To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression.

Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations of food insecurity and related coping strategies with anxiety and depression.

South Africa during COVID-19, October 2021.

Nationally representative sample of 3402 adults, weighted to 39,640,674 South African households.

About 20·4 % of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from ‘food secure’ to ‘at risk’ or from ‘at risk’ to ‘food insecure’ group was associated with 1·7 times greater odds of being in a higher category of anxiety or depression (P < 0·001). All coping strategies were used to some extent in South African households, with 46·0 % relying on less preferred and less expensive foods and 20·9 % sending a household member to beg for food. These coping strategies were mostly used by food-insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all P < 0·001), begging for food was associated with the highest odds (OR = 2·3).

Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.

To assess viewer engagement of a food advertising campaign on the live streaming platform Twitch.tv, a social media platform that allows creators to live stream content and communicate with their audience in real time.

Observational analysis of chat comments across the Twitch platform containing the word ‘Wendy’s’ or ‘Wendys’ during a 5-day ad campaign compared with two 5-day non-campaign time periods. Comments were categorised as positive, negative or neutral in how their sentiment pertained to the brand Wendy’s.

Twitch chatrooms.

None.

There were significantly more chatroom messages related to the Wendy’s brand during the campaign period. When considering all messages, the proportion of messages was statistically different (x2 = 1417·41, P < 0·001) across time periods, with a higher proportion of neutral and positive messages and a lower proportion of negative messages during the campaign compared with the comparison periods. Additionally, the proportion of negative messages following the campaign was lower than before the campaign. When considering only positive and negative messages, the proportion of messages was statistically different (x2 = 366·38, P < 0·001) across each time period with a higher proportion of positive messages and a lower proportion of negative messages during the campaign when compared with the other time periods. Additionally, there was a higher proportion of positive messages and a lower portion of negative messages following the campaign when compared with before the campaign.

This study demonstrates the impact and sustained impact of a fast-food brand ad campaign on brand engagement on the live streaming platform Twitch.

The emerging concept of ‘food justice’ describes a social movement and a set of principles. It align with the goals of social justice, demanding recognition of human rights, equal opportunity, fair treatment and is participatory and community specific. The aim of this study was to investigate the conceptualisation of food justice and to explore how community participation is positioned in food justice scholarship.

A scoping review of peer-reviewed literature was conducted using the term ‘food justice’. This study used a five-step scoping review protocol. The databases included Scopus, Web of Science and Medline (OVID). Data were extracted on country of origin, research discipline, study type and conceptualisations of food justice. Reflexive thematic analysis was used to identify the themes.

The search identified 546 abstracts of which ninety peer-reviewed studies met the inclusion criteria. Thematic analysis identified five themes of food justice across these ninety studies: (1) social equity, (2) food security, (3) food systems transformation, (4) community participation and agency and (5) environmental sustainability.

Current conceptualisations of food justice are evolving. Together, these five themes, using the term food justice, embrace a more holistic and structural view of the food system. They emphasise healthy, sustainable and equitable food as a human right and acknowledge the need to address structural barriers to that right. Community participation and agency in food justice decision-making is critical for transformative change towards a healthy, sustainable, and more just food system.

Efforts to improve the nutritional quality and health promotion in the charitable food system have been undertaken. Though methods exist to track these efforts in terms of food banks’ inventory, there are not research-tested tools to assess, monitor and influence policy, systems and environmental (PSE) changes. The study objective was to develop and evaluate a novel assessment tool that could be used to evaluate a food bank’s efforts to improve the promotion of health and nutritious foods.

The study had five phases: (1) initial development; (2) iterative review and revisions; (3) pilot testing; (4) content validity assessment and (5) inter-rater and test-retest assessment. The Food Bank Health and Nutrition Assessment (FB-HANA) was drafted after reviewing existing policies, nutrition-focused charitable food systems guidance and similar tools for food pantries.

Midwestern United States.

Eleven food banks.

Stakeholders and pilot testers provided initial feedback to refine the FB-HANA’s flow, ease of completion and collection of contextual information. External experts rated the FB-HANA and each of the eight objectives as content valid. A set of two assessments completed by twenty-six community-based professionals, employed by Extension and fourteen food bank staff across eleven food banks, supported moderate to excellent inter-rater and test-retest reliability for the FB-HANA overall and each of its objectives.

Evidence suggests that the FB-HANA can be used by either food bank or community-based professionals, such as Extension staff, to provide a perspective on ways food banks promote health and nutrition through PSE approaches.

One explanation for the relationship between TV viewing and obesity is that people may (over)eat while watching TV. The current study investigated associations between TV viewing and the time spent on (concurrent) eating in a naturalistic setting among a general population sample.

Preregistered secondary data analyses were performed of a diary survey in which respondents reported their time use in 10-min blocks for 7 d.

Concurrent TV viewing and eating was operationalised as all blocks in which TV viewing and eating occurred simultaneously. Furthermore, the TV content respondents watched was coded as food-related (i.e. culinary content) or non-food related.

The sample composed of 2292 adults (58·9 % female) in the Netherlands, aged ≥ 20 years, from all educational levels (18·1 % low, 29·8 % middle and 51·4 % high).

More than half of the respondents (51·3 %) reported concurrent TV viewing and eating at least once during the 7-d diary period. The average eating occasion was longer in duration while watching TV (v. without media use), and the total time spent on eating was longer on days of concurrent TV viewing and eating (v. days of eating without media use). The percentage of TV viewing time spent on concurrent eating did not differ between food-related and non-food-related TV content.

Eating while watching TV was related to an increased time spent on eating. Even though energy intake was not assessed, these findings from a naturalistic setting provide further evidence that concurrent TV viewing and eating may contribute to overeating.

To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents.

Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, ‘appropriate eating contexts at breakfast, lunch and dinner’; cluster 2, ‘inappropriate eating context at breakfast’ and cluster 3, ‘inappropriate eating context at dinner’. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference.

Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil.

Adolescents, 14–19-year-olds (n 835).

We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14–15-year-olds (less likely in cluster 2) and higher mother’s schooling (more likely in cluster 3).

We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother’s schooling).

This study assessed the level of fathers’ involvement in childcare activities and its association with the diet quality of their children in Northern Ghana.

The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation.

A community-based comparative analytical cross-sectional study.

A sample of 422 rural mother–father pairs who had at least one child aged 6–36 months.

The overall level of fathers’ involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father’s involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)).

The findings confirm earlier studies that show that fathers’ involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

To identify peri-conceptional diet patterns among women in Bangalore and examine their associations with risk of gestational diabetes mellitus (GDM).

BAngalore Nutrition Gestational diabetes LifEstyle Study, started in June 2016, was a prospective observational study, in which women were recruited at 5–16 weeks’ gestation. Peri-conceptional diet was recalled at recruitment, using a validated 224-item FFQ. GDM was assessed by a 75-g oral glucose tolerance test at 24–28 weeks’ gestation, applying WHO 2013 criteria. Diet patterns were identified using principal component analysis, and diet pattern–GDM associations were examined using multivariate logistic regression, adjusting for ‘a priori’ confounders.

Antenatal clinics of two hospitals, Bangalore, South India.

Seven hundred and eighty-five pregnant women of varied socio-economic status.

GDM prevalence was 22 %. Three diet patterns were identified: (a) high-diversity, urban (HDU) characterised by diverse, home-cooked and processed foods was associated with older, more affluent, better-educated and urban women; (b) rice-fried snacks-chicken-sweets (RFCS), characterised by low diet diversity, was associated with younger, less-educated, and lower-income, rural and joint families; and (c) healthy, traditional vegetarian (HTV), characterised by home-cooked vegetarian and non-processed foods, was associated with less-educated, more affluent, and rural and joint families. The HDU pattern was associated with a lower GDM risk (adjusted odds ratio (aOR): 0·80/sd, 95 % CI (0·64, 0·99), P = 0·04) after adjusting for confounders. BMI was strongly related to GDM risk and possibly mediated diet–GDM associations.

The findings support global recommendations to encourage women to attain a healthy pre-pregnancy BMI and increase diet diversity. Both healthy and unhealthy foods in the patterns indicate low awareness about healthy foods and a need for public education.

We evaluated associations between food insecurity (FI) and the quality and quantity of sleep in adults (≥18 years).

The current study represented a systematic review and meta-analysis of observational studies.

Databases of PubMed, Scopus, Embase and Web of Science were searched from inception until 6 June 2022. Meta-analyses were conducted using random-effects models, and effect sizes were reported as OR and 95 % CI.

Data from ten eligible observational studies, including 83 764 participants, were included.

FI was associated with an increased risk of poor sleep quality (OR = 1·45; 95 % CI (1·24, 1·70), I2 = 95, P < 0·001, n 7). Besides, subgroup analysis showed increased risk of poor sleep quality corresponding to the severity of FI across mild (OR = 1·31; 95 % CI (1·16, 1·48), I2 = 0 %, P < 0·001, n 5), moderate (OR = 1·49; 95 % CI (1·32, 1·68), I2 = 0 %, P < 0·001, n 5) and severe (OR = 1·89; 95 % CI (1·63, 2·20), I2 = 0 %, P < 0·001, n 5) levels. Similarly, subgroup analysis by sleep problems showed that FI was associated with an increased the risk of trouble falling asleep (OR = 1·39; 95 % CI (1·05, 1·83), I2 = 91 %, P = 0·002, n 3) and trouble staying asleep (OR = 1·91; 95 % CI (1·37, 2·67), I2 = 89 %, P < 0·001, n 3). Moreover, FI was associated with the odds of shorter (OR = 1·14; 95 % CI (1·07, 1·21), I2 = 0 %, P < 0·001, n 4) and longer sleep duration (OR = 1·14; 95 % CI (1·03, 1·26), I2 = 0 %, P = 0·010, n 4).

Collective evidence supports that FI is associated with poor sleep quality and quantity in adults. Preventative and management strategies that address FI may provide health benefits beyond improving nutritional status per se.

To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications.

A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled.

Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread.

Children aged 6 to 59 months.

Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <−2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC < 115 mm or WAZ < −3) and (WAZ < −3) had the highest informedness in predicting mortality. A combined case definition (MUAC < 115 mm or WAZ < −3) was better at predicting deaths associated with weight-for-height Z-score <−3 and concurrent wasting and stunting (WaSt) than the single WAZ < −3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC < 115 mm or WAZ < −3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC < 115 mm alone.

A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.

Stunted children have an increased risk of diminished cognitive development, diabetes, degenerative and CVD later in life. Numerous modifiable factors decrease the risk of stunting in children. This study aimed to assess the role of the individual, household and social factors on stunting in Zimbabwean children.

A 1:2 unmatched case–control study.

This study was conducted in two predominantly rural provinces (one with the highest national prevalence of stunting and one with the lowest prevalence) in Zimbabwe.

Data were obtained from the caregivers of 150 children aged between 6 and 59 months with stunting and from the caregivers of 300 children without stunting.

Multiple (39) correlates of stunting were identified. Child’s age, birth length, birth weight, and weight-for-age outcome (child-related factors), caregiver’s age, maternal HIV status, occupation, and education (parental factors), breast-feeding status, number of meals, and dietary quality (dietary factors), child’s appetite, diarrhoeal and worm infection (childhood illnesses), income status, access to safe water, access to a toilet, health clubs and maternal support in infant feeding (household, socio-cultural factors) were all found to be significant predictors of childhood stunting.

Nearly all aspects under review from the individual-, household- to social-level factors were significantly associated with childhood stunting. These findings add to the growing body of evidence supporting the WHO stunting framework and strengthen the need to focus interventions on a multi-sectoral approach to effectively address stunting in high prevalence countries.

Dietary transitions in China have undergone rapid changes in over the last three decades. The purpose of this study is to describe trends in the macronutrient consumption, the sources of those nutrients and the diet quality among Chinese adults.

Longitudinal China Health and Nutrition Survey (CHNS) cohort analysis. Main outcomes are dietary energy intake from total carbohydrate, protein and fat and their subtypes, as well as food sources of carbohydrates, protein, and fat, and the China Dietary Guidelines Index 2018 (CDGI-2018).

CHNS (1991, 2000, 2009 and 2015).

Data from the longitudinal 1991, 2000, 2009 and 2015 CHNS of adults aged 18 years or older who had complete demographic information.

The estimated mean energy intake from total carbohydrate decreased from 62·6 % to 50·6 % between 1991 and 2015, while the mean energy intake from total protein increased from 12·6 % to just 13·1 % and the mean energy intake from total fat significantly increased from 24·0 % to 35·8 % (P < 0·001 for trend). Decreases were observed in evaluated mean energy from low-quality carbohydrates (from 53·6 % to 41·7 %) and incomplete protein (from 9·3 % to 7·5 %), while increases were seen in estimated mean energy from high-quality protein (from 3·3 % to 5·5 %), high-quality fat (from 9·1 % to 16·7 %) and low-quality fat (from 14·9 % to 19·0 %). Low-quality carbohydrates, primarily those derived from refined grains, decreased from 52·2 % to 36·2 %. The diet quality as measured by CDGI-2018 improved, with the estimated mean increasing from 41·7 to 52·4 (P < 0·01 for trend).

For Chinese adults, there was a significant change in the macronutrient composition over the previous few decades. The percentage of energy consumed from carbohydrates significantly decreased; however, the percentage of energy consumed from total fat significantly increased. Additionally, the diet quality remains suboptimal.

To assess urban–rural disparities in the association between long-term exposure to high altitude and malnutrition among children under 5 years old.

A three-stage, stratified, cluster sampling was used to randomly select eligible individuals from July to October 2020. The data of participants, including demographic characteristics, altitude of residence, and nutritional status, were collected via questionnaire and physical examination.

Tibet, China.

Children under 5 years old in Tibet.

Totally, 1975 children under 5 years old were included in this study. We found that an additional 1000 m increase in altitude was associated with decreased Z-scores of height-for-age (β = –0·23, 95 % CI: –0·38, –0·08), Z-scores of weight-for-age (β = –0·24, 95 % CI: –0·39, –0·10). The OR for stunting and underweight were 2·03 (95 % CI: 1·51 to 2·73) and 2·04 (95 % CI: 1·38 to 3·02) per 1000 m increase in altitude, respectively; and OR increased rapidly at an altitude above 3500 m. The effects of long-term exposure to high altitudes on the prevalence of underweight in rural children were higher than that in urban children (P < 0·05).

High-altitude exposure is tightly associated with malnutrition among children under 5 years old. Improving children’s nutrition is urgently needed in areas above 3500 m, especially in rural ones.

The relationship of a diet low in fibre with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCD) attributable to a diet low in fibre globally from 1990 to 2019.

All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALY) and years lived with disability (YLD) were estimated with Bayesian geospatial regression using data at global, regional and country level acquired from an extensively systematic review.

All data sourced from the GBD Study 2019.

All age groups for both sexes.

The age-standardised mortality rates (ASMR) declined in most GBD regions; however, in Southern sub-Saharan Africa, the ASMR increased from 4·07 (95 % uncertainty interval (UI) (2·08, 6·34)) to 4·60 (95 % UI (2·59, 6·90)), and in Central sub-Saharan Africa, the ASMR increased from 7·46 (95 % UI (3·64, 11·90)) to 9·34 (95 % UI (4·69, 15·25)). Uptrends were observed in the age-standardised YLD rates attributable to a diet low in fibre in a number of GBD regions. The burden caused by diabetes mellitus increased in Central Asia, Southern sub-Saharan Africa and Eastern Europe.

The burdens of disease attributable to a diet low in fibre in Southern sub-Saharan Africa and Central sub-Saharan Africa and the age-standardised YLD rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fibre.

To investigate whether food insecurity helps explain the association between income and psychological distress and if its role differs by disability status.

Using 2011–2017 National Health Interview Survey cross-sectional data (n 102 543), we conducted linear regression models, fully interacted with disability status, to estimate the association between income-to-poverty ratio (IPR) (<1, 1–<2, 2–<4, ≥4) and psychological distress (Kessler 6 (K6) Scale, range: 0–24). Base models adjusted for socio-demographic factors. We then added food security (secure, low and very low), interacted with disability, and conducted post-estimation adjusted Wald tests.

USA.

Nationally representative sample of non-institutionalised adults 18 years and older.

The association between income and psychological distress was stronger for people with disabilities. Compared to those in the highest income category (IPR ≥4), poor individuals (IPR < 1) with and without disabilities scored 2·10 (95 % CI (1·74, 2·46)) and 0·81 (95 % CI (0·69, 0·93)) points higher on the K6 Scale, respectively. Accounting for food insecurity reduced the estimated income disparity in psychological distress significantly more among individuals with disabilities (0·96 points or 46 %) than without disabilities (0·34 points or 42 %), decreasing the difference in the income disparity between those with and without disabilities by 48 % (0·62 points). Further, food insecurity more strongly predicted psychological distress for individuals with disabilities independent of socio-economic disadvantage.

Food insecurity plays a more important role in shaping patterns of psychological distress for people with disabilities, explaining more of the association between income and psychological distress among those with than without disabilities. Improving food security may reduce mental health disparities.

To assess the clustering properties of residential urban food environment indicators across neighbourhoods and to determine if clustering profiles are associated with diet outcomes among adults in Brooklyn, New York.

Cross-sectional.

Five neighbourhoods in Brooklyn, New York.

Survey data (n 1493) were collected among adults in Brooklyn, New York between April 2019 and September 2019. Data for food environment indicators (fast-food restaurants, bodegas, supermarkets, farmer’s markets, community kitchens, Supplemental Nutrition Assistance Program application centres, food pantries) were drawn from New York databases. Latent profile analysis (LPA) was used to identify individuals’ food access-related profiles, based on food environments measured by the availability of each outlet within each participant’s 800-m buffer. Profile memberships were associated with dietary outcomes using mixed linear regression.

LPA identified four residential urban food environment profiles (with significant high clusters ranging from 17 to 57 across profiles): limited/low food access, (n 587), bodega-dense (n 140), food swamp (n 254) and high food access (n 512) profiles. Diet outcomes were not statistically different across identified profiles. Only participants in the limited/low food access profile were more likely to consume sugar-sweetened beverages (SSB) than those in the bodega-dense profile (b = 0·44, P < 0·05) in adjusted models.

Individuals in limited and low food access neighbourhoods are vulnerable to consuming significant amounts of SSB compared with those in bodega-dense communities. Further research is warranted to elucidate strategies to improve fruit and vegetable consumption while reducing SSB intake within residential urban food environments.

Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention.

We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens.

Communities.

Practice-based researcher experience and perspectives.

Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded.

We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.

To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention.

Pilot randomised controlled trial.

Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials.

Parents and their 2–5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups.

Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (−1·35, −0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (−1·52, −0·19)), using food as a reward (PE = -0·54, 95 % CI (−1·35, −0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)).

Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.