This study uses participatory modelling with stakeholders to assess the potential impacts of three interventions intended to increase fruit and vegetable (F&V) consumption in urban Kenya.

A participatory process using Group Model Building (GMB) developed a conceptual model of the determinants of vegetable consumption. A subsequent quantitative System Dynamics model using data from primary and secondary sources simulated vegetable consumption from 2020 to 2024 under three proposed interventions suggested by stakeholders: increasing consumer awareness, reducing post-harvest losses and increasing farm yields. Model analyses assumed mean parameter values and assessed uncertainty using 200 simulations with randomised parameter values.

The research was implemented in Nairobi, Kenya with simulation analyses of mean per capita consumption in this location.

Workshops convened diverse F&V value chain stakeholders (farmers, government officials, NGO staff and technical experts) to develop the conceptual model, data inputs and intervention scenarios.

Increasing consumer awareness was simulated to increase vegetable consumption by relatively modest amounts by 2024 (5 g/person/d from a base of 131 g/person/d) under mean assumed value of value chain response parameters. Reducing perishability was simulated to reduce consumption due to the higher costs required to reduce losses. Increasing farm yields was simulated to have the largest impact on consumption at assumed parameter values (about 40 g/person/d) but would have a negative impact on farm profits, which could undermine efforts to implement this intervention.

The combination of GMB and simulation modelling informed intervention priorities for an important public health nutrition issue.

Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers.

Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants.

A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20–59 years, working at 346 institutions.

A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis.

The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality.

Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

To evaluate the effectiveness of the multicomponent intervention trial ‘Are You Too Sweet?’ in reducing discretionary foods and drinks intake among young schoolchildren.

The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups.

Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2).

A total of 153 children aged 5–7 years.

No significant reduction in the children’s intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002).

The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

The objective of this commentary is to provide an overview of the rationale and objectives of the Researching the Obesogenic Food Environment (ROFE) project that was conducted in Ghana and South Africa.

Narration has been used to describe the main objectives, phases as well as the methods used for the conduct of this project.

The project described in this commentary was conducted in Khayelitsha and Mount Frere in South Africa and Ahodwo and Ejuratia for Ghana.

Participants of the study described here include households in South Africa and Ghana, stakeholders and policymakers, and various actors within the food chain in both countries.

The ROFE findings provide a good understanding of the extent of the impact of the food environment on consumption, characteristics of value chains of healthy and unhealthy foods, as well as the potential for improved governance and policy that is relevant to the region. The supplement provides the opportunity to share the extensive findings of the ROFE project. Nine papers that describe the process and findings of the three phases of the ROFE project have been presented. Some of the papers focus on phases of the ROFE, while others cut across different phases and explore the linkages between the phases. Briefly descriptions of key findings of some of the papers in the supplement are provided.

Together, the findings of the ROFE study presented in this supplement have increased understanding of how communities in SA and Ghana interact with their food supplies and have led to identification of specific opportunities to improve food supply policies, in ways that create incentives for the production and consumption of healthy, relative to unhealthy foods.

Few studies have examined the healthy eating environments within the Australian out of school hours care (OSHC) setting. This study aims to describe healthy eating environments, consisting of: (a) the alignment of provided food and beverages to Australian Dietary Guidelines; (b) healthy eating promotion practices; (c) nutrition education through cooking experiences; (d) staff role modelling healthy eating and (e) regular water availability.

A cross-sectional study was conducted using direct observations and the validated System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) tool.

OSHC located in urban and semi-rural regions of NSW, Australia.

Staff (151) and children (1549) attending twelve OSHC services operating in the hours after school.

Fifty per cent (50 %) of services offered fruits and 100 % offered water as a part of the afternoon snack on all four observation days. Discretionary foods were offered on more days compared to vegetables (+1·9/d, P = 0·009), lean meats (+2·7/d, P =·0 004) and wholegrains (+2·8/d, P = 0 002). Staff promoted healthy eating on 15 % of days, sat and ate with children 52 %, consumed high sugar drinks 15 % and ate discretionary foods in front of children 8 % of days, respectively. No opportunities for cooking or nutrition education were observed.

Afternoon snacks regularly contained fruits and water. Opportunities exist to improve the frequency by which vegetables, wholegrains and lean meats are offered in addition to staff healthy eating promotion behaviours. Future research is warranted to further explore healthy eating behaviours, practices and policies within the after-school sector.

To explore how fathers with young children contributed to healthy home food provisioning and the factors enabling or inhibiting their involvement in family food tasks.

Cross-sectional study using purpose-designed online survey. The survey assessed the level of responsibilities and practices in family food tasks, food agency (Cooking and Food Provisioning Action Scale), and use of resources to support involvement in family food tasks. Data collection took place over 3 weeks in November–December 2020 when various COVID-19-related restrictions were in place. Descriptive and regression analyses were used to assess psychosocial factors influencing responsibilities in family food tasks and food agency.

Online survey.

Included in the analysis were 435 Australian fathers with children aged under 5 years.

Between 75 and 77 % of fathers in this study reported having at least half of the responsibilities in meal planning, shopping, and cooking. Health was frequently considered when deciding what to eat, but few used nutrition or food labels when shopping, tried new recipes or modified recipes to make them healthier. Involvement in family food tasks was promoted by a higher food agency, but time spent in employment was a significant barrier to reported food agency and greater involvement in food tasks. There was a high interest in resources to support healthy home food provisioning.

The findings suggest the need to consider father-specific strategies to overcome time barriers and opportunities to enhance their capabilities for healthy home food provisioning.

To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases.

Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5–8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised.

Virtual supermarket.

Dutch adults (n 386).

Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress.

Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.

To investigate the relationship between functional dentition (FD) and changes in dietary patterns (DP) in older adults.

This was a 12-month prospective study, with dental examinations at baseline and questionnaires at baseline and follow-up. Dentition was classified as FD (containing ≥10 occlusal contacts), non-FD with dentures and non-FD without dentures. A 154-item FFQ assessed dietary intake in the previous month. Food items (servings/d) were combined into twenty-two food groups based on their similar nutrient profile, culinary use and previous studies in Thailand. DP were identified through factor analysis of baseline intake and applied scores were used to estimate changes in DP scores. The association between baseline FD (exposure) and change in each DP score (outcome) was tested in linear regression models adjusting for baseline socio-demographic factors, behaviours, chronic conditions, medications, total energy intake and DP score.

Phetchaburi, Thailand.

Totally, 788 community dwellers aged ≥ 60 years.

In total, 651 participants were retained after 12 months (82·6 % retention rate), of whom 14·1 % had FD. Having an FD was positively associated with larger increases in vegetable intake. Three DP were identified. Participants with FD had larger increases in healthy (0·13; 95 % CI: −0·13, 0·39) and carbohydrate-rich diets intake (0·12; 95 % CI: −0·17, 0·40) as well as larger reductions in meat-rich diet intake (−0·12; 95 % CI: −0·45, 0·21) than those with neither FD nor dentures. However, these differences were not significant.

There was little support for an association between baseline FD and changes in DP.

Excessive salt intake raises blood pressure and increases the risk of non-communicable diseases (NCD), such as CVD, chronic kidney disease and stomach cancer. Reducing the Na content of food is an important public health measure to control the NCD. This study quantifies the amount of salt reduced by using umami substances, i.e. glutamate, inosinate and guanylate, for adults in the USA.

The secondary data analysis was performed using data of the US nationally representative cross-sectional dietary survey, the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Per capita daily salt intake corresponding to the NHANES food groups was calculated in the four hypothetical scenarios of 0 %, 30 %, 60 % and 90 % market share of low-Na foods in the country. The salt reduction rates by using umami substances were estimated based on the previous study results.

The USA

4139 individuals aged 20 years and older in the USA

Replacing salt with umami substances could help the US adults reduce salt intake by 7·31–13·53 % (7·50–13·61 % for women and 7·18–13·53 % for men), which is equivalent to 0·61–1·13 g/d (0·54–0·98 g/d for women and 0·69–1·30 g/d for men) without compromising the taste. Approximately, 21·21–26·04 % of the US adults could keep their salt intake below 5 g/d, the WHO’s recommendation in the scenario where there is no low-Na product on the market.

This study provides essential information that the use of umami substances as a substitute for salt may help reduce the US adults’ salt intake.

To estimate the prevalence of vitamin A deficiency (VAD) in children and associated risk factors.

Analysis of data from a cross-sectional multicentre study performed in the primary care units of the municipalities from January to June 2015. The children’s legal guardians answered a socio-economic questionnaire, and the children’s blood samples were obtained by venipuncture. Plasma retinol was determined by HPLC. Plasma retinol values of <0·70 μmol/l were considered VDA. Poisson multiple regression with robust variance was used. Values of P < 0·05 were considered significant. The data were analysed in the SPSS software, 21.0.

Forty-eight poorest municipalities in the South Region of Brazil.

Children (n 1503) aged 12–59 months.

The prevalence of VAD in the sample was 1·9 % (95 % CI (0·5, 6·8)). The following risk factors were associated with the outcome in the final explanatory model: family received Bolsa Familia program benefits (PR = 3·19; 95 % CI (1·69, 6·02)), child was not being breastfed (PR = 5·22; 95 % CI (1·68, 16·18)) and stunting (PR = 4·75; 95 % CI (2·10, 10·73)).

VAD did not represent a public health problem for children living in socio-economically vulnerable municipalities in the South Region of Brazil, suggesting a new panorama of this nutritional deficiency even in regions of low socio-economic conditions in these three states. Thus, in view of the current nutritional transition scenario, it is necessary to continuously monitor and improve public policies related to vitamin A supplementation in the country.

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

A total of 130 communities in the USA.

In sum, 5138 US children aged 4–15 years.

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

To assess the comprehensiveness (scope of nutrition guidance) and strength (clarity of written language) of centre-based nutrition policies (CBNP) within early childhood education (ECE) centres. To also consider the applicability of an existing CBNP assessment tool and policy alignment with best practice food provision and feeding practices.

Cross-sectional online study to assess written ECE CBNP using the Wellness Child Care Assessment Tool.

Licenced ECE centres in the state of Victoria, Australia.

ECE centres (operating at least 8 h per d, 48 weeks per annum), stratified by location (rural and metropolitan), centre management type (profit and not-for-profit) and socio-economic area (low, middle, high).

Included individual CBNP (n 118), predominantly from metropolitan centres (56 %) and low-medium socio-economic areas (78 %). Policies had low overall Wellness Child Care Assessment Tool scores, particularly strength scores which were low across all four domains (i.e. nutrition education, nutrition standards, health promotion and communication/evaluation). The nutrition standards domain had the lowest strength score. The communication/evaluation domain had the lowest comprehensiveness score. Content analysis indicated low scores may relate to the Wellness Child Care Assessment Tool applicability for the Australian context due to differences in best practice guidance.

Despite the presence of written nutrition policies in ECE centres, many showed weak language and lacked comprehensiveness and strength. This may relate to poor implementation of best practice food provision or feeding practices. Low scores, however, may partly stem from using an assessment tool that is not country-specific. The redevelopment of country-specific tools to assess ECE CBNP may be warranted.

Elevated BMI is associated with multiple chronic conditions including diabetes and CVD. Patients with overweight or obesity may also suffer from comorbidities not directly related to the pathophysiology of elevated BMI. The current study sought to determine the impact of BMI and different types of chronic conditions on health-related quality of life (HRQoL) outcomes.

Six weight categories by BMI were identified: underweight, normal weight, overweight, Class-I obesity, Class-II obesity and Class-III obesity. Twenty chronic conditions were considered and categorised as elevated BMI-related (concordant) or -unrelated (discordant) conditions. HRQoL outcomes were measured using Short Form-6 Dimensions (SF-6D). Multivariable regression models were performed to examine the impact of type, number of comorbid conditions and BMI categories on SF-6D scores.

Medical Expenditure Panel Survey (2013–2015).

Nationally representative sample of US population; 18 years or older (n 58 960).

Of the sample, 1·7 %, 32·9 %, 34·0 % and 31·4 % were classified as underweight, normal weight, overweight and obese, respectively. The SF-6D scores were significantly decreased across all obesity classes, with the largest reduction in Class-III obesity (0·033; P < 0·001). Additionally, individuals with obesity having one or more concordant or discordant comorbidities further reduced SF-6D scores between 0·031 and 0·148 (P-values < 0·001) or between 0·080 and 0·212 (P-values < 0·001), respectively.

Individuals with obesity had a significant reduction in HRQoL outcomes compared to those with normal BMI. Importantly, discordant comorbidity resulted in greater reduction in HRQoL outcomes compared to concordant comorbidity in subjects with elevated BMI.

Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children’s drinks.

In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children’s drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children’s drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored.

Online survey

Six hundred and forty-eight US caregivers of young children (1–5 years)

FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research.

FOP disclosures on children’s drink packages can increase caregivers’ understanding of product ingredients and aid in selecting healthier children’s drinks.