To assess the differences in healthy, environmentally sustainable and safe food consumption by education levels among adults aged 19–69 in the Netherlands.

This study used data from the Dutch National Food Consumption Survey 2007–10. Food consumption data were obtained via two 24-h recalls. Food consumption data were linked to data on food composition, greenhouse gas emissions (GHGe) and concentrations of contaminants. The Dutch dietary guidelines (2015), dietary GHGe and dietary exposure to contaminants were used as indicators for healthy, environmentally sustainable and safe food consumption, respectively.

The Netherlands.

2106 adults aged 19–69 years.

High education groups consumed significantly more fruit (+28 g), vegetables (men +22 g; women +27 g) and fish (men +6 g; women +7 g), and significantly less meat (men –33 g; women –14 g) compared with low education groups. Overall, no educational differences were found in total GHGe, although its food sources differed. Exposure to contaminants showed some differences between education groups.

The consumption patterns differed by education groups, resulting in a more healthy diet, but equally environmentally sustainable diet among high compared with low education groups. Exposure to food contaminants differed between education groups, but was not above safe levels, except for acrylamide and aflatoxin B1. For these substances, a health risk could not be excluded for all education groups. These insights may be used in policy measures focusing on the improvement of a healthy diet for all.

To assess the nutritional quality of Australian supermarket own brand chilled convenience foods (SOBCCF), for example, ready meals, pizza, pies and desserts.

Cross-sectional.

Two large supermarkets (Coles and Woolworths) in Perth, Western Australia were audited in February 2017.

Data were extracted from photographic images of 291 SOBCCF, including front-of-pack information (i.e. product name, description and nutrition labels including Health Star Rating (HSR)) and back-of-pack information (i.e. nutrition information panel and ingredients list). SOBCCF were classified as healthy or unhealthy consistent with principles of the Australian Guide to Healthy Eating (AGTHE), NOVA classification of level of food processing and HSR score.

Fifty-four percentage of SOBCCF were classified as unhealthy according to AGTHE principles, 94 % were ultra-processed foods using NOVA and 81 % scored a HSR of ≥2·5, implying that they were a healthy choice. Some convenience food groups comprised more healthy choices overall including prepared vegetables, salad kits and bowls, soups and vegetarian food. A significantly larger proportion of SOBCCF from Coles were classified as unhealthy compared with Woolworths (70 v. 44 %, P < 0·05) using the AGTHE.

The findings suggest there is potential for Australian supermarkets to improve the nutritional quality of their SOBCCF and highlights the differences between supermarkets in applying their corporate social responsibility policies. Policies to assist consumers to select healthier foods should address difficulties in identifying healthy convenience foods. The findings reveal misclassification of unhealthy SOBCCF as healthy by the HSR suggesting that its algorithm should be reformed to align with recommendations of the AGTHE.

Several authors have questioned the suitability of WHO Child Growth Standards (WHO-CGS) for all ethnic groups. The aim of this study was to identify potential misclassification of stunting, underweight and wasting in children of Surinamese Asian Indian, South Asian (Pakistan/India) and Dutch descent.

A series of routine cross-sectional measurements, collected 2012–2015. South Asian-specific normative growth references for weight-for-age and weight-for-length/height were constructed using the LMS method based on historic growth data of Surinamese Asian Indians born between 1974 and 1976. WHO-CGS and ethnic-specific references were applied to calculate z-scores and prevalence of stunting, underweight and wasting.

Youth HealthCare, providing periodical preventive health check-ups.

11 935 children aged 0–5 years.

Considerable deviations from WHO-CGS were found, with higher-than-expected stunting rates, especially in the first 6 months of life. Surinamese Asian Indian children showed stunting rates up to 16·0 % and high underweight and wasting over the whole age range (up to 7·2 and 6·7 %, respectively). Dutch children consistently had mean WHO-CGS z-scores 0·3–0·5 sd above the WHO baseline (>6 months). The application of ethnic-specific references showed low rates for all studied indicators, although South Asian children were taller and larger than their Surinamese Asian Indian counterparts.

WHO-CGS misclassify a considerable proportion of children from all ethnic groups as stunted in the first 6 months of life. Underweight and wasting are considerably overestimated in Surinamese Asian Indian children. Ethnic-specific growth references are recommended for Surinamese Asian Indian and Dutch children. The considerable differences found between South Asian subpopulations requires further research.

In 2014, a Nutrition Report Card (NRC) was developed as a sustainable, low-cost framework to assess the healthfulness of children’s food environments and highlight action to support healthy eating. We summarise our experiences in producing, disseminating, evaluating and refining an annual NRC in a Canadian province from 2015 to 2019.

To produce the NRC, children’s food environment indicator data are collected, analyzed and compiled for consensus grading by an Expert Working Group of researchers and practitioners. Knowledge translation activities are tailored annually to the needs of target audiences: researchers, practitioners, policymakers and the public. Evaluation of reach is conducted through diverse strategies, including tracking media coverage and website traffic. Assessment of impact on diets and health outcomes is planned.

Alberta, Canada.

Not applicable.

The grading process has facilitated refining the NRC to enhance its relevance and utility as a tool for its target audiences. Its public release consistently captures media interest and policymakers’ attention. The importance of partnerships in revealing data sources and in strategising to enhance policy approaches to improve food environments is apparent. The NRC has benchmarked progress and stimulated dialogue regarding healthy food environments for children.

The NRC may help to foster a supportive climate for improving the quality of children’s food environments. As an engaging and accessible document, the NRC represents a key mechanism for collating data related to children’s food environments and ensuring it reaches the audiences best positioned to use it. Efforts are underway to expand the NRC across Canada.

Waist-to-height ratio has been shown to be an important indicator of cardiometabolic risk. There are few studies evaluating this measure against existing measures of adiposity and cardiometabolic markers in early childhood. The objectives were: (i) to determine in young children the ability of waist-to-height ratio, BMI z-score, weight for length, and sum of skin fold thickness to predict cardiometabolic risk and (ii) to examine this association at ages 1, 3 and 5 years.

Prospective cohort study.

A university hospital in Toronto, Ontario.

Infants at 1 (n 406), 3 (n 112) and 5 years of age (n 94) born to mothers with and without gestational diabetes mellitus.

Weight for length and BMI z-score demonstrated the strongest correlations with biochemical measures compared to waist-to-height ratio, including leptin (at 5 years, weight for length z-score: ρ = 0·65, P < 0·001; BMI z-score: ρ = 0·67, P < 0·001) and measures of insulin resistance (at 3 years, weight for length z-score: ρ = 0·25, P = 0·02; BMI z-score: ρ = 0·24, P = 0·02). The magnitude of associations between anthropometric measures and biochemical measures strengthened over time. Weight for length and BMI z-scores were moderately correlated with overall measures of fat mass as measured by dual-energy X-ray absorptiometry (ρ = 0·65, P = 0·00; ρ = 0·61, P = 0·01).

Waist-to-height ratio was not superior to existing measures in predicting cardiometabolic risk in young children. BMI z-score is a preferred measure of adiposity between birth and 5 years of age.

The obesity pandemic is an increasing burden for society. Information on key drivers of the nutrition cycle of (a) social causation, (b) biological causation and (c) health selection is vital for effective policies targeted at the reduction of obesity prevalence. However, empirical causal knowledge on (a) the social predictors of diet quality, (b) its impact on corpulence and (c) the socioeconomic consequences of obesity is sparse. We overcome the limitations of previous research and acquire comprehensive causal insight into this cycle.

Therefore, we analyse two German socio-epidemiological panel surveys exploiting their longitudinal panel structure utilising hybrid panel regression models.

General population of Germany.

German Health Interview and Examination Survey for Children and Adolescents (KiGGS, n 17 640; age 0–24 years) and the German National Nutrition Monitoring (NEMONIT, n 2610; age 15–82 years).

The results indicate that (a) interestingly only sex, education and age explain healthy diets; (b) increases in a newly developed Optimised Healthy Eating Index (O-HEI-NVSII) and in nuts intake reduce BMI, while growing overall energy intake, lemonade, beer and meat (products) intake drive corpulence; (c) in turn, developing obesity decreases socioeconomic status.

These results suggest that policies targeted at the reduction of obesity prevalence may be well advised to focus on boys and men, people with low education, the promotion of a healthy diet and nuts intake, and the limitation of lemonade, beer and meat (products) intake. Therefore, future research may focus on the replication of our findings utilising longer panels and experimental approaches.

To investigate the influence of current food and nutrition trends on dietitians’ perceptions of the healthiness of packaged foods.

This observational study used a cross-sectional survey. Participants rated (strongly disagree to strongly agree) the extent to which a range of factors, independent of the energy, nutrient and ingredient content, influenced their perceptions of the healthiness of packaged foods. Two open-ended questions allowed for participants to list additional items they considered important.

Online survey.

Australian dietitians (n 117).

The greatest consensus was a positive influence of the fit within the core food groups and presence of seasonal ingredients, and a negative influence of an increasing number of additives. Mixed opinions were obtained for GM ingredients, locally sourced ingredients, labelling of animal welfare and organic certification. Nutritional indicators received a split where almost half of participants disagreed/strongly disagreed that they positively influenced their perception of healthiness. Content analysis of open-ended responses (n 53, 45 %) revealed four broad categories as important in considering healthiness: ‘a whole food approach’, ‘marketing and labelling’, ‘product information’ and ‘context of diet’. A small number of responses (count of 6, 5 %) reported that packaging, advertising and features such as celebrity endorsement were a negative influence.

Dietitians have a broad concept of the healthiness of packaged foods, which incorporates elements of food safety, wholeness of the ingredients and marketing. Providing unified messages to the consumer can help to build the public perception of dietitians as experts in nutrition advice and counselling.

To examine the associations of changes in the local food environment, individual behaviours and perceptions with changes in dietary intake, following relocation from an established neighbourhood to a new residential development.

Spatial food environment exposure measures were generated relative to each participant’s home address using the locations of food outlets at baseline (before moving house) and follow-up (1–2 years after relocation). Self-reported data on socio-demographics, self-selection, usual dietary intake, individual behaviours and perceptions of the local food environment were sourced from the RESIDential Environments (RESIDE) Project. Changes in spatial exposure measures, individual behaviours and perceptions with changes in dietary outcomes were examined using mixed linear models.

Perth, Western Australia, 2003–2007.

Adults (n 1200) from the RESIDE Project.

Moving to a new residential development with more convenience stores and café restaurants around the home was significantly associated with an increase in unhealthy food intake (β = 0·049, 95 % CI 0·010, 0·089; β = 0·020, 95 % CI 0·007, 0·033) and was partially mediated by individual behaviours and perceptions. A greater percentage of healthy food outlets around the home following relocation was significantly associated with an increase in healthy food (β = 0·003, 95 % CI 0·001, 0·005) and fruit/vegetable intake (β = 0·002, 95 % CI 0·001, 0·004).

Policy and planning may influence dietary intakes by restricting the number of convenience stores and other unhealthy food outlets and increasing the relative percentage of healthy food outlets.

To identify correlates and underlying beliefs regarding the adolescents’ intention to abstain from consuming sugar-sweetened beverages (SSB) and the consumption of ≤1 daily portion of SSB.

Correlational study.

Region of Chaudière-Appalaches in the province of Quebec, Canada.

311 adolescents aged 13–18 years completed a self-administrated online questionnaire based on the Reasoned Action Approach. Frequency and quantity of different types of SSB within the past month were measured.

Total mean SSB intake was 882·6 ml/d (654·0 kJ/d ). Only 11·3 % abstained from SSB within the last month. Intention to abstain from SSB was explained by identification as SSB abstainers (β = 0·47), perceived norm (β = 0·32), attitude (β = 0·30), age 13–14 years (β = –0·27) and perception of the school environment (β = 0·14), which explained 66 % of the variance. Consumption of ≤1 daily portion of SSB was explained by the intention to abstain (OR = 1·55; 95 % CI 1·14, 2·11), perceived behavioural control to abstain (OR = 1·80; 95 % CI 1·29, 2·52), sex (girls v. boys: OR = 2·34; 95 % CI 1·37, 3·98) and socio-economic status (advantaged v. disadvantaged school: OR = 2·08; 95 % CI 1·21, 3·56). Underlying beliefs (i.e. more energy, decreased risk of addiction and friends’ approval) associated with intention as well as perceived barriers (e.g. access to SSB, after an activity that makes you thirsty), and facilitating factors (e.g. access to water) linked to SSB consumption were identified.

The results can inform public health interventions to decrease SSB consumption and their associated health problems among adolescents.

To evaluate the relationship between fruits and vegetables (F&V) availability at home and young people’s F&V consumption behaviour, and how the theory of planned behaviour (TPB) constructs could potentially mediate the relationship.

Cross-sectional face-to-face survey questionnaire to assess the TPB constructs and home food availability assessed using open inventories method. F&V availability was categorised into low and high levels based on median split.

Singapore.

Two hundred and ten households (each consisting one parent–child pair) recruited via stratified cluster sampling with child participants ranging from 9 to 16 years of age.

Mediation analyses were conducted using structural equation modelling. The relationship between home F&V availability and F&V consumption behaviour did not have a significant direct association, but there were significant indirect effects through the routes of perceived behavioural control (PBC) and intention as well as attitude and intention. Specifically, higher level of F&V availability at home was related to more positive PBC and attitude towards F&V, and subsequently greater intention to consume F&V and higher consumption of F&V.

Parents should make F&V more readily available at home as increased exposure to F&V could be related to enhanced liking, sense of control and intention to consume F&V and facilitate children’s healthy diet.

Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.

A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.

USA.

Toddlers aged 1–3 years, n 559; children aged 4–12 years, n 1540; adolescents aged 13–18 years, n 992; and adults aged ≥19 years, n 576.

Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2–82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.

Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.

To examine the perspectives of librarians and staff about Lunch at the Library, a library-based summer meal programme for children. The study examines: (i) motivating factors behind implementing the meal programme; (ii) issues of feasibility; and (iii) perceived programme outcomes.

One-on-one semi-structured interviews with library stakeholders (librarians and staff) from a purposeful sample of California libraries.

Twenty-two library jurisdictions across California that implemented the Lunch at the Library summer meal programme in 2015 in areas of high financial need.

Twenty-five library stakeholders representing twenty-two of the thirty-three Californian library jurisdictions that implemented Lunch at the Library at their sites.

Library stakeholders recognised the need for a child meal programme during summer. Despite lack of sufficient resources and personnel, they were motivated to implement the programme not only to fill a community need but also to ensure children at their libraries were primed for learning over the summer. Library stakeholders also perceived the public library’s changing role in society as shifting from reference provision to social service provision either directly or by referral.

The public library is an ideal place to provide social services because of its accessibility to all. Librarians and library staff are motivated to address the social needs of their communities. This study demonstrates the feasibility of implementing new social programmes at public libraries. Funding to support these programmes would increase the library’s capacity to address other community needs.

To investigate how dietary patterns (DP) change following engagement in a weight management programme. Using the DP identified, to study their relationship with weight loss achieved and ability to meet the Scientific Advisory Committee on Nutrition’s 2015 fibre and sugar recommendations.

Secondary analysis of FFQ data, which collected dietary information at two time points: retrospectively before (T0) and presently during (T1) Slimming World’s programme, was analysed. Principal component analysis derived the DP present.

Online FFQ, hosted by Slimming World (SW) in the UK.

Female SW members (n 325; 17–68 years old).

At T0, two DP, ‘plant based’ and ‘processed meat and sugar added by the consumer’ were identified. At T1, three DP were identified, ‘high meat’, ‘high fat salt and sugar (HFSS) products’ and ‘nuts and oils’. Participants with a diet low in ‘HFSS products’ lost significantly more weight (P for trend = 0·001), were more likely to consume breakfast (P = 0·021) and consumed less free sugar compared with high ‘HFSS product’ consumers. Those initially presenting with a low ‘plant based’ diet score lost more weight at T1 (P for trend = 0·046). With engagement, mean fibre intake increased from 24·3 to 32·4 g/d (P < 0·001) and free sugar intake decreased from 12·6 to 8·7 % total dietary energy (P < 0·001).

An individual’s DP before and with engagement in a weight management programme may indicate their weight loss success. Advising reduced HFSS product intake may aid initial weight loss. SW appears to promote dietary changes towards UK fibre and sugar recommendations.

To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.

A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.

Navajo Nation, USA.

Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.

The Navajo Fruit and Vegetable Prescription (FVRx) Programme.

A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.

To (i) identify and synthesise findings from interventions to improve the dietary intake, physical activity and weight status of children aged 0–6 years attending family day care services; and (ii) assess the impact of interventions on family day care environments, intervention cost and adverse outcomes.

Medline in Process, PsycINFO, ERIC, Embase, CINAHL, CENTRAL and Scopus databases were searched in March 2019. Studies were included if they (i) evaluated an intervention to improve the diet, physical activity and/or weight of children aged 0–6 years; (ii) were delivered in family day care services; (iii) targeted child diet, physical activity and/or weight; and (iv) used a parallel control group design. Screening was undertaken by two reviewers with disagreements resolved by a third reviewer.

Family day care services, also known as family childcare homes.

Children aged 0–6 years attending family day care services.

In total, 8977 titles were retrieved, and 199 full-texts reviewed. No studies met the inclusion criteria for the primary outcome; however, two studies reporting on the secondary outcome of family day care environments were included. The 4-year community-wide obesity prevention programme and the 12-month train-the-trainer programme both reported statistically significant improvements in the healthy eating and physical activity environments of family day care, compared to cross-sectional state-average control groups.

Findings highlight few existing interventions in family day care services and a need for high-quality controlled trials to identify effective interventions to improve children’s diet, activity and weight in this setting.

To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.

Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.

All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.

Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011–2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).

The proportion of products carrying claims that do not meet nutrient profiling and consumers’ tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.

Increasing prevalence of overweight and obese people in England has led policymakers to consider regulating the use of price promotions on foods high in fat, sugar and salt content. In January 2019, the government opened a consultation programme for a policy proposal that significantly restricts the use of price promotions that can induce consumers to buy higher volumes of unhealthy foods and beverages. These proposed policies are the first of their kind in public health and are believed to reduce excess purchasing and, therefore, overconsumption of unhealthy products. This study summarises evidence relating price promotions to the purchasing of food and drink for home consumption and places it in the context of the proposed policy.

Non-systematic review of quantitative analyses of price promotions in food and drink published in peer-reviewed journals and sighted by PubMed, ScienceDirect & EBSCOhost between 1980 and January 2018.

While the impact of price promotions on sales has been of interest to marketing academics for a long time with modelling studies showing that its use has increased food and drink sales by 12–43 %, it is only now being picked up in the public health sphere. However, existing evidence does not consider the effects of removing or restricting the use of price promotions across the food sector. In this commentary, we discuss existing evidence, how it deals with the complexity of shoppers’ behaviour in reacting to price promotions on foods and, importantly, what can be learned from it in this policy context.

The current evidence base supports the notion that price promotions increase purchasing of unhealthy food, and while the proposed restriction policy is yet to be evaluated for consumption and health effects, there is arguably sufficient evidence to proceed. This evidence is not restricted to volume-based promotions. Close monitoring and proper evaluation should follow to provide empirical evidence of its intended and unintended effects.

To provide baseline evidence of sugar-sweetened beverage (SSB) consumption in a sample of Irish children prior to the introduction of the SSB tax; to identify the energy contribution of SSB to daily energy intake; and to explore the association between SSB consumption and overweight/obesity.

Cross-sectional study.

Primary schools in Cork, Ireland in 2012.

1075 boys and girls aged 8–11 years. SSB consumption was assessed from 3-d food diaries. BMI was used to define obesity (International Obesity Taskforce definitions). Plausible energy reporters (n 724, 68 % of total sample) were classified using Schofield equation.

Eighty-two per cent of children with plausible energy intake consumed SSB. Mean energy intake from SSB was 485 kJ (6 % of total kJ). Mean kilojoules from SSB increased with weight status from 443 kJ for normal-weight children to 648 kJ for children with overweight/obesity (5·8 and 7·6 % of total kJ, respectively). Mean SSB intake was significantly higher in children with overweight/obesity than normal-weight children (383 and 315 ml/d). In adjusted analyses, children consuming >200 ml/d had an 80 % increased odds of overweight/obesity compared to those consuming <200 ml/d (OR 1·8, 95 % CI 1·0, 3·5). Family socioeconomic status and lifestyle determinants, including frequency of takeaway consumption and TV viewing, were also significantly associated with SSB consumption.

SSB account for a substantial proportion of daily energy intake and are significantly associated with child overweight/obesity. This study provides baseline data from a sample of children from which the impact of the SSB tax can be benchmarked.

To compare the nutritional quality of children’s combination meals offered at large US chain restaurants characterised by three versions – default (advertised), minimum (lower-energy) and maximum (higher-energy).

We identified default children’s meals (n 92) from online restaurant menus, then constructed minimum and maximum versions using realistic additions, substitutions and/or portion size changes for existing menu items. Nutrition data were obtained from the MenuStat database. Bootstrapped linear models assessed nutrition differences between meal versions and the extent to which meal components (main dish, side dish, beverage) drove differences across versions. For each version, we examined the proportion of meals meeting the Guidelines for Responsible Food Marketing to Children.

Twenty-six fast-food and fast-casual restaurants, in 2017.

None.

Nutrient values differed significantly across meal versions for energy content (default 2443 kJ (584 kcal), minimum 1674 kJ (400 kcal), maximum 3314 kJ (792 kcal)), total fat (23, 17, 33 g), saturated fat (8, 6, 11 g), Na (1046, 915, 1287 mg) and sugar (35, 14, 51 g). The substitution of lower-energy beverages resulted in the greatest reduction in energy content (default to minimum, −418 kJ (−100 kcal)) and sugar (−20 g); choosing lower-energy side dishes resulted in the greatest reduction in total fat (default to minimum, −4 g), saturated fat (−1·1 g) and Na (−69 mg). Only 3 % of meals met guidelines for all nutrients.

Realistic modifications to children’s combination meals using existing menu options can significantly alter a meal’s nutrient composition. Promoting lower-energy items as the default option, especially for beverages and side dishes, has a potential to reduce fat, saturated fat and/or sugar in children’s meals.