To determine associations between household food security status and risk of Cu toxicity.

A population-level cross-sectional study to determine adult household food security status and its relationship with serum total Cu concentration (serum Cu) using multivariable regression models.

Adult participants in the US National Health and Nutrition Examination Survey (NHANES) 2011–2014.

The NHANES phlebotomy data, a nationally representative sample (n 2780; 1360 men and 1420 women), were analysed.

A significantly greater proportion of food-insecure persons had serum Cu that was above the upper value of the normal range (clinical cut-off) compared with their food-secure counterparts. In men, food insecurity (OR = 2·24, P < 0·001) and marginal food security (OR = 1·79, P < 0·001), and in women, marginal food security (OR = 1·82, P = 0·016), associated with greater likelihood to have serum Cu that was above the upper value of the normal range. Food insecurity was significantly associated with greater likelihood (OR = 1·65, P = 0·020) to have serum Cu that was within the upper quartile (≥75th centile).

Food-insecure persons associate with higher serum Cu concentration and are at greater risk of Cu toxicity. There is need to study the sources of Cu in general, and specifically in food-insecure persons, to facilitate reduction of Cu exposure. Examining Cu contents of the food and water supplies could explicate any relationships to food insecurity and Cu intake.

To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared.

Data were from a nationally representative health survey.

Secondary schools in New Zealand, 2012.

A total of 7769 students, 9 % were SGM individuals.

Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96).

SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.

The majority of groceries purchased by US households are industrially processed, yet it is unclear how processing level influences diet quality. We sought to determine if processing level is associated with diet quality of grocery purchases.

We analysed grocery purchasing data from the National Household Food Acquisition and Purchase Survey 2012–2013. Household grocery purchases were categorized by the NOVA framework as minimally processed, processed culinary ingredients, processed foods or ultra-processed foods. The energy share of each processing level (percentage of energy; %E) and Healthy Eating Index-2015 (HEI-2015) component and total scores were calculated for each household’s purchases. The association between %E from processed foods and ultra-processed foods, respectively, and HEI-2015 total score was determined by multivariable linear regression. Foods purchased by households with the highest v. lowest ultra-processed food purchases and HEI-2015 total score <40 v. ≥60 were compared using linear regression.

USA.

Nationally representative sample of 3961 households.

Processed foods and ultra-processed foods provided 9·2 (se 0·3) % and 55·8 (se 0·6) % of purchased energy, respectively. Mean HEI-2015 score was 54·7 (se 0·4). Substituting 10 %E from minimally processed foods and processed culinary ingredients for ultra-processed foods decreased total HEI-2015 score by 1·8 points (β = −1·8; 95 % CI −2·0, −1·5). Processed food purchases were not associated with diet quality. Among households with high ultra-processed food purchases, those with HEI-2015 score <40 purchased less minimally processed plant-foods than households with HEI-2015 score ≥60.

Increasing purchases of minimally processed foods, decreasing purchases of ultra-processed foods and selecting healthier foods at each processing level may improve diet quality.

To develop a dish composition database (DCD) and assess its ability to estimate dietary intake.

The DCD was developed based on 16 d dietary records (DR). We aggregated all reported dishes into 128 dish codes and calculated mean food group and nutrient contents for each code. These data were used to calculate dietary intake in a different population that completed a 4 d DR. The estimated values were compared with those estimated using the standard food composition database (FCD) of Japan.

Japan.

A total 252 adults aged 31–81 years for the 16 d DR (3941 d in total) and 392 adults aged 20–69 years for the 4 d DR (1568 d in total) participated.

There were significant differences in median intakes between the DCD and the FCD for eighteen and twenty (of twenty-six) food groups and for twenty-nine and twenty-two (of forty-three) nutrients (including energy) in men and women, respectively. For food group intakes, Spearman correlation coefficients between the DCD and FCD ranged from 0·19 (animal fats) to 0·90 (fruits and alcoholic beverages) in men (median: 0·61) and from 0·25 (oils) to 0·89 (noodles) in women (median: 0·58). For nutrient intakes, the corresponding values ranged from 0·25 (retinol) to 0·90 (alcohol) in men (median: 0·60) and from 0·15 (retinol) to 0·74 (alcohol) in women (median: 0·53).

Whereas it is difficult to accurately estimate absolute dietary intake values using the present DCD, it has acceptable ability to rank the intakes of many food groups and nutrients.

To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.

Nine European countries.

European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.

Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).

zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

To determine if constraints on agricultural production were a novel construct in the Panama Food Security Questionnaire (FSQ) and to characterize agricultural and economic determinants of food insecurity during the planting, growing and harvesting time periods in subsistence farming communities.

This longitudinal study followed households during land preparation, growing and harvest periods in one agricultural cycle. Agricultural production and economic variables were recorded and the Panama FSQ was administered. Exploratory factor analysis was used to verify construct validity of the FSQ. A food insecurity score (FIS), ranging from 0 to 42, was derived. Multiple regression analyses of FIS were conducted for each agricultural period.

Fifteen rural villages in Panama.

Subsistence farming households (n 237).

The FSQ contained four constructs: (i) ability to buy food; (ii) decreased amount/number of meals; (iii) feeling hungry; and (iv) lower agricultural production because of weather or lack of resources. Although most households were mildly food insecure in all time periods, determinants of food insecurity differed in each. Higher FIS was associated during land preparation with less rice and legumes planted and lower asset-based wealth; during growing months with less rice, more maize and pigeon peas planted and not selling produce; and during harvest with less rice planted, fewer chickens and lower income.

Constraints on agriculture was a novel construct of the Panama FSQ. Different income-related variables emerged in each agricultural period. Planting staple foods and raising chickens were associated with food security, but some crop choices were associated with food insecurity.

The present study aimed to explore how healthy food choices are translated into everyday life by exploring definitions of healthy food choices, perceptions of own food choice, and healthy food choice drivers (facilitators) and barriers.

An exploratory qualitative study design was employed using semi-structured face-to-face interviews. Convenience sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and cross-checked for consistency. Thematic analysis was used to identify patterns emerging from the data.

Canberra, Australia, October 2015–March 2016.

A total of twenty-three participants aged 25–60 years were interviewed. The mean age was 38 years and the mean BMI was 29·1 kg/m2. All male participants (n 4) were within the healthy weight range compared with 58 % of female participants, with 26 % being overweight and 16 % being obese.

(i) Healthy food choices are important but are not a daily priority; (ii) healthy eating information is known but can be difficult to apply into everyday life; (iii) popular diets are used in attempts to improve healthy eating; and (iv) social media inspires and connects people with healthy eating.

Social media facilitates healthy food choices by providing access to healthy eating information. In addition to Facebook and Instagram, healthy eating blogs were highlighted as a source of nutrition information. Research should consider exploring the use of healthy eating blogs and whether these blogs can be used as a tool by dietitians to communicate procedural healthy eating information more effectively in the future.

To derive healthy and sustainable food-based dietary guidelines (FBDG) for different target groups in the Netherlands and describe the process.

Optimised dietary patterns for children, adolescents, adults and the elderly were calculated using an optimisation model. Foods high in saturated and trans-fatty acids, salt and sugar, and low in dietary fibre, were excluded. The dietary patterns resembled the current food consumption as closely as possible, while simultaneously meeting recommendations for food groups, nutrients, maximum limits for foods with a high environmental impact, and within 85 % of the energy requirement. Recommended daily amounts of food groups were based on the optimised dietary patterns and expert judgement.

The Netherlands.

FBDG were derived for Dutch people with different ages, genders, activity levels and food preferences.

For most target groups the optimisation model provided dietary patterns that complied with all requirements. For some food groups, the optimised amounts varied largely between target groups. For consistent messages to consumers, the optimised dietary patterns were adjusted to uniform recommendations per target group. Recommendations were visualised in the Wheel of Five. The advice is to eat the recommended amounts of foods according to the Wheel of Five and limit consumption of other foods.

Based on an optimisation model, scientific evidence, information on dietary patterns and expert knowledge, we derived FBDG for different target groups. The Wheel of Five is a key food-counselling model that can help Dutch consumers to make their diets healthier and more environmentally sustainable.

To determine whether neighbourhood supermarket and convenience store availability and broader built environment context are associated with food purchasing behaviour in a national population.

We used observational data to perform a cross-sectional study of food purchases for US households in 2010. We used three-level mixed-effect regression models to determine whether the associations between the number of neighbourhood supermarkets and convenience stores and the self-reported annual household expenditures for fruits and vegetables were affected by regional destination accessibility, neighbourhood destination diversity, availability of neighbourhood destinations and neighbourhood street connectivity.

Metropolitan statistical areas (n 378) in the USA.

Households (n 22 448).

When we controlled for broader built environment context, there was no significant association between availability of neighbourhood supermarkets and expenditures on fruits and vegetables; instead, we observed an inverse association between the number of convenience stores and expenditures for fruits (P = 0·001). The broader built environment context was associated with food purchase, although the magnitude was small: (i) higher regional destination accessibility was associated with higher expenditures for fruits (P < 0·001); (ii) higher neighbourhood destination diversity was associated with lower expenditures for vegetables (P = 0·002); and (iii) higher neighbourhood street connectivity was associated with higher expenditures for fruits (P < 0·001).

The broader built environment factors contributed to understanding how people use neighbourhood food stores. However, there was only a small relationship between the broader environment context and fruit and vegetable expenditures. Policy interventions that focus exclusively on increasing the availability of neighbourhood supermarkets likely will not promote fruit and vegetable consumption.

Diets lower in meat are considered both highly beneficial for human health and more environmentally friendly. The present study compared consumer groups with different self-declared diet styles regarding meat (vegetarians/vegans, pescatarians, low- and regular meat consumers) in terms of their motives, protein consumption, diet quality and weight status.

Cross-sectional data from the Swiss Food Panel 2.0 (survey 2017).

Switzerland, Europe.

Data of 4213 Swiss adults (47·4 % females) from a nationally representative sample living in the German- and French-speaking regions of Switzerland (mean age 55·4 years).

For vegetarians, vegans and pescatarians, ethical concerns about animal welfare and environmental friendliness, as well as taste preferences are stronger reasons to avoid meat consumption. Female low-meat consumers are more likely to be motivated by weight regulation. Only 18 % of the sample and 26 % of self-declared low-meat consumers met the official dietary recommendations for meat intake. Concerns about animal welfare and taste preferences predicted lower meat intake, whereas perceived difficulty of practising a low-meat diet and weight-loss motives were associated with higher meat consumption in consumers who reported eating little or no meat.

Our study demonstrates that there can be large discrepancies between consumers’ self-perception and their actual meat consumption. This has to be taken into account when designing public health interventions. Addressing ethical concerns about animal welfare (e.g. through awareness campaigns), further improving the range of vegetarian options and increasing consumers’ knowledge about the dietary recommendations may be ways to promote diets lower in meat.

Previous studies have associated dietary patterns with diabetes risk in Western countries, but such studies among the Japanese population are scarce. The present study aimed to investigate dietary patterns associated with abnormal glucose tolerance determined by elevated glycated Hb (HbA1c) levels.

The 2012 National Health and Nutrition Survey (NHNS) database was used for the cross-sectional study. Dietary patterns were analysed by factor analysis of twenty-five food items from the dietary intake survey and household-based semi-weighed dietary records. OR and 95 % CI for elevated HbA1c levels (≥6·5 %) according to dietary patterns were estimated using logistic regression models.

Japan.

The study population comprised 9550 Japanese aged ≥40 years registered in the nationwide NHNS.

Three dietary patterns were identified: (i) high-bread and low-rice; (ii) high-meat and low-fish; and (iii) vegetable. The high-bread and low-rice pattern, characterised by high frequent consumption of bread, milk and dairy products, and fruits, and low rice intake, was associated with marginally decreased prevalence of elevated HbA1c levels (Ptrend=0·047). The vegetable pattern, characterised by vegetables, mushrooms, soyabeans and soybean products, was significantly inversely associated with elevated HbA1c levels (4th v. 1st quartile: multivariable OR=0·68; 95 % CI 0·49, 0·95; Ptrend=0·007).

Our findings suggest that the vegetable pattern is associated with decreased prevalence of elevated HbA1c levels among Japanese.

To examine the frequency of shopping at different food sources and the associations between shopping at different food sources and fruit and vegetable (FV) intake among upstate New York rural residents.

Cross-sectional study. Descriptive statistics and linear mixed models were used.

Eighty-two rural communities in upstate New York, USA.

Adults (n 465; 82·3 % female, mean age 51·5 years, mean BMI 31·7 kg/m2).

Within one’s community, the majority of participants reported often going to supermarkets (73·1 %). Many participants sometimes or occasionally shopped at superstores (48·0 %), convenience stores (57·9 %), small grocery stores or local markets (57·2 %), farmers’ markets or FV stores (66·6 %), dollar stores (51·5 %), pharmacies (46·0 %), or farm stands or community-supported agriculture (56·8 %). Most participants had never utilized food banks or food pantries (94·0 %), community gardens (92·7 %) or home food delivery (91·9 %). While frequent visits to farmers’ markets or farm stands were associated with higher fruit intake (P < 0·001), frequent visits to food co-ops or food hubs were associated with lower fruit intake (P = 0·004). Frequent visits to convenience stores (P = 0·002) and dollar stores (P = 0·004) were associated with lower vegetable intake. When FV intakes were combined, frequent visits to farmers’ markets or farm stands (P < 0·001) were associated with higher FV intake, and frequent visits to convenience stores (P = 0·005) were associated with lower FV intake.

Findings from the present study provide important insight for informing future food environment interventions related to helping rural residents consume adequate FV.

While scholarship has investigated how to provide more healthy food options in choice pantry environments, research has just begun to investigate how pantry users go about making decisions regarding food items when the ability to choose is present. The present analysis sought to investigate the factors prohibiting and inhibiting food decision making in choice pantries from the perspective of frequent pantry users.

Six focus group interviews were conducted with visitors to choice food pantries, to discuss the decision-making process involved in food selection during choice pantry visits. Each was provided a $US 15 remuneration for taking part.

A school-based choice food pantry in Anderson, Indiana, USA, a small Midwestern community.

Thirty-one men and women, largely aged 45–64 years, who made use of choice food pantries at least once monthly to meet their family’s food needs.

Choice pantry visitors indicated that the motivation to select healthy food items was impacted by both individual and situational influences, similar to retail environments. Just as moment-of-purchase and place-of-purchase factors influence the purchasing of food items in retail environments, situational factors, such as food availability and the ‘price’ of food items in point values, impacted healthy food selection at choice pantries. However, the stigmatization experienced by those who visit pantries differs quite dramatically from the standard shopping experience.

Choice pantries would benefit from learning more about the psychosocial factors in their own pantries and adapting the environment to the desires of their users, rather than adopting widely disseminated strategies that encourage healthy food choices with little consideration of their unique clientele.

To assess the effectiveness of a nutrition and physical activity (PA) intervention on dietary intake (DI), nutritional knowledge (NK), blood pressure (BP), anthropometric measures and cardiorespiratory fitness (CRF) of schoolchildren.

Longitudinal study. DI, NK, BMI, waist-to-height ratio (WHtR), BP and CRF were all measured/calculated prior to (October 2014) and at the end of (June 2016) intervention delivery.

Two primary schools (one intervention and one control), Cork, Ireland.

Six-year-olds (n 49; mean age = 6·09 (sd 0·33) years) and 10-year-olds (n 52; mean age = 9·90 (sd 0·37) years).

There was a large and a moderate statistically significant difference between the change in systolic (P = 0·005, effect size (ES) = 0·165) and diastolic BP (P = 0·023, ES = 0·116), respectively, for 10-year-olds in the intervention and control groups. There was also a large statistically significant difference between the change in WHtR (P = 0·0005, ES = 0·386) and a moderate statistically significant difference between the change in NK (P = 0·027, ES = 0·107) for 10-year-olds in the intervention and control groups. There was a large statistically significant difference between the change in percentage of energy from protein in 10-year-old females (P = 0·021, ES = 0·276) in the intervention and control groups.

Project Spraoi is Ireland’s first ever school-based intervention that has been evaluated and proven effective in improving DI, NK, WHtR and BP in older primary-school children in one intervention school.

The present study aimed to evaluate the impact of a Transtheoretical Model-based programme titled ‘Fruit & Vegetable-Friendly’ on the fruit and vegetable (F&V) consumption of adolescents.

A quasi-experimental study. The ‘Fruit & Vegetable-Friendly’, a multicomponent intervention based on the Transtheoretical Model, was completed in eight weeks. The data were collected one week before the intervention, one week after the completion of the intervention and six months after the post-test with an F&V intake questionnaire and the stages of change, processes of change (α = 0·91), situational self-efficacy (α = 0·91) and decisional balance (α = 0·90 for pros, α = 0·87 for cons) scales. Data were analysed with the Friedman, Wilcoxon and marginal homogeneity tests.

A public secondary school in Istanbul, Turkey.

Seven hundred and two adolescents.

The mean (sd) F&V intake of adolescents in the passive stages rose from the daily average at the time of the pre-test of 3·40 (1·79) portions to 5·45 (2·54) portions on the post-test and to 5·75 (2·70) portions on the follow-up test (P < 0·01). While the students in the passive stages represented 41·6 % of the participants prior to the programme, this rate fell to 23·7 % at the post-test and to 22·7 % at the follow-up. Students in the active stages first represented 58·5 % of the participants; this rate rose to 76·4 % at the post-test and to 77·2 % at the follow-up test.

The programme was effective in increasing the amount of F&V the adolescents consumed on a daily basis.

To examine the frequency of television (TV) food and beverage advertisements (F&B ads) to which children (4–11 years) are likely exposed and the nutrient profile of products advertised.

TV broadcasting between September and November 2016 was recorded (288 h of children’s programming; 288 h of family programming) resulting in 8980 advertisements, of which 1862 were F&B ads. Of those, 1473 could be classified into one of the seventeen food groups, and into permitted/non-permitted according to the WHO-EU nutrient profile model. Persuasive marketing techniques used were also identified.

TV programming was recorded for four weekdays and four weekend days, between 06.00 and 00.00 hours (576 total hours), for four channels (two national and two cable), in Costa Rica.

Mean (sd) number of F&B ads/h was greater in cable than national channels (3·7 (0·4) v. 2·8 (0·4), P < 0·05) and during children’s peak viewing hours (4·4 (0·4) v. 2·9 (0·3)). Of F&B ads classified with WHO-EU nutrient profile model (n 1473, 71·1 %), 91·1 % were non-permitted to be marketed to children. Categories most frequently advertised were ready-made/convenience foods (16 %), chocolates/confectionery/desserts (15 %), breakfast cereals (14 %), beverages (15 %), edible ices (9 %) and salty snacks (8 %). Non-permitted F&B ads were more likely to use promotional characters, brand benefit claims, and nutrition and health claims than permitted F&B ads.

Children watching popular TV channels in Costa Rica are exposed to a high number of unhealthy F&B ads daily. Our findings help justify the need for regulatory actions by national authorities.

National public health organizations recommend that local governments improve access to healthy foods. One way is by offering incentives for food retailer development and operation, but little is known about incentive use nationwide. We aimed to describe the national prevalence of local government reported incentives to increase access to healthy food options in three major food retail settings (farmers’ markets, supermarkets, and convenience or corner (smaller) stores) overall and by municipality characteristics.

Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living.

USA, nationally representative survey of 2029 municipalities.

Municipal officials (e.g. city/town managers or planners; n 1853).

Overall, 67 % of municipalities reported incentives to support farmers’ markets, 34 % reported incentives to encourage opening new supermarkets, and 14 % reported incentives to help existing convenience or corner stores. Municipality characteristics significantly associated with incentive use were larger population size (all settings), location in Midwest v. West (supermarkets, smaller stores), higher poverty level (farmers’ markets) and ≤50 % of the population non-Hispanic White (supermarkets, smaller stores). The most commonly reported individual incentives were permission of sales on city property for farmers’ markets, tax credits for supermarkets and linkage to revitalization projects for smaller stores.

Most municipalities offered food retail incentives for farmers’ markets, but fewer used incentives to open new supermarkets or assist existing smaller stores. National data can set benchmarks, provide relative comparisons for communities and identify areas for improvement.