In the USA, community-based food pantries provide free groceries to people struggling with food insecurity. Many pantries obtain food from regional food banks using an online shopping platform. A food bank introduced a visible nutrition rank (i.e. green, yellow or red) onto its platform. The hypothesis was that pantry orders would increase for the healthiest options (green) and decrease for the least healthy options (red).

Interrupted time series (ITS) analysis of a natural experiment. Monthly data included nutrition ranks of available inventory and itemised records of all products ordered during the 15-month baseline period and 14-month intervention.

A New England food bank.

The twenty-five largest food pantries in the network based on pounds of food ordered.

Descriptive analyses of 63 922 pantry ordering records before and after the visible ranks identified an increase in the proportion of green items ordered (39·3–45·4 %) and a decrease in the proportion of red items ordered (10·5–5·1 %). ITS analyses controlling for monthly changes in inventory available and pantry variables indicated that average monthly orders of green items increased by 1286 pounds (P < 0·001) and red orders decreased by 631 pounds (P = 0·045). Among the largest changes were increases in orders of fresh produce, brown rice, low-fat dairy and low-fat meats and decreases in orders of sugary juice drinks, canned fruit with added sugar, higher fat dairy and higher fat meats.

This promising practice can support system-wide efforts to promote healthier foods within the food banking network.

To determine the impact of an educational programme for primary schools that explored the biodiversity of tomato, by promoting science and sensory education with three distinct varieties of it, in the acceptance of vegetables.

A randomised controlled study in which children were exposed to the educational programme (intervention group) or remained in the class, as usual (control group). The educational programme consisted of three sessions where children explained the observed differences between the three varieties of tomato and individual perceptions of their flavours based on sensory-based food education and by planning and implementing experiments to explain those differences. We tested the effects on both children’s willingness to try and their liking for tomato, and for lettuce and cabbage to study the carry-over effect, compared with the control group (Mann–Whitney U test; P < 0·05).

The study took place in public primary schools in Porto, Portugal.

Children in the third grade (8–13-year-old children) (n 136) were randomly assigned to intervention or control group.

Children in the intervention group reported significant increases in their willingness to try and liking for tomato compared to the control group (P < 0·05), but not for lettuce and cabbage (P > 0·05).

These results highlight the potential for fostering children’s acceptance of a vegetable by exploring biodiversity through science education. Further work may clarify the effects of exploring biodiversity on the consumption of vegetables and establish whether the results are stable over time and replicable across contexts and populations.

The study sought to assess the influence of nutrition education and intervention programmes on nutrition knowledge and dietary practice among both students and staff (including faculty) of Princess Nourah Bint Abdulrahman University in Saudi Arabia.

A pretest–posttest, non-randomised experimental study design was implemented at Princess Nourah Bint Abdulrahman University in Riyadh City between September 2019 and February 2020.

Princess Nourah Bint Abdulrahman University is the largest women’s university in the world and has eighteen colleges and institutions and around ninety academic programmes.

The survey was completed by 1824 participants (1350 students and 474 staff/faculty) before the intervention and by a different cohort of 1731 participants (1317 students and 414 staff/faculty) after the intervention. In total, an independent sample of 3555 staff and students participated. Participants were asked about dietary knowledge and practices. Dietary knowledge entailed food variety and nutrients, fast food and its poor nutritional value, and the influence of cooking style on the nutritional quality of food. Dietary practices involved eating breakfast; consuming salt/sugar, eating high-salt food; eating pre-packaged food and consumption of vegetables, fruits, supplements, water and caffeine.

The majority of the sample consisted of students (75·1 %) and had not been diagnosed with any disease (73·7 %). The result of the current study showed that nutrition knowledge improved after completion of the nutrition programme.

The nutrition awareness programme improved students’ nutritional knowledge; however, there was no significant effect on their dietary practices. Future nutrition awareness programmes should separate activities for students and staff, focusing on one target population at a time.

The current study undertook a systematic scoping review on the drivers and implications of dietary changes among Inuit in the Canadian Arctic.

A keyword search of peer-reviewed articles was performed using PubMed, Web of Science, CINAHL, Academic Search Premier, Circumpolar Health Bibliographic Database and High North Research Documents. Eligibility criteria included all full-text articles of any design reporting on research on food consumption, nutrient intake, dietary adequacy, dietary change, food security, nutrition-related chronic diseases or traditional food harvesting and consumption among Inuit populations residing in Canada. Articles reporting on in vivo and in vitro experiments or on health impacts of environmental contaminants were excluded.

A total of 162 studies were included. Studies indicated declining country food (CF) consumption in favour of market food (MF). Drivers of this transition include colonial processes, poverty and socio-economic factors, changing food preferences and knowledge, and climate change. Health implications of the dietary transition are complex. Micro-nutrient deficiencies and dietary inadequacy are serious concerns and likely exacerbated by increased consumption of non-nutrient dense MF. Food insecurity, overweight, obesity and related cardiometabolic health outcomes are growing public health concerns. Meanwhile, declining CF consumption is entangled with shifting culture and traditional knowledge, with potential implications for psychological, spiritual, social and cultural health and well-being.

By exploring and synthesising published literature, this review provides insight into the complex factors influencing Inuit diet and health. Findings may be informative for future research, decision-making and intersectoral actions around risk assessment, food policy and innovative community programmes.

To assess ultra-processed food (UPF) consumption and its socio-demographic, psychosocial and behavioural correlates in a general population of Italian children, adolescents and adults.

Cross-sectional telephone-based survey

Italy, 2010–2013.

In total, 9078 participants (5–97 years) from the Italian Nutrition & Health Survey. Dietary intakes were collected by a 1-d 24-h dietary recall. UPF was defined by the NOVA classification and expressed as percentage of total energies.

Average energy intake from UPF (95 % CI) was 17·3 % (17·1 %, 17·6 %) among adults and 25·9 % (24·8 %, 27·0 %) in children/adolescents. Top sources of UPF were processed meats (32·5 %) and bread substitutes (16·7 %). Among adults, age (β = −3·10; 95 % CI (−4·40, −1·80) for >65 years v. 20–40 years; βs are dimensionless) and residing in Southern Italy (β = −0·73; 95 % CI (−1·32, −0·14) v. Northern) inversely associated with UPF. Screen view during meals was directly linked to UPF, as well as poor self-rated health (β = 5·32; 95 % CI (2·66, 7·99)), adverse life events (β = 2·33; 95 % CI (1·48, 3·18)) and low sleep quality (β = 2·34; 95 % CI (1·45, 3·23)). Boys consumed two-point percent more UPF of the total energy than girls (β = 2·01; 95 % CI (0·20, 3·82)). For all ages, a Mediterranean diet was inversely associated with UPF (β = −4·86; 95 % CI (−5·53, −4·20) for good v. poor adherence in adults and (β = −5·08; 95 % CI (−8·38, −1·77) for kids).

UPF contributes a modest proportion of energy to the diets of Italian adults while being one-quarter of the total energies in children/adolescents. UPF was associated with several psychosocial factors and eating behaviours. Increased adherence to Mediterranean diet would possibly result in lower UPF consumption.

To assess the association between adverse childhood experiences (ACE) and behaviours of fruit and vegetable consumption among adults.

Cross-sectional analysis. Weighted χ2 and weighted multiple logistic regression analyses were conducted to determine the association between ACE and low fruit and vegetable consumption.

The 2017 Nevada Behavioral Risk Factor Surveillance System.

The sample consisted of 2939 adults.

After controlling for potential confounders, exposure to three or more ACE (adjusted OR (AOR) 1·42, 95 % CI 1·02, 2·00) and experiencing parental divorce/separation (AOR 1·50, 95 % CI 1·13, 1·98) were significantly associated with low fruit and vegetable consumption. The study did not find a dose–response relationship between the number of ACE and fruit and vegetable consumption.

The study suggests that participants who experienced three or more ACE or parental divorce/separation were at increased risk for low fruit and vegetable consumption. The findings highlight the continuing need for public health interventions and policies that decrease exposure to ACE and increase fruit and vegetable intake among the populations with ACE.

Previous studies from European countries noted that food products promoted on TV for children did not comply with international guidelines, including the World Health Organization European Nutrient Profile Model (WHO-ENPM) and the EU Pledge Nutrition Criteria (EU-PNC, an initiative developed by leading food companies). We aim to provide new data from Italy.

Evaluation of Italian TV advertisements. Data on nutritional values for food product advertised were compared with nutritional standards issued by the WHO-ENPM and the EU-PNC.

In total, 180 h of TV programmes from six Italian channels, 2016–2017.

Eight hundred and ten consecutive advertisements during children’s programmes.

Out of 810 advertisements, 90 (11·1 %) referred to food products. Among these, 84·5 % of the foods promoted did not meet the WHO-ENPM and 55·6 % the EU-PNC guidelines. Advertisements promoting sweet and salty snacks (i.e. ≥ 70 % of all foods) v. other food products showed higher non-compliance with both the WHO-ENPM (OR: 73·8; 95 % CI: 4·09, 1330) and the EU-PNC (OR: 9·21; 95 % CI: 2·82, 30·1).

In Italy, most food advertisements during children’s programmes are not compliant with European nutritional standards. Almost all the advertisements for snacks do not meet international guidelines. As the WHO-ENPM guidelines do not propose standards for all the food products, including meals, there is an urgent need to define independent and easy-to-read guidelines for food advertisements targeting children. As a first step towards the complete ban of food advertisements targeting children recommended by other researchers, these guidelines should be enforced by all the TV broadcasts.

To evaluate regional differences in factors associated with food insufficiency during the initial months of the COVID-19 pandemic among three major metropolitan regions in California, a state with historically low participation rates in the Supplementation Nutrition Assistance Program, the nation’s largest food assistance programme.

Analysis of cross-sectional data from phase 1 (23 April–21 July 2020) of the US Census Household Pulse Survey, a weekly national online survey.

California, and three Californian metropolitan statistical areas (MSA), including San Francisco–Oakland–Berkeley, Los Angeles–Long Beach–Anaheim and Riverside–San Bernardino–Ontario MSA.

Adults aged 18 years and older living in households.

Among the three metropolitan areas, food insufficiency rates were lowest in the San Francisco–Oakland–Berkeley MSA. Measures of disadvantage (e.g., having low-income, being unemployed, recent loss of employment income and pre-pandemic food insufficiency) were widely associated with household food insufficiency. However, disadvantaged households in the San Francisco Bay Area, the area with the lowest poverty and unemployment rates, were more likely to be food insufficient compared with those in the Los Angeles–Long Beach–Anaheim and Riverside–San Bernardino–Ontario MSA.

Food insufficiency risk among disadvantaged households differed by region. To be effective, governmental response to food insufficiency must address the varied local circumstances that contribute to these disparities.

The present study examines the association between mild and moderate-to-severe household food insecurity and school readiness among a nationally representative sample of preschool-aged children.

Cross-sectional data pertaining to household food availability as well as four domains of school readiness – early learning skills, self-regulation, social-emotional development and physical health & motor development – were employed.

The USA.

15 402 children aged 3–5 years from the 2016–2018 National Survey of Children’s Health.

Both mild and moderate-to-severe food insecurity are associated with an increase in needing support or being at-risk in each of the four school readiness domains, particularly Self-Regulation (IRR = 4·31; CI 2·68, 6·95) and Social-Emotional Development (IRR = 3·43; CI 2·16, 5·45). Furthermore, while nearly half of the children in food-secure households are on-track across all four school readiness domains (47·49 %), only one in four children experiencing moderate-to-severe household food insecurity is on-track across all domains (25·26 %).

Household food insecurity is associated with reductions in school readiness among preschool-aged children.

Adequate and appropriate nutrition education is expected to contribute towards preventing risk of child stunting and maternal overweight/obesity. Understanding women’s information-seeking behaviours is an important key step for health professionals and departments of health in order to improve the development of optimal and targeted nutrition education during pregnancy. This study investigated the experience of Indonesian women in seeking and receiving nutritional information during pregnancy and its relationship to women’s socio-demographic and pregnancy characteristics.

An online cross-sectional study.

Malang City, Indonesia.

Women who had given birth within the past 2 years (n 335).

All women in this study sought or received food and nutrition information from multiple sources, including social and health professional contacts and media sources. The women frequently discussed nutrition issues with their family, particularly their husband (98·2 %) and mother or mother-in-law (91·6 %). This study identified four groups of sources based on women’s search habits. Women from high socio-economic strata were more likely to discuss food and nutrition issues or received nutrition information from obstetricians, their family or online sources (adjusted R2 = 26·3 %). Women from low socio-economic strata were more likely to receive nutrition information from midwives, health volunteers or Maternal and Child Health books (adjusted R2 = 14·5 %).

A variety of nutrition information sources needs to be provided for women from different socio-economic strata. Involvement of family members in antenatal nutrition education may improve the communication and effectiveness of young mothers’ dietary and nutrition education.

To determine the impact of a healthy food and drink policy on hospital staff and visitors’ food purchasing behaviours, and their awareness and support for the changes introduced.

Two repeated cross-sectional surveys, consisting of intercept interviews and observations of food items purchased, were conducted before (March–July 2018) and after (April–June 2019) the target date for implementation of thirteen food and drink practices (31 December 2018). Food purchases were coded as ‘Everyday’ (healthy) or ‘Occasional’ (unhealthy).

Ten randomly selected New South Wales public hospitals, collection sites including hospital entrances and thirteen hospital cafés/cafeterias.

Surveys were completed by 4808 hospital staff and visitors (response rate 85 %). The majority were female (63 %), spoke English at home (85 %) and just over half had completed tertiary education (55 %).

Significant increases from before to after the implementation target date were found for policy awareness (23 to 42 %; P < 0·0001) and support (89 to 92 %; P = 0·01). The proportion of ‘Everyday’ food purchases increased, but not significantly (56 to 59 %; P = 0·22); with significant heterogeneity between outlets (P = 0·0008). Overall, younger, non-tertiary-educated adults, visitors and those that spoke English at home were significantly less likely to purchase ‘Everyday’ food items. Support was also significantly lower in males.

The findings provide evidence of strong policy support, an increasing awareness of related changes and a trend towards increased ‘Everyday’ food purchasing. Given the relatively early phase of policy implementation, and the complexity of individual food purchasing decisions, longer-term follow-up of purchasing behaviour is recommended following ongoing implementation efforts.

This cross-sectional study evaluated the dietary characteristics of snacks, the contribution of snacks to daily nutrient intake and the association of energy intake (EI) from snacks with the prevalence of nutritional inadequacy in Japanese nursery school children.

Foods and nutrients consumed in each eating occasion were assessed by 3-d dietary records. The prevalence of inadequate intake of twenty nutrients assessed by the age- and sex-specific reference values in the Japanese Dietary Reference Intakes was compared according to tertile categories of EI from snacks.

A multi-regional dietary survey based on nursery schools in Japan.

A total of 187 boys and 191 girls aged 3–6 years.

EI from snacks accounted for 19·5 % (sd 6·9) of total daily EI. Confectionaries accounted for the largest part of EI from snacks (35·3 %), followed by milk (19·5 %). Relative to their energy contribution, snacks accounted for a small proportion for all nutrients examined, except for free sugar, calcium, SFA and riboflavin. Although a higher EI from snacks was associated with favourable profiles for intakes of calcium, iron, thiamine and riboflavin, excessive intakes of free sugar and Na were more prevalent among children with a higher EI from snacks.

Although snacks are effective in meeting the requirement of some nutrients among Japanese nursery school children, snacks are generally not nutrient-dense and have an impact on excessive intake of some nutrients. There is hence room for improvement in food choices at snack time.

To determine the temporal directionality of the association between food insecurity and maternal depression.

Food insecurity was measured at two time points using the eighteen-item USDA Food Security Scale. Maternal depression was measured at two time points using the fifteen-item Composite International Diagnostic Interview-Short Form. Two structural equation models were utilised to evaluate the impact of food insecurity on maternal depression (model 1) and the impact of maternal depression on food insecurity (model 2). Both models controlled for socio-demographic and parenting characteristics and child behaviour problems, along with prior measures of the dependent variable and concurrent measures of the independent variable.

Fragile Families and Child Wellbeing (FFCW) study, twenty cities across the USA.

4897 mothers who participated in two waves of the FFCW study.

On average, 17 % (time 1) and 15 % (time 2) of mothers experienced food insecurity and 21 % (time 1) and 17 % (time 2) of mothers experienced depression over time. Maternal depression at time 1 was associated with 53 % increased odds (OR = 1·53; B = 0·43; P < 0·001) of food insecurity at time 2, controlling for time 1 food insecurity, concurrent depression and covariates. Food insecurity at time 1 was associated with 36 % increased odds (OR = 1·36; B = 0·31; P < 0·001) of maternal depression at time 2, controlling for time 1 depression, concurrent food insecurity and covariates.

We found a bidirectional relationship between food insecurity and maternal depression. A holistic approach that combines food assistance and mental health services may be an efficacious approach to reducing both depressive symptoms and food insecurity among low-income mothers.

This process evaluation aimed to understand factors affecting the implementation of a government-sponsored short message service (SMS) programme for delivering nutrition information to rural populations, including message access, acceptability and putting messages into action.

The study was nested within a larger randomised controlled trial. Cross-sectional data collection included structured surveys and in-depth interviews. Data were analysed for key trends and themes using Stata and ATLAS.ti software.

The study took place in Tanzania’s Mtwara region.

Surveys were conducted with 205 women and 93 men already enrolled in the randomised controlled trial. A sub-set of 30 women and 14 men participated in the in-depth interviews.

Among women relying on a spouse’s phone, sharing arrangements impeded regular SMS access; men were commonly away from home, forgot to share SMS or did not share them in women’s preferred way. Phone-owning women faced challenges related to charging their phones and defective handsets. Once SMS were delivered, most participants viewed them as trustworthy and comprehensible. However, economic conditions limited the feasibility of applying certain recommendations, such as feeding meat to toddlers. A sub-set of participants concurrently enrolled in an interpersonal counselling (IPC) intervention indicated that the SMS provided reminders of lessons learned during the IPC; yet, the SMS did not help participants contextualise information and overcome the challenges of putting that information into practice.

The challenges to accessing and implementing SMS services highlighted here suggest that such platforms may work well as one component of a comprehensive nutrition intervention, yet not as an isolated effort.

Educational inequalities in cardiometabolic diseases (CMD) are globally recognised; nonetheless, the evidence on potential explanatory mechanisms and effective strategies for CMD prevention and inequality reduction is relatively scarce in Asia. Therefore, the current study examined the extent and potential mediators of the association of education level with CMD conditions (i.e., hypertension and diabetes) in an advanced economy in Asia.

A cross-sectional study.

This territory-wide cross-sectional Population Health Survey in 2014–2015 was performed in Hong Kong. Demographic, socio-economic and lifestyle factors were collected via questionnaire, while clinical data on blood pressure and glucose levels, lipid profiles and anthropometric measures were obtained during health examination. Hypertension and diabetes statuses were objectively defined by both clinical data and the use of relevant medications.

2297 community-dwelling adults aged between 15–84 years recruited via systematic replicated sampling of living quarters.

Multivariable binary logistic regression analysis showed that lower education level was significantly associated with hypertension among women but not men, whereas similar pattern was also observed for diabetes and other related clinical risk factors. Also, general and abdominal obesity were independently associated with hypertension and diabetes among both women and men, and substantially mediated the observed inequalities across education levels among women. Specifically, abdominal obesity was a particularly strong risk factor and mediator for diabetes.

Educational patterning of CMD was more apparent among women in Hong Kong. Obesity control appears to be important for both overall CMD prevention and reduction of educational inequalities in CMD among women.

To investigate (i) changes in stakeholder commitment and (ii) perceptions of the purpose, challenges and benefits of healthy food and beverage provision in community sports settings during the stepwise implementation of a healthy beverage policy.

Convergent, parallel, mixed-methods design complemented (i) repeat semi-structured interviews with council stakeholders (n 17 interviews, n 6 interviewees), with (ii) repeat quantitative stakeholder surveys measuring Commitment to Organisational Change; (iii) weekly sales data examining health behaviour and revenue effects (15 months pre-intervention; 14 months post-intervention); (iv) customer exit surveys (n 458); and (v) periodic photographic audits of beverage availability. Interviews were analysed inductively. Stakeholder surveys, sales data, customer surveys and audits were analysed descriptively.

Four local government-owned sports and recreation centres in Melbourne, Australia, completed a 3-month trial to increase the availability of healthy beverages and decrease the availability of unhealthy beverages in food outlets.

Interviews were conducted with council managers and those involved in implementation (September 2016–October 2017). Customers were surveyed (September–October 2017).

Interviews and surveys indicated that stakeholders’ commitment to policies varied such that, over time, optimism that changing beverage availability could increase the healthiness of customers’ purchases became more widespread among interviewees. Stakeholder focus generally progressed from anticipatory concern to solutions-focused discussions. Sales, audit and customer survey data supported interview findings.

We found a general increase in optimism regarding policy outcomes over time during the implementation of a healthy beverage policy. Stepwise trials should be further explored as an engagement tool within community retail settings.

Maternal nutrition during pregnancy is a key factor influencing birth outcome. Dietary diversity is a proxy for multiple macro- and/or micronutrient sufficiency of an individual’s diet. This systematic review aimed to summarise the findings on the association between maternal dietary diversity during pregnancy and the risk of low birth weight (LBW) in newborns.

This is a systematic review study.

Google and the PubMed, Scopus and Google Scholar databases were searched to extract original studies on humans published until June 2020, without date restrictions. There was no limitation regarding geographic region or economic condition of countries. Duplicated and irrelevant studies were screened out and data were obtained through critical analysis.

Articles that examined the association between maternal dietary diversity during pregnancy and the risk of LBW in infants were included.

Of the ninety-eight studies retrieved, fifteen articles were included in the final review. All included articles represent low- and middle-income countries. Eighty percentage of the studies (n 12) indicated that low maternal dietary diversity during pregnancy is associated with an increased risk of LBW infants. Three studies that included a small number of LBW infants and did not take into account factors which may bias study results failed to show this association.

The results suggest that low maternal dietary diversity during pregnancy may be associated with the risk of LBW, more specifically in developing countries. Dietary diversity might be a valuable predictor of maternal nutrition during pregnancy and the chance of giving birth to a LBW infant.

Ethiopia recently scaled up the implementation of a school feeding programme (SFP). Yet, evidence on the impact of such programmes on academic outcomes remains inconclusive. We evaluated the effect of the SFP on class absenteeism and academic performance of primary school students (grade 5–8) in Sidama zone, Southern Ethiopia.

This prospective cohort study enrolled SFP-beneficiary (n 240) and non-beneficiary (n 240) children 10–14 years of age from sixteen public schools and followed them for an academic year. School absenteeism was measured as the number of days children were absent from school in the year. Academic performance was defined based on the average academic score of the students for ten subjects they attended in the year. Data were analysed using multivariable mixed effects negative binomial and linear regression models.

Food insecure districts in Sidama zone, Southern Ethiopia.

SFP-beneficiary and non-beneficiary children 10–14 years of age.

The mean (sd) number of days children were absent from school was 4·0 (sd 1·5) and 9·3 (sd 6·0), among SFP beneficiaries and non-beneficiaries, respectively. Students not covered by the SFP were two times more likely to miss classes (adjusted rate ratio = 2·30; 95 % CI 2·03, 2·61). Pertaining to academic performance, a significant but small 2·40 (95 % CI 0·69, 4·12) percentage point mean difference was observed in favour of SFP beneficiaries. Likewise, the risk of school dropout was six times higher among non-beneficiaries (adjusted rate ratio = 6·04; 95 % CI 1·61, 22·68).

SFP promotes multiple academic outcomes among socio-economically disadvantaged children.