This paper examines the associations of socio-economic and demographic correlates with malnutrition among women and investigates education and wealth-related inequalities in malnutrition among women by region.

We utilise a two-level mixed-effects logistic regression model to evaluate the associations and employ the concentration, Wagstaff and Erreygers’s correction indices to measure socio-economic inequalities in malnutrition among women.

Bangladesh Demographic and Health Survey data.

Non-pregnant women aged 15–49 years.

We find evidence of a significant cluster effect in the data. Women’s age, marital status, total children ever born, education level, husband’s/partner’s education level, residence and wealth index appear to be significantly associated with women underweight and overweight/obesity status. Underweight status is higher among less-educated women and women from poor households, whereas overweight/obesity is more concentrated among higher educated women and women from wealthy households. The southwestern region of the country demonstrates lower education and wealth-related inequalities in malnutrition among women. In contrast, the central and the northeastern areas apparently experience the highest education and wealth-related inequalities in malnutrition among women. The regional differences in predicted probabilities of being underweight shrink at higher education level and the richest quintile, whereas the differences in overweight/obese diminish at the primary education level and lower quintile households.

Our findings strengthen the evidence base for effective regional policy interventions to mitigate education and wealth-related inequalities in malnutrition among women. There is a need for developing regional awareness programmes and establishing regional monitoring cells to ensure proper health and nutrition facilities in underprivileged regions.

Previous studies on the association between glycaemic index (GI) and glycaemic load (GL) in relation to breast cancer risk are contradictory. The aim of this study was to examine the association between dietary GI and GL and risk of breast cancer in Iranian women.

Population-based case–control study. Dietary GI and GL were assessed using a validated Willett-format 106-item semi-quantitative FFQ.

Isfahan, Iran.

Cases were 350 patients with newly diagnosed stage I–IV breast cancer, for whom the status of breast cancer was confirmed by physical examination and mammography. Controls were 700 age-matched apparently healthy individuals who were randomly selected from general population.

After controlling for potential confounders, individuals in the highest tertile of dietary GI had 47 % higher odds of breast cancer than women in the lowest tertile (OR: 1·47; (95 % CI 1·02, 2·12)). Stratified analysis by menopausal status showed such association among postmenopausal women (OR: 1·51; (95 % CI 1·02, 2·23)). We found no significant association between dietary GL and odds of breast cancer either before (OR: 1·35; (95 % CI 0·99, 1·84)) or after adjustment for potential confounders (OR: 1·24; (95 % CI 0·86, 1·79)). In addition, stratified analysis by menopausal status revealed no significant association between dietary GL and odds of breast cancer.

Our findings showed a significant positive association between dietary GI and odds of breast cancer. However, we observed no significant association between dietary GL and odds of breast cancer.

As older adults are at higher risk for severe illness and mortality from SARS-CoV-2 infection, social distancing has been a primary means of mitigating risk. However, this lifestyle change may impact eating habits and food choices. The aim of this study was to explore individual and interpersonal factors affecting the eating behaviours and dietary intake of community-dwelling older adults during the COVID-19 pandemic.

Semi-structured individual interviews were conducted. All interviews were audio-recorded and transcribed verbatim. Qualitative data were analysed using a deductive content analysis approach to identify themes.

Southeastern United States

Twenty-three men and women, 60 years of age and older (mean age 71·9 ± 7·7, 22 % male), completed both the interview and questionnaire.

Themes that emerged at the individual level included changes in eating habits and foods eaten, with most participants reporting healthier food choices during the pandemic. Participants also reported more frequent cooking, improved cooking skills and cooking as a form of stress relief. Although some older adults described increased snacking and consumption of ‘comfort foods’, others noted no influence of mood on food choices. At the interpersonal level, an increased use of technology for social interaction and the importance of social support were identified as influencing factors.

Findings provide insight on how to help older adults maintain good nutrition amidst lifestyle changes imposed by social distancing. Nutrition educators may capitalise on positive behaviour changes that occurred during the pandemic such as increased cooking and increased use of technology for social interaction.

To investigate the effects of providing a daily healthy school snack on children’s nutritional, social and educational outcomes and explore stakeholders’ perceptions of an emergency school feeding programme (SFP).

Convergence triangulation mixed-methods study design. Associations were examined between receiving the school feeding intervention and children’s outcomes using multivariable regression models. Quantitative data were complemented with interviews and focus group discussions with parents and staff.

In vulnerable communities in Lebanon, the World Food Programme has implemented an emergency SFP targeting Lebanese (attending morning sessions) and Syrian refugee children (attending afternoon sessions) in public schools.

Children from ten intervention schools (morning n 403; afternoon n 379) and ten matched control schools (morning n 399; afternoon n 401), as well as twenty-nine parents and twenty-two school staff members.

Diet diversity was higher in intervention schools as compared with control with a significantly higher consumption of dairy products, nuts and fruit in both sessions. Child-reported food insecurity experience was lower in children attending the afternoon session of intervention v. control schools. The SFP intervention was associated with higher school engagement and sense of school community in the morning session only. While the SFP was significantly associated with higher attendance for children in afternoon sessions only, it was significantly associated with school retention of children in both sessions.

A daily healthy snack potentially acts as an incentive to improve children’s nutritional outcomes, school engagement, sense of belonging, equality between students and improvement in children’s attendance and retention in public schools.

To systematically assess Germany’s nutrition policies, to benchmark them against international best practices and to identify priority policy actions to improve population-level nutrition in Germany.

We applied the Food Environment Policy Index (Food-EPI), a methodological framework developed by the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) network. Qualitative content analysis of laws, directives and other documents formed the basis of a multistaged, structured consultation process.

Germany.

The expert consultation process included fifty-five experts from academia, public administration and civil society.

Germany lags behind international best practices in several key policy areas. For eighteen policy indicators, the degree of implementation compared with international best practices was rated as very low, for twenty-one as low, for eight as intermediate and for none as high. In particular, indicators on food taxation, regulation of food marketing as well as retail and food service sector policies were rated as very low to low. Identified priority actions included the binding implementation of nutrition standards for schools and kindergartens, a reform of the value added tax on foods and beverages, a sugar-sweetened beverage tax and stricter regulation of food marketing directed at children.

The results show that Germany makes insufficient use of the potential of evidence-informed health-promoting nutrition policies. Adopting international best practices in key policy areas could help to reduce the burden of nutrition-related chronic disease and related inequalities in nutrition and health in Germany. Implementation of relevant policies requires political leadership, a broad societal dialogue and evidence-informed advocacy by civil society, including the scientific community.

The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI).

We re-enrolled families from two statewide studies (2017–2020) in an observational cohort (May–August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programmes (e.g. Coronavirus Aid, Relief, and Economic Security (CARES) stimulus payment, school meals).

Maryland, USA.

Economically, geographically and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n 496).

Prevalence of risk of FI was unchanged (pre-pandemic: 22 %, early-pandemic: 25 %, p = 0·27). Risk of early-pandemic FI was elevated for non-Hispanic Black (adjusted relative risk (aRR) = 2·1 (95 % CI 1·1, 4·0)) and Other families (aRR = 2·6 (1·3, 5·4)) and families earning ≤ 300 % federal poverty level. Among pre-pandemic food secure families, decreased income, job loss and reduced hours were associated with increased early-pandemic FI risk (aRR = 2·1 (1·2, 3·6) to 2·5 (1·5, 4·1)); CARES stimulus payment (aRR = 0·5 (0·3, 0·9)) and continued school meal participation (aRR = 0·2 (0·1, 0·9)) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net programme participation was not associated with early-pandemic FI risk.

The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children’s health and reduce disparities in response to pandemics.

To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption.

We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing.

We estimated policy effects in scenarios representing two stages of the ‘social transition’ in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile.

A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico.

A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario.

Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.

The current study aimed to evaluate policies and actions for food environments by the Japanese Government using the Healthy Food Environment Policy Index (Food-EPI).

Public health experts rated the extent of implementation of food environment-related Policy and the Infrastructure-support components, compared with international best practices. Subsequently, the experts proposed and prioritised future actions to address implementation gaps in an online workshop.

Japan.

A total of sixty-six experts rated policy implementation by the Japanese Government and twenty-three participated in the workshop on future actions.

The implementations of regulations on unhealthy foods and non-alcoholic beverages were rated low in the domains of Food composition, Food labelling and Food promotion, Food prices and Food retail in the Policy component. The implementations of several domains in the Infrastructure-support component were, overall, rated at a higher level, specifically for monitoring and intelligence systems. Based on the rating, reducing health inequalities by supporting people, both economically and physically, was the highest priority for future actions in both components.

The current study found that Japan has a robust system for long-term monitoring of population health but lacks regulations on unhealthy foods and non-alcoholic beverages compared with international best practices. The current study confirmed the importance of continuous accumulation of evidence through national monitoring systems. Developing comprehensive regulations to restrict food marketing, sales and accessibility of unhealthy foods and non-alcoholic beverages is needed to improve the health of food environments in Japan.