set by the Global Nutrition Targets(2) (<20%). Meanwhile overweight and obesity among school aged children is off track the target(2), with the prevalence in urban areas increasing from 8.5% in 2010 to 31% in 2020. Low serum zinc, anaemia and iron deficiency (ID) were the common MNDs observed, affecting 53.1%, 15.2%, and 13.9% of children. Prevalence of low serum retinol was relatively low (<7%). In the bivariate regressions, older child (2-4 years old) [OR (95% CI): 1.43 (1.20, 1.72)], ethnic minorities [5.94 (3.78, 9.36)], and living in mountainous areas [5.06 (1.18, 14.42)] had increased odds of stunting, whereas reduced odds were found in children from the richest quintile [0.13 (0.05, 0.32)]. Similar determinants were found to be associated with underweight and MNDs. Males [1.43 (1.16, 1.76)], older children (5-9 years old) [10.02 (6.71, 14.97), and children from the richest quintile [2.91 (1.20, 7.05)] had increased odds of overweight. After adjusting for covariates including age, sex, region, wealth index and inflammation, children with anaemia, low serum retinol and low serum zinc had increased odds of stunting and underweight than non-micronutrient deficient children (AOR = 1.43-1.71). Compared to children without MNDs, those with ≥3 MNDs had almost double the odds of stunting and underweight, whereas those with ≤3 MNDs had reduced odds of overweight (AOR = 0.38−0.60).

TBM is becoming a major public health concern for Vietnamese children, and significant demographic variation and socioeconomic inequalities in malnutrition were observed. These findings suggest that national policies and programmes in Vietnam should address age-specific, sex-specific, geographical and socioeconomic disparities to accelerate progress in reducing child malnutrition.

South Asian diaspora is one of the largest in the world, with India having the largest diaspora in the world at over 17.7 million(1). In the United Kingdom, South Asian population increased from 56.1 million to 59.6 million between 2011 and 2022(2). Presently, there is a rise of non-communicable diseases among the South Asians, both residing in the United Kingdom and India. Could migration have impact on the eating habit and level of participation in physical activity and subsequent influence on health and wellbeing of the South Asian was the main research question. Therefore, young South Asians in two different countries were recruited to explore their eating behaviour to promote and support better health and wellbeing practices.

This is qualitative research whereby photovoice was used with thematic analysis for the interview. For photovoice, after, the pre-trial photos were checked, participants were requested to take at least five pictures with captions to express their eating behaviour and related aspects such as that can best describe (i) the type of food they eat (ii) the place they eat their food or drink (iii) what influence what they eat.

Interviews were conducted among 7 South Asians (3 from UK and 4 from India, all female and aged between 24-35 years old) was conducted. Photovoice was followed up with interviews, discussing the photographs and taken by the participants. NVivo was used to manage and thematically analysed.

Four main themes emerged: changes to eating behaviour, impact of culture on food habits, impact of eating behaviour on wellbeing and impact of eating behaviour on physical activity. It was evident that their eating behaviour was deeply rooted in culture and shaped by their family habits. The impact of eating behaviour among the young adults were huge especially among the UK participants and many had to resolve to different means of coping with the changes. Some of the changes were evident in some students almost completely changing their food preference to foods that are available, affordable, acceptable and time-friendly. These factors were reported as negatively impacting on their health, mental health and wellbeing. They engaged in physical activity only when they have health challenges. Generally, they follow their family routine, which explains the reason the young adults were less interested in physical activity due to family influences and habits.

Moving away from the family home among participants in the UK and India impacts healthy food consumption, wellbeing, and physical activity. Food accessibility and acculturation was evidently an issue, which was emphasized through photovoice. Food insecurity remains to be explored, especially among those who move to the UK, as they prefer to consume food that they are familiar with and culturally based.

The consumption of larger food portion size(s) (PS) can result in overconsumption and a reduced ability to self-regulate appetite, which has been implicated in the rising prevalence of childhood obesity globally(1). Larger PS of food have sustained effects on energy intake in children(2–4), which has been attributed to the ‘portion size effect’, where more food is consumed when larger quantities are offered(4). This study aimed to explore 3 different PS of a breakfast meal on consumption and satiety levels of children aged 7-10 years.

Parents with their children (n 25) were invited to participate in a within-subject, repeated measures, randomised cross-over study, to compare the PS of a typically consumed breakfast meal (ready-to-eat breakfast cereal [flakes, puffed rice or hoops] with milk) consumed by children under three different PS conditions: self-serve (SS) of typical PS; <25% than SS, and; >25% than SS, with at least 3 days between each experimental PS condition. The children were provided with a 10cm visual analogue scale to rate satiety post-consumption. Repeated measures ANOVA was used to assess differences between the PS consumed and satiety ratings, with paired samples ttests used to compare differences between PS conditions.

Total PS of the breakfast meal consumed was greatest in the SS condition, followed by the >25% than SS with the least PS consumed in the <25% than SS (165.0 ± 72.0g, 138.2 ± 83.3g and 126.0 ± 77.9g respectively, p = 0.011). A significantly higher proportion of the breakfast meal was also consumed in the SS condition compared to both manipulated conditions - SS vs <25% than SS (84.2 ± 19.9% vs 77.2 ± 24.7%, p = 0.030), SS vs >25% than SS (84.2 ± 19.9% vs68.9 ± 28.9%, p<0.001), with a significantly higher proportion consumed in the <25% vs >25% than SS

(77.2 ± 24.7% vs 68.9 ± 28.9%, p = 0.027). Post-consumption, children reported feeling ‘least satisfied’ in the SS condition compared to both other conditions (6.2 ± 2.5cm in SS, 7.5 ± 2.1cm in <25% than SS condition, 7.9 ± 2.1cm in the >25% than SS condition, p = 0.011).

In this exploratory study, children aged 7 to 10 years did not consume a larger amount of food in response to exposure to larger PS. Results suggest that the presentation of smaller PS resulted in higher satiety ratings post-consumption, highlighting the potential of downsizing as a strategy for portion control in children of this age, where needed.

Childhood overweight/obesity (Ov/Ob) and its combination with metabolic complications, known as metabolically unhealthy obesity (MUO), is a major public health problem1. Diet is one of the most important modifiable determinants of weight status and health, but the relationship between dietary patterns and Ov/Ob or MUO in children and adolescents remains poorly studied2,3. The aim of this study was to explore associations between adherence to dietary patterns and the risk of childhood Ov/Ob or MUO.

A literature search was performed following PRISMA guidelines4 in Scopus and Medline databases to identify longitudinal prospective studies, and randomized controlled clinical trials (RCTs) with ≥12-month follow-up, in children and adolescents (age: 2-19 years; regions: Europe, USA, Canada or Oceania, in English language, publication period: January 2013-June 2023). Studies’ quality was also evaluated with the ROBINS-E and RoB-2 tools.

From the 2603 references initially identified, 29 prospective studies were included in this systematic review and meta-analysis. All studies reported on Ov/Ob risk. Dietary patterns were assessed with a-priori method in 15 studies and with a-posteriori method in 14 studies. Conceptually, dietary patterns were characterized as “healthy” (HDP) or “unhealthy” (UDP), however there were inherent differences in the way dietary patterns were defined/ extracted, the items loading high in each extracted pattern and the scoring system applied for the degree of adherence to each pattern. Limited evidence suggests that adherence to patterns during childhood, which are lower in fruits, vegetables, and whole grains, while higher in sweets, refined grains, fast foods, and processed meats are associated with higher BMI later in adolescence. Eighteen studies were included in meta-analysis. Adherence to a HDP was associated with lower odds of Ov/Ob [odds ratio (OR): 0.85 (95% confidence interval (CI): 0.80; 0.91) for the adjusted model] compared to non-adherence, while adherence to UDP was associated with higher odds of Ov/Ob [OR: 1.34 (95%CI: 1.17; 1.53) for the adjusted model] compared to non-adherence. Higher adherence to a HDP was associated with lower BMI [beta: −0.02 (95%CI: −0.04; −0.01) kg/m2 for the adjusted model] and lower increase in BMI over time [beta: −0.11 (95%CI: −0.18; −0.04) kg/m2 for the adjusted model], compared to lower adherence. No significant associations were found between adherence to a HDP and z-BMI, while a marginally significant association was revealed between adherence to UDP and z-BMI [beta: 0.04 (95%CI: −0.00; 0.08) kg/m2 for the adjusted model].

Higher adherence to HDP exhibits preventive effect against Ov/Ob in children and adolescents. Results should be interpreted cautiously because of the heterogeneity in defining “exposure” and should be confirmed through future research both in prospective cohorts and RCTs.

Non-alcoholic fatty liver disease (NAFLD) affects 5.5–10% of children worldwide, while in individuals with obesity, it increases to almost 34%1,2. Long-term dietary habits, leisure-time physical activity and sedentary activities have been proposed as modifiable risk factors for developing NAFLD in children/adolescents3,4, however, data to date remain limited. The aim of this study was to investigate differences in dietary intake and physical activity between children/adolescents with overweight/obesity and NAFLD and children/adolescents with overweight/obesity without the disease.

A total of 106 children/adolescents with overweight/obesity, aged 12.5±1.8 years, were included in the study, of whom 48 were diagnosed with NAFLD and 58 belonged to the control group. Participants in the two groups were matched for age, gender, body mass index, and Tanner stage. The diagnosis of NAFLD was based on elevated alanine aminotransferase (ALT) and/or abdominal ultrasound, followed by exclusion of other causes of secondary liver fat accumulation5.

Additionally, the dietary intake of the participants was assessed by four 24-hour recall method and analyzed for energy, macronutrients, and micronutrients using the Nutritionist Pro software program. The adherence to the Mediterranean Diet (MD) was assessed using the KIDMED index6. Physical activity was assessed using a questionnaire validated in the Greek population, the SelfAdministered Physical Activity Checklist7. Each participant completed the above questionnaire 4 times together with the 24-hour recalls.

No significant differences in the energy intake and the intake of macro-/micro-nutrients were observed between children/adolescents with NAFLD and the control group (all p >0,05). Regarding adherence to MD, there was no significant difference between children/adolescents with NAFLD and children/adolescents without NAFLD, with only 5% of the total sample demonstrating a high level of adherence to MD (score >8). Children/adolescents with NAFLD spent fewer minutes per day on physical activity compared with children/adolescents without NAFLD [49 (29, 70) min/day versus 67 (44, 95) min/day, p = 0.006]. In addition, children/adolescents with NAFLD spent more hours per day playing computer/video games compared with the control group [2.7 (1.4, 5.2) hours/day versus 1.9 (0.7, 3.3) hours/day, p = 0.035].

In conclusion, no differences in dietary intake in terms of energy, macro- and micro- nutrients intake were recorded between overweight/obese children/adolescents with and without NAFLD. Participation in physical activities was significantly lower, and time spent in sedentary activities was higher, in children/adolescents with NAFLD compared with their counterparts without NAFLD.

Eating a healthy diet rich in fruits and vegetables (FV) throughout life is crucial for preventing various types of malnutrition, reducing the risk of non-communicable diseases, and promoting overall well-being. Childhood presents a prime opportunity to establish lifelong dietary habits. The World Health Organization advocates promoting healthy diets by integrating culinary skills development, especially in schools. The Cooking in Yorkshire Project (1), a cluster-randomized controlled trial, assessed the impact of the PhunkyFoods programme on dietary behaviour, nutrition knowledge, and cooking skills among primary-aged children (7-9 years) in two-areas of North Yorkshire. We performed a secondary analysis of baseline-data to explore FV intakes of children by deprivation level, provision of free school meals (FSM) and mealtimes at baseline.

The Child and Diet Evaluation Tool (CADET) (2) was used to assess the self-reported frequency of consumption of 13 fruits and 18 vegetables on the previous day, categorized by mealtime. Poisson regression was used to evaluate associations between FV consumption (portion/day), deprivation level (categorized based on a median level of 22,642 of the Index of Multiple Deprivation rank 2019 to determine high or low levels) and FSM percentage per mealtime and per day.

Twenty-six schools (n = 333 children, 57% girls) completed the dietary assessment. 60% of children reported consuming FV 5 times a day. Significant differences were observed in the proportions of children’s FV intake by mealtimes. During breakfast, 92% of children did not consume any vegetable, and 50% did not eat fruit (p<0.001). At lunchtime, approximately 35% of children reported not consuming any fruits or vegetables. Overall, consumption of FV recorded (7 portions per day) was considerably higher than national average consumption (3 standard portions) (3). The school FSM index was negatively associated with child vegetable intake. For children in schools with high FSM percentage compared to low percentage, the frequency of vegetable intake was 31% lower at lunch (95%CI: 56, 85; p=0.001) and 15% lower over the whole day (95%CI: 76, 94; p=0.003), after adjusting for sex and area. No associations were observed in fruit intake by mealtimes or deprivation level.

North Yorkshire schools offer free meals to financially supported children, aligning with healthy eating policies. However, negative associations observed between FSM and vegetable intake indicate there may be room for enhanced FV promotion.

Childhood overweight/obesity (Ov/Ob) is a major public health problem, of greater concern when accompanied with comorbidities such as hypertension, insulin resistance leading to metabolically unhealthy obesity (MUO). Current evidence suggests a linkage between meal frequency, diet quality and nutritional status(1–3) in children and adolescents, however data regarding associations between meal patterns, Ov/Ob risk and MUO are limited. The aim was to explore associations between meal patterns and the risk of childhood Ov/Ob and MUO.

The PRISMA methodology was used to retrieve prospective studies and randomized controlled trials conducted in children/adolescents 2-19 years old in Europe, USA, Canada or Oceania, from 01/2013 to 06/2023. Exposures that were considered under the umbrella “meal patterns” included consumption of a meal, meal skipping, timing, format and context. The quality of the studies was assessed with the ROBINS-E and RoB-2 tools.

Of the 3,020 studies initially retrieved, 27 were included. All studies reported on Ov/Ob risk, whilst no studies on MUO were identified. All but one study had a longitudinal study design. Twenty-two studies (81%) had a high/very high risk of bias, mainly due to the methods measures of exposure were assessed. Consumption of/skipping breakfast was the most common exposure, followed by consumption of lunch (n = 5), dinner (n = 5), meal frequency/eating occasion (EO; n = 5) and consumption of fast foods (n = 4). Some studies reported on meal context (eating while watching TV; n = 4). In most studies, frequent breakfast and evening family dinners (i.e. 7 days/week vs <7days/week) were associated with lower odds of childhood Ov/Ob, BMI and %body fat at followup (FU). Four studies also showed that skipping breakfast was associated with increased obesity markers, while three studies showed no associations. There was limited evidence of a positive association between eating while watching TV and weight trajectories (n = 2). No associations were reported in relation to frequency of lunch and fast food intake. Results regarding meal frequency/EO and Ov/Ob at FU are conflicting, with differences attributed to the definition of an EO.

Evidence supports that frequent consumption of breakfast and family dinners may be associated with lower Ov/Ob risk in children and adolescents, while eating in front of TV with increasing weight trajectories. No studies were identified in relation to MUO, highlighting a significant research gap. Nevertheless, clear definition on EOs and improved methodological approach in the assessment of meal patterns emerged as a need, according to current review findings.

Responding to rising concerns about obesity and health issues among children, the UK

Government has advised manufacturers to reduce the added sugar content in key product ranges that have been identified to be the major sources of sugar in children’s diets: baked products (cakes, cereal bars, biscuits, pastries), yoghurt, chocolate, and sweet spreads(1). Soft drinks were excluded in this review due to significant progress in this area(2). This study aimed to review the total sugar content in these key food products, in major supermarkets, popular children’s cookbooks, and website resources used by parents of children aged 6 months–5 years in the UK.

This cross-sectional market analysis study was conducted between January 2023 and March 2024.

1. 1. Reviewed the total sugar content in these key product ranges from five major UK supermarketsand compared these findings with data from previous research(3).

2. 2. Analysed the same products from a website resource and 10 children’s cookbooks, eithermentioned by previously interviewed parents6 or UK bestsellers on Amazon7, as cooking is important in combating obesity but relies on ensuring popular recipes fit within healthy eating guidelines(4).

Supermarket product total sugar content was determined by back-of-pack labelling(3). Nutritics software was utilised for total sugar analysis of the selected recipes(5).

A total of 440 products were analysed from the supermarkets, 115 recipes from children’s cookbooks and 50 recipes from the BBC Good Food site. Supermarket chocolate and cake products contained the most total sugar per 100g ranging from 14-68g/100g (mean 51.79± 10.06g/100g) for chocolate and 27-71g/100g (mean 37.41 ±8.50/100g) for cake. Yoghurt contained the lowest amounts of sugar (1.9-19g/100g mean 9.11±3.88g/100g). Cereal bars, often believed to be healthy were found to be medium to high in sugar 7.3-45g/100g (mean 25.99±7.28g/100g).

These preliminary findings indicate a slight reduction in the average total sugar content of the reviewed supermarket products compared to 2016 levels3. However, a significant proportion of supermarket products (57.5%) and recipes still exceed the government’s high sugar threshold of 22.5g/100g1. More than 85% of cakes in children’s cookbooks and 60% of cakes on BBC Good Food website have high sugar. Overall products and recipes classified as low in sugar (5g or less per 100g) remain limited, with the majority out of the 605 combined products and recipes, 55%, contained high sugar, 38% medium sugar and 7% low sugar content.

Many key food products and recipes intended for children remain high in sugar, highlighting a need for further reformulation/healthier recipe modifications. The persistence of high sugar content in children’s diets highlights the complexity of addressing UK childhood obesity levels.

Cardiovascular disease (CVD) is a major national and international public health problem(1). Many factors contribute to the development of CVD including low socioeconomic status (SES), poor diet and obesity. Previous studies indicate that childhood SES may influence the development of CVD risk factors in adulthood(2). Therefore, the aim of this study was to explore associations between SES, as measured by area of residence, occupation group and population dietary quality during childhood, and CVD risk in older adults in Ireland, and to illustrate how the mapping of data from previous studies based on SES information can offer insights into health outcomes.

The most recent clinical grandparent data from the Lifeways Cross-Generational Cohort Study (2001-2013)(3) were used. SES (area of residence and occupation group) data from the Lifeways grandparent data were mapped to population dietary quality from the 1948 National Nutrition Survey (NNS)(4), using the assumption that the grandparent’s current area of residence was the same as in 1948. The 1948 NNS included the assessment of individual nutritional status by a trained clinician. Clinical signs related to inadequate nutrition were recorded. Dietary quality, based on the assessment of dietary signs by the clinician, was categorised into poor, fair or good and was presented as the percentage of the population with poor, fair or good dietary quality for a given combination of occupation group and geographical area. The CVD risk variables [BMI, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)] in the Lifeways data were categorised based on World Health Organisation cut-offs. Blood pressure (BP) was categorised based on European Society of Hypertension/European Society of Cardiology guidelines. Relationships between the percentage of the population with poor, fair or good dietary quality in childhood and CVD risk factors were explored using Pearson’s or Spearman’s correlation as determined by the normality of data distribution. Chi-squared tests were used to investigate associations between age group, occupation group, area of residence and CVD risk factors. Binary logistic regression was used to test the predictive value of occupation group and area of residence independently on CVD risk factors.

Some CVD risk factors (elevated or raised BP, a diagnosis of diabetes and/or being prescribed diabetes medications) were significantly associated with area of residence (p=<0.05).

Grandparents in the Lifeways cohort from an unskilled manual background in childhood were more likely to be overweight/obese in adulthood (OR 4.67, 95% CI 1.41-15.54, p=0.012). Inverse associations were observed between good population dietary quality in childhood and all CVD risk factors in adulthood (p <0.05).

This secondary analysis of Lifeways grandparent data mapped to the 1948 NNS highlights the role childhood SES and dietary quality play in the development of CVD risk factors in adulthood and older age.