This study aimed to examine the association between ultra-processed food intake and dyslipidemia risk, and whether this association varied by the polygenic score for dyslipidemia in the adult Korean population.

Prospective cohort study

Ultra-processed foods were identified under the NOVA classification. Participants were categorized into <5, 5 to <10, 10 to <15, 15 to <20, and ≥20%E/d of ultra-processed food intake. The polygenic scores for dyslipidemia were calculated from 53,950 single nucleotide polymorphisms. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariate logistic regression models.

20,044 Korean adults aged ≥40 years in the Health Examinees (HEXA) study, the Cardiovascular Disease Association Study (CAVAS), and the Korea Association Resource (KARE) study

During median follow-ups of 4.09, 8.67, and 15.67 years in the HEXA, CAVAS, and KARE studies, respectively, there were a total of 7,331, 786, and 1,732 incident dyslipidemia events. Ultra-processed food intake was not significantly associated with dyslipidemia risk. Compared with <5%E/d, the pooled OR (95% CI) of ≥20%E/d of ultra-processed food intake for dyslipidemia incidence was 1.01 (0.90, 1.13; p for trend=0.83). There was no interaction by dyslipidemia-related genetic variations; ORs (95% CIs) were 1.04 (0.89, 1.22; p for trend=0.91) and 0.98 (0.84, 1.15; p for trend=0.72) for individuals with high and low polygenic scores, respectively (p for interaction=0.90).

No significant association was observed between ultra-processed food intake and the overall risk of dyslipidemia, nor in subgroups of polygenic scores for dyslipidemia among Korean adults with low ultra-processed food intake.

The Mediterranean diet (MD) is a dietary pattern associated with several health benefits, including reduction of risk for various cancers. We conducted a study to investigate associations between adherence to the MD and colorectal cancer (CRC) subtype risk among Moroccan adults.

A matched case-control study.

The five major university hospitals in Morocco.

A total of 3032 subjects (1516 CRC patients and 1516 controls) matched on age, sex and center, were recruited between September 2009 and February 2017 at five major hospitals in Morocco. Diet was assessed using a validated Food Frequency Questionnaire (FFQ). Adherence to the Mediterranean diet was assessed through a score, ranging from 0 (no adherence) to 10 (maximal adherence) and divided into three categories (low, middle and high). Conditional logistic regression was performed to calculate multivariable odd ratios (OR) and 95% confidence intervals (CI) with low adherence (score 0-3) as referent, adjusting for potential confounding factors.

Close adherence to the Mediterranean diet (score 6-9) was associated with reduced risk of CRC (ORa = 0.74, 95% CI 0.63-0.86); rectal cancer (ORa = 0.73, 95% CI 0.58- 0.90) and colon cancer (ORa = 0.74, 95% CI 0.60-0.92).

Our study, conducted in a southern Mediterranean population, adds to the evidence suggesting a protective effect of MD against CRC risk.

This paper explores the characteristics of Ghanaian households’ consumption of obesogenic versus protective foods, including their retail, distribution, and origin.

A household food consumption survey was conducted using an adapted Prospective Urban and Rural Epidemiology study Food Frequency Questionnaire. Product pathways for selected obesogenic (processed meat, Sugar-Sweetened Beverages, and biscuits) and protective (cooked vegetables, legumes, and fish) foods were traced from retailers through distributors/wholesalers to producers.

Rural and urban communities in the Ashanti Region and selected retail/wholesale/producers nationwide.

612 households, 209 retailers and 185 wholesalers/distributors.

About 20% of households consume Sugar-Sweetened Beverages (SSB) and confectionery weekly, and just 2% consumed processed meat. Of the protective foods, fish had the highest proportion of households consuming weekly (74.5%), followed by cooked vegetables (53.1%) and legumes (22.8%). Frequent SSB consumption is higher in younger (p<0.001), male (p=0.010), urban (p<0.001), and more educated (p<0.001) food purchaser households. Below 10% of households followed the healthiest dietary pattern (high-protective-and-low-obesogenic) but higher in older and more educated food purchaser households. In contrast, most households (about 80%) consumption patterns did not discriminate between obesogenic and protective foods. Generally, characteristics of purchasers from retail/wholesale outlets agree with those of households, where obesogenic foods were retailed to younger, less educated buyers than older, more educated ones. While the protective foods had a strong local producer presence, the obesogenic foods were predominantly imported.

Household consumption and retail/distribution of obesogenic foods are associated with socio-demographic characteristics, but obesogenic foods are almost entirely produced outside Ghana. Policies that regulate importation on health grounds can promote a healthier food environment.

To evaluate the association between dietary fiber intake and obesity in Japanese outpatients with type 2 diabetes, as well as the demographic and dietary factors influencing this association.

Cross-sectional study with nationwide registry data on Japanese type 2 diabetes outpatients (2014-2019). Diet was self-reported via a Food Frequency Questionnaire. Obesity was defined as BMI ≥25 kg/m2.

Clinics throughout Japan.

1,565 Japanese outpatients with type 2 diabetes (63.1% men; age range 30–89 years).

Multivariate analysis revealed that a higher dietary fiber intake was associated with a lower risk of obesity in all participants (95% CI = 0.439–0.795, p < 0.001). Stratified analysis showed a significant inverse association between fiber intake and obesity in men and the older age groups (59–89 years), but not in women or the younger age group (30–58 years). In men, higher fiber intake was associated with healthier lifestyle behaviors, including increased physical activity (p < 0.001) and non-smoking (p < 0.001), with stronger associations compared to women. Vegetables, fruits, and soybeans/soy products were strongly correlated with fiber, while grains had a weak correlation. Folate was the micronutrient most strongly correlated with fiber.

Higher fiber intake was associated with lower obesity risk, particularly in men and older age groups. These findings emphasize the need for targeted public health initiatives promoting the intake of diverse fiber-rich foods to effectively manage obesity. Further research is needed to understand sex- and age-specific factors in the fiber-obesity relationship in diverse populations.

Poor diets and food insecurity during adolescence can have long lasting effects, and Métis youth may be at higher risk. This study, as part of the Food and Nutrition Security for Manitoba Youth (FANS) study, examines dietary intakes, food behaviours, and health indicators of Métis compared to non-Métis youth.

This observational cross-sectional study involved a cohort of adolescents completed a self-administered web-based survey on demographics, dietary intake (24-h recall), food behaviours, food security, and select health indicators.

Manitoba, Canada

Participants included 1587 Manitoba grade nine students, with 135 (8.5%) self-identifying as Métis, a distinct Indigenous nation living in Canada.

Median intake of sugar was significantly higher in Métis (89.2 g) compared with non-Métis (76.3 g) participants. Percent energy intake of saturated fat was also significantly higher in Métis (12.4%) than non-Métis (11.6%) participants. Median intakes of Grain Products and Meat and Alternatives servings were significantly lower among Métis than non-Métis (6.0 vs. 7.0 and 1.8 vs. 2.0, respectively) participants. Intake of Other Foods was significantly higher in Métis (4.0) than non-Métis (3.0). Significantly more Métis participants were food insecure (33.1%) compared to non-Métis participants (19.1%). Significantly more Métis participants ate family dinners and breakfast less often than non-Métis participants, and had lower self-reported health. Significantly more Métis participants had a BMI classified as obese compared to non-Métis participants (12.6% vs. 7.1%).

The dietary intakes observed in this study, both among Métis and non-Métis youth, are concerning. Many have dietary patterns that put them at risk for developing health issues in the future.

To understand caregivers’ perceptions about their children’s mealtime social experiences at school, and how they believe these social experiences impact their children’s consumption of meals at school (both meals brought from home and school meals).

Qualitative data were originally collected as part of a larger mixed methods study using an embedded-QUAN dominant research design.

Semi-structured interviews were conducted with United States (U.S.) caregivers over ZoomTM in English and Spanish during the 2021-2022 school year. The interview guide contained 14 questions on caregivers’ perceptions about their children’s experiences with school meals.

Caregivers of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n=46) and Maine (n=20) were interviewed. Most (60.6%) were caregivers of children who were eligible for free or reduced-price meals.

Caregivers reported that an important benefit of eating meals at school is their child’s opportunity to socialize with their peers. Caregivers also stated that their child’s favorite aspect of school lunch is socializing with friends. However, some caregivers reported the cafeteria environment caused their children to feel anxious and not eat. Other caregivers reported that their children sometimes skipped lunch and chose to socialize with friends rather than wait in long lunch lines.

Socializing during school meals is important to both caregivers and students. Policies such as increasing lunch period lengths and holding recess before lunch have been found to promote school meal consumption and could reinforce the positive social aspects of mealtime for students.

Ultra-processed beverages (UPBs) have known adverse impacts on health, but their impact on the environment is not well understood across different environmental indicators. This study aimed to quantify the environmental impacts of water-based UPBs and bottled waters sold in Australia and assess the impacts of various scenarios which may reduce such impacts in the future.

This study presents a quantitative environmental impact assessment of a major sub-category of UPBs (water-based UPBs, including soft drinks, energy drinks, cordials, fruit drinks) and non-UPBs (bottled waters) in Australia. Alternative mitigation scenarios based on existing health and environmental targets were also modelled using sales projections for 2027. Sales data from Euromonitor International were matched with environmental impact data from peer-reviewed lifecycle assessment databases. Environmental impact indicators included greenhouse gas emissions, land use, eutrophication potential, acidification potential, water scarcity and plastic use.

The Australian beverage supply in 2022 and projected sales for 2027.

N/A

Environmental impacts of UPBs were higher than bottled waters. UPBs accounted for 81-99% of total environmental impacts, partly driven by the volume of sales. Reformulation, reducing UPB consumption and increasing recycling all led to meaningful reductions in environmental impacts but with diverse effects across different environmental indicators. The largest reductions occurred when policy scenarios were combined to represent a suite of policy actions which aimed to meet health and environmental targets (30-82% environmental savings).

The results indicate that implementing a suite of policies which act to target multiple drivers of environmental harm are likely to lead to the most environmental benefits.

To examine power and governance arrangements in food and nutrition policy formulation and agenda-setting in South Africa

Analysis of the policy implementation environment and in-depth interviews were conducted focussing on: existing policy content and priorities across food system sectors; institutional structures for cross-sectoral and external stakeholder engagement; exercise of power in relation to food system policies; and opportunities to strengthen action on nutrition.

South Africa

Interviews were conducted with 48 key stakeholders involved in the food and nutrition policy sphere: government sectors relevant to food systems (n=21), the private sector (n=4), academia (n=10), NGOs (n=11) and farmers (n=2).

This study found that there are power dynamics involved in shaping the planning agenda that is inadvertently generating a food system that undermines the right to food. The concept of nutrition governance remains poorly defined and applied in different ways and usually based on a relatively narrow interpretation – therefore limiting policy coherence and coordination. South Africa has strong legal institutions and practices, and social policies that support public provisioning of food, but a non-interventionist approach to the food system.

The right to food and nutrition, as outlined in the South African Constitution, has not yet been effectively utilized to establish a robust normative and legal basis for tackling the dual challenges of food insecurity and malnutrition. Currently, the governance of the food system is grappling with substantial obstacles, balancing the influence of powerful stakeholders who uphold the status quo against its responsibilities for food justice.

To investigate the concordance between Australian government guidelines for classifying the healthiness of foods across various public settings.

Commonly available products in Australian food service settings across 8 food categories were classified according to each of the 17 Australian state and territory food classification guidelines applying to public schools, workplaces, and healthcare settings. Product nutrition information was retrieved from online sources. The level of concordance between each pair of guidelines was determined by the proportion of products rated at the same level of healthiness.

Australia

No human participants.

Approximately half (56%) of the 967 food and drink products assessed were classified as the same level of healthiness across all 15 ‘traffic light’-based systems. Within each setting type (e.g., schools), pairwise concordance in product classifications between guidelines ranged from 74% to 100%. ‘Vegetables’ (100%) and ‘sweet snacks and desserts’ (78%) had the highest concordance across guidelines while ‘cold ready-to-eat foods’ (0%) and ‘savoury snacks’ (23%) had the lowest concordance. In addition to differences in classification criteria, discrepancies between guidelines arose from different approaches to grouping of products. The largest proportion of discrepancies (58%) were attributed to whether products were classified as ‘Red’ (least healthy) or ‘Amber’ (moderately healthy).

Results indicate only moderate concordance between all guidelines. National coordination to create evidence-based consistency between guidelines would help provide clarity for food businesses, which are often national, on how to better support community health through product development and reformulation.

The current study is an attempt to explore under-five child malnutrition in a low-income population setting using the Extended Composite Index of Anthropometric Failure (ECIAF).

Data from the Bangladesh Demographic and Health Survey 2017-18 were analyzed. Malnutrition using ECIAF was estimated using stunting, wasting underweight and overweight. Multilevel logistic regression models identified factors associated with malnutrition. Geospatial analysis was conducted using R programming.

Bangladesh.

Children under five years of age.

In Bangladesh, as indicated by the ECIAF, approximately 40.8% (95% Confidence interval (CI): 39.7, 41.9) of children under-five experience malnutrition where about 3.3% (95% CI: 2.9, 3.7) were overweight. Children of parents with no formal education (56.3%, 95% CI: 50.8, 61.8), underweight mothers (53.4%, 95% CI: 50.4, 56.3), belonging to the lowest socio-economic strata (50.6%, 95% CI: 48.3, 53.0), residing in rural areas (43.3%, 95% CI: 41.9, 44.6), and aged below three years (47.7%, 95% CI: 45.2, 50.2) demonstrated a greater age and sex adjusted prevalence of malnutrition. The Sylhet division (Eastern region) exhibited a higher prevalence of malnutrition (>55.0%). Mothers with no formal education (Adjusted odds ratio (AOR): 1.51, 95% CI: 1.08, 2.10), underweight mother (AOR: 1.54, 95% CI: 1.03, 1.83), poorest socio-economic status (AOR: 2.14, 95% CI: 1.64, 2.81), children age 24-35 months of age (AOR: 2.37, 95% CI: 1.97, 2.85), and fourth and above birth order children (AOR: 1.41, 95% CI: 1.16, 1.72) were identified key factors associated with childhood malnutrition while adjusting community and household level variations.

In Bangladesh, two out of five children were malnourished and one in 35 children was overweight. Continuous monitoring of the ECIAF over time would facilitate tracking changes in the prevalence of different forms of malnutrition, helping to plan interventions and assess the effectiveness of interventions aimed at addressing both undernutrition and overweight.

To evaluate the relationship between the food environment in favelas and the presence of arterial hypertension and diabetes among women in the context of social vulnerability.

A cross-sectional and partially ecological population-based study was conducted in a Brazilian capital city. The healthiness and availability of ultra-processed foods in the food environment were assessed through retailer audits using the AUDITNOVA instrument. The presence of diabetes and arterial hypertension was evaluated based on self-reported prior medical diagnosis. Logistic regression models were applied using generalized estimating equations, adjusted for age, education, race/skin color, and poverty status.

1,882 adult women of reproductive age (20 to 44 years).

It was found that 10.9% of women were hypertensive, and 3.2% had diabetes. The likelihood of having diabetes and arterial hypertension decreases with higher levels of healthiness in the food environment (Diabetes [OR: 0.25; 95% CI: 0.07, 0.97]/Arterial hypertension [OR: 0.45; 95% CI: 0.24, 0.81]) and increases with greater availability of ultra-processed foods in their living area (Diabetes [OR: 2.18; 95% CI: 1.13, 4.21]/Arterial hypertension [OR: 1.64; 95% CI: 1.09, 2.47]).

These results suggest that characteristics of the consumer food environment have a significant effect on the occurrence of chronic diseases among socially vulnerable women, adding to the existing evidence in the literature and highlighting the need for integrated health care.

To characterise children’s lunchbox contents for food, waste, and packaging.

A cross-sectional study was conducted. Lunchboxes were photographed at two time points on the same day: before first morning break to capture food and packaging and post-lunch break to capture food waste. Contents were coded using an audit tool developed using REDCap.

23 sites across metropolitan Adelaide, South Australia including 14 preschools and 9 primary schools in low (n=8), medium (n=7), and high (n=8) socioeconomic areas.

Preschool (3-5 years) to Grade 7 (6-13 years) school students.

673 lunchboxes were analysed. Grain foods dominated (with at least half of them being discretionary varieties), with 92% of lunchboxes having at least one item from that category, followed by fruits (78%), snacks (62%), dairy (32%), and vegetables (26%). Lunchboxes of preschool children contained more fruits (92% vs 65%; χ2(1)=73.3, P<0.01), vegetables (36% vs 16%; χ2(1)=34.0, P<0.01), and dairy items (45% vs 19%; χ2(1)=53.6, P<0.01), compared to lunchboxes of primary school children. Snack foods were more prevalent in primary school (68%) than preschool (55%; χ2(1)=11.2, P<0.01). Discretionary foods appeared more frequently, and single-use packaging accounted for half (53%) of all packaging in lunchboxes, primarily from snacks and grain foods. Preschool children had less single-use packaging but more food waste. Vegetables were the most wasted food group.

Sandwiches, fruits, and various snacks are typical lunchbox foods, often accompanied by single-use packaging. Considering both health and environmental factors in lunchbox choices could benefit children and sustainability efforts in schools.

To characterize food group consumption, assess the contribution of food groups to energy and micronutrient intake, and estimate usual nutrient intake among adults in rural Sri Lanka.

A baseline survey (Dec 2020–Feb 2021) was conducted as part of an agriculture-based, nutrition-sensitive resilience program evaluation. Dietary intake was assessed using telephone-based 24-hour recalls (n=1283), with repeat recalls from 769 participants. Mean daily intake of food groups and their contribution to energy and nutrient intakes were calculated. The National Cancer Institute method was used to estimate usual intakes and the prevalence of adequate micronutrient intake (PAI). Differences by sex, district, and wealth were assessed using t-tests and ANOVA.

Forty-five rural villages throughout Sri Lanka.

Men and women from households in the program evaluation study area.

On average, grains and coconut milk provided 56% and 12% of energy, respectively. Rice, fish, dairy, and pulses were the primary sources of micronutrients. Participants consumed 118±117g vegetables and 71±243g fruit per day. PAI was <25% for calcium; zinc; niacin; folate; and vitamins B6, B12, and C, reflecting low consumption of animal-source foods (ASF; 80 g/day), whole grains, fruits, and vegetables (F&V). Significant differences in food group consumption by sociodemographic subgroup were observed among districts and wealth quintiles.

We observed high consumption of rice and coconut milk and low prevalence of micronutrient adequacy. We recommend increasing ASF, whole grain, and F&V consumption to close nutrient gaps, as well as research to identify effective solutions to increase micronutrient intake.

While fast-food is typically considered highly processed, an analysis to demonstrate this has yet to be conducted. Therefore, the objective of this research was to examine the menu items and ingredients from six fast-food restaurant menus using the NOVA Classification.

Cross-sectional study.

Data were collected from the top six highest selling United States restaurants, per each food category, identified using the Quick Service and Fast Casual Restaurants (QSR) 2020 Report.

A total of 740 menu items were identified and classified according to their degree of processing based on ingredient lists using the NOVA Classification: Minimally Processed (MPF), Culinary Processed Ingredient (CPF), Processed (PRF), or Ultra-processed (UPF). In addition, individual ingredients that appeared on at least three menus were classified into NOVA groups, and the 20 most common ingredients were identified based on frequency of appearance in ingredient lists.

Across all menus, 85% (Range: 70-94%) of items were UPFs with only 11% (Range: 6-25%) being MPF (p<0.001). Additionally, 46% of the ingredients that appeared on at least three menus were ultra-processed ingredients. Three ultra-processed ingredients appeared on all six menus: natural flavors, xanthan gum, and citric acid.

These findings show that the vast majority of menu items from major fast-food restaurants are UPFs and there are few options for MPFs. Fast-food companies should consider reformulation or the addition of MPF to the menu to increase healthful food options for their patrons.

Early childhood obesity (ECO) significantly increased in the United States. ECO interventions lack focus on the prevention of ECO for infants under two. Caregiver’s feeding styles (CFS) has shown to affect ECO development, but studies on CFS are limited. This study examined socioecological factors associated with CFS for infants under two in Nevada.

This cross-sectional study utilizing a survey, examined the five CFS-constructs: Responsive (RP), Non-Responsive (NRP) laissez-faire, NRP-pressuring, NRP-restrictive, and NRP-indulgent. Descriptive analysis and logistic regression following a hierarchical modeling approach were used to determine the associations between the CFS-constructs and socioecological factors (e.g., household, maternal mental health, and infant feeding).

Clark County, Nevada.

304 caregivers with infants under two.

NRP feeding styles were associated with low-income households (e.g., NRP-restrictive (AOR=2.60, 95% CI [1.01-6.71])), water insecurity (e.g., NRP-pressuring (AOR=2.46, 95% CI [1.00-6.06]), young mothers (e.g., NRP-laissez-faire (AOR=2.39, 95% CI [1.00-5.84])), lower maternal education (e.g., RP (AOR=0.58, 95% CI [0.33-1.00])), mild risk for depression (e.g., NRP-restrictive (AOR=0.50, 95% CI [0.28-0.90])) and a moderate to severe risk for anxiety (e.g., NRP-pressuring (AOR=0.32, 95% CI [0.14-0.74])). There were no associations between infant feeding factors and RP feeding.

Our study identified socioecological factors associated with dissimilarities in CFS in Nevada. These findings can be used to tailor educational approaches to address disparities in early childhood obesity.

To develop and evaluate the validity and reliability of the Street Food and Beverage Tool (SFBT).

This methodological study contains two phases: a) tool development, which involves conducting a systematic review followed by expert evaluation of the items, the creation of a Nutritional Healthfulness Index (NH), and pilot testing; and b) evaluation of the Tool’s Validity and Reliability: Content validity was judged by an external technical group, which evaluated the adequacy and pertinence of each tool item. Construct validity was evaluated around schools by testing the hypothesis: In high-income areas, there will be greater availability of healthy food and beverages at street food outlets (SFOs), as measured by the NH-index. Inter-rater and test-retest reliability were assessed outside subway stations. Pearson’s correlation, Cohen’s kappa, and Content validity Indexes were used for reliability and validation. A multinomial regression model was used to estimate construct validity.

Mexico City, Mexico.

80 SFOs at subway station exits and 1,066 around schools from diverse income areas.

The SFBT content validity index was satisfactory. The construct validity of the NH-index indicated higher values in higher-SDI areas. The NH-index showed a positive linear correlation between raters and across the first and second evaluations. The majority of item availability (>60%) showed moderate to strong kappa values for inter-rater and test-retest reliability.

The SFBT is a reliable and valid tool for assessing the availability of foods and beverages. Compared to other tools, it can measure the nutritional quality of SFOs expressed as an NH-index.

To analyze the global cancer burden associated with dietary factors across 204 countries and regions from 1990 to 2019.

A population-based study

Global Burden of Disease Study

Using data from the 2019 global burden of disease, we calculated Population Attributable Fractions (PAFs), death and disability-adjusted life years (DALYs). A comparative risk assessment framework was employed, along with estimated annual percentage changes (EAPCs).

In 2019, approximately 6.01% of cancer mortality and 5.50% of DALY rates can be attributed to dietary risk factors, particularly low intake of whole grains, milk, and fruits and vegetables. The High Socio-Demographic Index (SDI) region had the highest cancer mortality and DALY PAFs, mainly due to high consumption of red and processed meats, while the Low SDI region showed the highest PAFs from low fruit and vegetable consumption. In 2019, the High-middle SDI region had the highest age-standardized death rate (ASDR) and DALY rate attributable to dietary factors. Among geographic regions, Southern Latin America had the highest ASDR, and Central Europe had the highest age-standardized DALY rate. At the country level, Mongolia exhibited the highest rates for both ASDR and DALYs attributable to dietary risks. From 1990 to 2019, the largest increase in ASDR was observed in Western Sub-Saharan Africa, with Bulgaria showing the largest country-specific increase. Similarly, the largest increase in the age-standardized DALY rate was seen in Western Sub-Saharan Africa, with Lesotho experiencing the highest increase at the country level.

Our findings underscored the importance of increasing the consumption of whole grains, milk, and calcium, which can inform global dietary guidelines and cancer prevention strategies.

Early education and care (ECEC) is part of the everyday life of most children in developed economies presenting exceptional opportunity to support nutrition and ongoing food preferences. Yet, the degree to which such opportunity is captured in policy-driven assessment and quality ratings of ECEC services is unknown.

Abductive thematic analysis was conducted, guided by key domains of knowledge in nutrition literature and examining identified themes within these domains.

ECEC services (n=38) in Queensland, Australia.

Data were a random sample of field notes pertaining to mealtimes and food provision (n=182) collected as evidence to inform quality ratings during assessment visits to ECEC services.

The field notes mapped to three theory-driven domains: Provisions, Practices and Education. Reflecting policy specification, health, hygiene, and safety were a key focus but food quality and quantity were not. Assessors noted promotion of child autonomy at mealtimes yet little evidence pertaining to characteristics of educator-child interactions.

Despite evidence that childhood nutrition is crucial for optimal development and learning, quality and quantity of food is not directly assessed. Relationships and interactions at mealtimes provide an environment ideal for promoting learning and development yet the policy guiding inspection and assessment of ECEC services directs focus to a more limited lens of safety, hygiene and promotion of ‘healthy foods’. Our findings identify a narrow conceptualisation of mealtimes focused on ‘health’ as limiting the potential to leverage mealtimes as places to support children’s nutrition and attendant development and learning.

In response to increasing hypertension rates, South Africa implemented a regulation which set a maximum total sodium content for certain packaged food categories. We assess changes in reported sodium intake among 18-39 year old adults living in one township in the Western Cape as a result of the implementation of the regulation in 2016.

By linking one set of 24 hour dietary recall data to two versions of the South Africa Food Composition Database which reflect the pre-regulation and post-regulation periods, we calculated changes in sodium intake due to reformulation of food products, not behavior change. We statistically tested differences in mean consumption in this sample with paired t-tests.

Langa, Western Cape, South Africa

Surveyed participants were residents of Langa between 18-39 years old (n=2,148)

Before and after the implementation of the regulation there was a statistically significant decrease in the estimated sodium intake among adults of 189.4 mg (137.5, 241.4; p=0.00). Reported sodium from cured meat (such as Russians) and certain types of soup powder, cereals, and salted peanuts had a 9 to 33 percent lower calculated sodium consumption.

Our conclusions show that independent of any behavioral changes on the part of consumers, it is possible to lower sodium intake by using regulations to induce food manufacturers to lower the sodium levels in their products. As countries explore similar regulatory strategies, this work can add to that body of evidence to inform policies to improve the food system.

To investigate the relationship between violence and the nutritional status of pregnant women, and whether mental health could be a mediator in this relationship.

Cross-sectional study. Violence and mental health status were investigated using the following questionnaires: World Health Organization Violence Against Women (WHO-VAW), Abuse Assessment Screen (AAS), Patient Health Questionnaire (PHQ-9), and General Health Questionnaire (GHQ). Demographic, socioeconomic, obstetric, and lifestyle factors (smoking/alcohol consumption) were also investigated. The nutritional status of the women was assessed by the body mass index.

Data were collected from February 2021 to August 2022 in Araraquara city, Brazil.

Four hundred pregnant women recruited at 34 health units and the municipal maternity hospital.

Experience of violence was reported by 52.2% of the women and psychological violence in the last 12 months was the most prevalent type of domestic violence (19.5%). Approximately 43% of the women showed mental health changes and 59.7% had a risk of major depression. Women with mental health changes had an increased risk (OR=2.34) of obesity. Psychological violence in the last 12 months was associated with obesity (p=0.01) when mediated by mental health changes. The mediation effect was significant (β=0.708; 95%BCa CI=0.004-1.460), with mental health changes mediating 46.1% of the relationship between psychological violence and obesity.

The relationship between psychological violence and obesity during pregnancy was mediated by changes in mental health. This original study shows that nutritional status is not limited to biological factors and highlights the importance of social, mental, and psychological factors.