To explore explicit beliefs about the controllability of obesity and the internalisation of negative weight-related stereotypes among public health trainees.

Cross-sectional online survey assessing explicit beliefs about the controllability of obesity using the Beliefs About Obese Persons Scale (BAOP) and internalisation of weight bias using the Modified Weight Bias Internalization Scale (WBIS-M). Bivariate associations between BAOP and WBIS-M scores and demographic characteristics were examined using t tests or ANOVA with post hoc Tukey’s tests.

School of Public Health at a large, Midwestern University.

Public health students (n 322).

Relative to students who identified as male, those who identified as female had a stronger belief that obesity is not within the control of the individual (P = 0·03), yet had more internalisation of weight bias (P < 0·01). Greater weight bias internalisation was also seen among students who perceived themselves to be of a higher weight status (P < 0·001) and those who were at risk for food insecurity (P < 0·01).

Public health trainees may be more attuned to the complexities of weight relative to trainees in other health-related fields, but are still susceptible to internalisation of negative weight-related stereotypes.

The current study aimed to predict disability-adjusted life years (DALY) rate in Japan through 2040 with plausible future scenarios of fruit intake for neoplasms, cardiovascular diseases (CVD) and diabetes and kidney diseases (DKD).

Data from National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017 were used. We developed an autoregressive integrated moving average model with four future scenarios. Reference scenario maintains the current trend. Best scenario assumes that the goal defined in Health Japan 21 is achieved in 2023 and is kept constant afterwards. Moderate scenario assumes that the goal is achieved in 2040. Constant scenario applies the same proportion of 2016 for the period between 2017 and 2040.

DALY rates in Japan were predicted for the period between 2017 and 2040.

Population aged more than than 20 years old.

In our reference forecast, the DALY rates in all-ages group were projected to be stable for CVD and continue increasing for neoplasms and DKD. Age group-specific DALY rates for these three disease groups were forecasted to decrease, with some exceptions. Among men aged 20–49 years, DALY attributable to CVD differed substantially between the scenarios, implying that there is a significant potential for reducing the burden of CVD by increasing fruit intake at the population level.

Our scenario analysis shows that higher fruit intake is associated with lower disease burden in Japan. Further research is required to assess which policies and interventions can be used to achieve an increase in fruit intake as modelled in the scenarios of the current study.

This article assesses the nutritional status of Indigenous women from 14 to 49 years of age in Brazil.

Sample size was calculated for each region considering a prevalence of 50 % for all disease outcomes, a relative error of 5 % and a CI of 95 %. In the initial data analysis, the prevalence of excess weight and obesity was calculated according to independent variables. Multivariate multilevel hierarchical analyses were conducted based on a theoretical model of two ranked blocks.

The 2010 Indigenous population in Brazil was 896 000, with approximately 300 Indigenous ethnic groups, making Brazil one of the most ethnically diverse countries in the Americas and the world.

Of the total target sample of 6722 women evaluated by the National Survey, thirty did not participate, 939 were not eligible for analyses due to pregnancy or unknown pregnancy status, and thirty-nine were excluded due to missing anthropometric data.

The evaluation of nutritional status was completed for 5714 non-pregnant women (99·3 % of eligible participants for this outcome). High prevalence rates were encountered for both excess weight (46·2 %) and obesity (15·8 %) among the sampled women. In the multivariate analyses, higher socioeconomic indicators, market-integrated living conditions and less reliance on local food production, as well as increased age and parity were associated with excess weight and obesity.

Results point to distinct patterns of associations between socioeconomic indicators and the occurrence of excess weight and obesity among Indigenous women, which have potentially significant implications from a public policy perspective for Indigenous peoples in Brazil.

In 2018, Minneapolis began phased implementation of an ordinance to increase the local minimum wage to $15/h. We sought to determine whether the first phase of implementation was associated with changes in frequency of consumption of fruits and vegetables (F&V), whole-grain-rich foods, and foods high in added sugars among low-wage workers.

Natural experiment.

The Wages Study is a prospective cohort study of 974 low-wage workers followed throughout the phased implementation of the ordinance (2018–2022). We used difference-in-difference analysis to compare outcomes among workers in Minneapolis, Minnesota, to those in a comparison city (Raleigh, North Carolina). We assessed wages using participants’ pay stubs and dietary intake using the National Cancer Institute Dietary Screener Questionnaire.

Analyses use the first two waves of Wages data (2018 (baseline), 2019) and includes 267 and 336 low-wage workers in Minneapolis and Raleigh, respectively.

After the first phase of implementation, wages increased in both cities, but the increase was $0·84 greater in Minneapolis (P = 0·02). However, the first phase of the policy’s implementation was not associated with changes in daily frequency of consumption of F&V (IRR = 1·03, 95 % CI: 0·86, 1·24, P = 0·73), whole-grain-rich foods (IRR = 1·23, 95 % CI: 0·89, 1·70, P = 0·20), or foods high in added sugars (IRR = 1·13, 95 % CI: 0·86, 1·47, P = 0·38) among workers in Minneapolis compared to Raleigh.

The first phase of implementation of the Minneapolis minimum wage policy was associated with increased wages, but not with changes in dietary intake. Future research should examine whether full implementation is associated dietary changes.

The massive increase in COVID-19 cases led to the implementation of nationwide lockdown in Turkey. While enforced lockdown is an effective strategy to abate the transmission of the virus, it causes significant lifestyle changes in every part of the community. This study aims to assess the changes in eating habits, sleeping behaviour and physical activity status of final-year medical students (interns) whose education was suspended during the pandemic.

In this cross-sectional epidemiological study, an online questionnaire was created. Interns were asked questions regarding socio-demographic status, eating habits, sleeping behaviour and physical activity status before and during COVID-19 pandemic. Changes in dietary habits and sleep quality were evaluated under the guidance of Turkey Dietary Guidelines, Determination of Nutritional Status Report, Turkey National Nutrition and Health Survey and Pittsburgh Sleep Quality Index.

Hacettepe University Faculty of Medicine – Ankara, Turkey.

Among 536 students, a total of 340 students (63·4 %) answered the questionnaire.

After the beginning of lockdown, an increase in BMI was observed in both female (P = 0·002) and male students (P = 0·013). Students having healthy dietary habits increased by 18·8 % and unhealthy dietary habits decreased by 3·2 % during lockdown (P < 0·001). Overall, 63·2 % of students reported a decrease in physical activity, and 33·6 % reported a reduction in sleep quality, whereas 38·6 % reported an improvement in sleep quality. There was no significant difference in sleep quality between genders (P = 0·075).

This study indicated that medical school suspension and enforced lockdown led to significant changes in interns’ eating behaviour, physical activity and sleeping habits.

Given the competing needs for food and housing under the limited household income among poor families, there is lack of research on the associations between housing affordability and food insecurity. The current study examines how housing cost burden affects food insecurity of low-income families and whether decreased housing cost enhances food security.

Longitudinal data from the Korean Welfare Panel Study, of which the final sample for the analysis consisted of 31 304 household-level observations from 5466 households based on twelve waves (2007–2018).

South Korea.

Low-income households in the lowest 40 % of household income distribution.

19·3 % had food insecurity, and housing cost burden was associated with food insecurity. While in-kind housing assistance and in-cash assistance from all sources were likely to reduce food insecurity partially through influencing housing cost burden, in-cash housing assistance was associated with higher likelihood of food insecurity.

Housing cost burden potentially limits food access among poor families, and housing assistance, particularly public housing and sufficient in-cash assistance, is conducive to alleviating food insecurity.

The objective is to analyse Danish consumers’ attitudes to buying food with reduced salt content.

The study is based on a comprehensive store intervention that included 114 stores belonging to the same supermarket chain. Three different salt claims were tested for 8 weeks on six test products within the categories bread, cornflakes and frozen pizzas. Scanner data were supplemented with 134 brief interviews with consumers in nine selected stores.

Stores spread across Denmark.

Consumers who buy food in the stores.

Statistical regression analyses of the scanner data indicated that none of the three claims significantly affected demand for any of the test products. The interviews confirmed that many consumers were more focused on other elements of the official dietary advice than reduced salt consumption, such as eating plenty of vegetables, choosing products with whole grains and reducing their intake of sugar and fat.

Overall, both the scanner data and the interviews pointed in the same direction, towards the conclusion that salt content is often a secondary factor when Danish consumers make dietary choices.

Agriculture accounts for around 70 % of global freshwater withdrawals. As such, the food system has been identified as a critical intervention point to address water scarcity. Various studies have identified dietary patterns that contribute less to water scarcity. However, it is unclear what level of reduction is necessary to be considered sustainable. The pursuit of unnecessarily aggressive reductions could limit dietary diversity. Our objective was to assess the sustainability of water use supporting Australian dietary habits and the adequacy of current dietary guidelines.

Dietary intake data were obtained from the National Nutrition and Physical Activity component of the Australian Health Survey. For each individual daily diet, the water scarcity footprint was quantified, following ISO14046:2014, as well as a diet quality score. Water scarcity footprint results were compared with the planetary boundary for freshwater use downscaled to the level of an individual diet.

Australia.

9341 adults participating in the Australian Health Survey.

Dietary water scarcity footprints averaged 432·6 L-eq (95 % CI 432·5, 432·8), less than the 695 litres/person per d available to support the current global population of 7·8 billion, and the 603 litres/person per d available for a future population of 9 billion. Diets based on the Australian Dietary Guidelines required 521 L-eq/d, or 379 L-eq/d with lower water scarcity footprint food choices.

Diets based on the Australian Dietary Guidelines were found to be within the freshwater planetary boundary. What is needed in Australia is greater compliance with dietary guidelines.

Many countries are considering the implementation of front-of-pack nutrition labels as a strategy to address high and increasing levels of overweight and obesity. A growing body of work demonstrates the superiority of labels that use colour and/or provide a summary indicator of product healthiness to enhance comprehension. However, previous studies have been confounded in determining the relative effectiveness of these two attributes by comparing labels that also differ in other ways. The present study tested labels that varied only on use of colour and/or reliance on a summary indicator across an international sample to provide unique insights into the relative importance of these attributes.

Participants were randomised to see one of four variations of the Health Star Rating label that differed on the basis of use of colour and sole provision of a summary indicator.

Australia, Canada, China, India, New Zealand, the UK and the USA.

Adults (n 7545) in seven countries were exposed to online choice tasks requiring them to select a preferred breakfast cereal and then nominate the healthiest cereal.

Overall, the coloured versions, and particularly the one with just a summary indicator, outperformed the monochrome version that included nutrient-specific information. However, there were some differences by country, with results from Canada and China indicating superior outcomes for monochrome labels and those providing nutrient-specific information.

The results highlight the importance of colour, but suggest that the introduction of front-of-pack nutrition labels should be preceded by country-specific formative testing to identify potential differences in outcomes.

Sustainable diets are diets with low environmental impacts and high affordability which contribute to food and nutrition security. The present study aimed to develop a healthy, low-cost and environmental-friendly food basket for Iran based on current consumption.

The Households Income and Expenditure Survey data were used. Linear Programming was utilised to obtain the optimal diets, separately, for each goal of the sustainable food basket: (1) Diet with maximum Nutrient Rich Food (NRF) index, (2) Diet with minimum cost, (3) Diet with the minimum water footprint and (4) Diet with the minimum carbon footprint. Goal Programming techniques were used to optimise the sustainable food basket by considering all goals simultaneously.

Iran.

Households (n 100 500) in urban and rural areas of Iran, nationally representative.

In the ‘optimal model’, compared with the usual consumption, the amount of the ‘bread, cereal, rice, and pasta’, ‘meat, poultry, fish, eggs, legumes, and nuts’ and ‘fats, oils, sugars, and sweets’ groups was decreased. Inside those food groups, cereals, poultry and vegetable oil subgroups were increased. Also, dairy, fruits and vegetable groups were increased. In this model, there was a 14 % reduction in the total water footprint, a 14 % decrease in the total carbon footprint, a 23 % decrease in the cost and a 7 % increase in NRF of diet compared with the usual consumption.

Increasing the consumption of dairy, fruits and vegetables and reducing the consumption of bread, rice, pasta, meat, fish, eggs, legumes, nuts, hydrogenated fats and sugars are required to achieve a sustainable food basket.

To analyse nutritional and packaging characteristics of toddler-specific foods and milks in the Australian retail food environment to identify how such products fit within the Australian Dietary Guidelines (ADG) and the NOVA classification.

Cross-sectional retail audit of toddler foods and milks. On-pack product attributes were recorded. Products were categorised as (1) food or milk; (2) snack food or meal and (3) snacks sub-categorised depending on main ingredients. Products were classified as a discretionary or core food as per the ADG and level of processing according to NOVA classification.

Supermarkets and pharmacies in Australia.

A total of 154 foods and thirty-two milks were identified. Eighty percentage of foods were snacks, and 60 % of foods were classified as core foods, while 85 % were ultraprocessed (UP). Per 100 g, discretionary foods provided significantly more energy, protein, total and saturated fat, carbohydrate, total sugar and Na (P < 0·001) than core foods. Total sugars were significantly higher (P < 0·001) and Na significantly lower (P < 0·001) in minimally processed foods than in UP foods. All toddler milks (n 32) were found to have higher energy, carbohydrate and total sugar levels than full-fat cow’s milk per 100 ml. Claims and messages were present on 99 % of foods and all milks.

The majority of toddler foods available in Australia are UP snack foods and do not align with the ADG. Toddler milks, despite being UP, do align with the ADG. A strengthened regulatory approach may address this issue.

To consider the principal effect of an interaction between year (pre- and post-Universal Infant Free School Meals (UIFSM)) and school on pupil’s dietary intakes.

A repeated cross-sectional survey using dietary data from 2008 to 2009 (pre-) and 2017 to 2018 (post-UIFSM)

Two primary schools, NE England.

Pupils aged 4–7 years (2008–2009 n 121; 2017–2018 n 87).

At lunchtime, there was a statistically significant decrease in pupils non-milk extrinsic sugars intake (%E NMEs) pre- to post-UIFSM (mean change –4·6 %; 95 % CI –6·3, –2·9); this was reflected in total diet (–3·8 %; –5·2, –2·7 %). A year and school interaction was found for mean Ca intakes: post-UIFSM pupils in School 2 had a similar mean intake as pre; in School 1 intakes had increased (difference of difference: –120 mg; 95 % CI –179, –62); no reflection in total diet. Post-UIFSM mean portions of yogurt decreased in School 2 and remained similar in School 1 (–0·25; –0·46, –0·04); this was similar for ‘cake/pudding’ and fruit.

Within the limitations, these findings highlight positives and limitations following UIFSM implementation and demonstrate the role of school-level food practices on pupil’s choices. To facilitate maximum potential of UIFSM, national levers, such as discussions on updating school food standards, including sugars, could consider removing the daily ‘pudding’ option and advocate ‘fruit only’ options 1 d/week, as some schools do currently. Small school-level changes could maximise positive health impacts by decreasing NMEs intake. A more robust evaluation is imperative to consider dietary impacts, equitability and wider effects on schools and families.

We aimed to evaluate the association between coffee and/or tea consumption and breast cancer (BC) risk among premenopausal and postmenopausal women and to conduct a network meta-analysis.

Systematic review and network meta-analysis.

We conducted a systematic review of electronic publications in the last 30 years to identify case–control studies or prospective cohort studies that evaluated the effects of coffee and tea intake.

Forty-five studies that included more than 3 323 288 participants were eligible for analysis. Network meta-analysis was performed to determine the effects of coffee and/or tea consumption on reducing BC risk in a dose-dependent manner and differences in coffee/tea type, menopause status, hormone receptor and the BMI in subgroup and meta-regression analyses. According to the first pairwise meta-analysis, low-dose coffee intake and high-dose tea intake may exhibit efficacy in preventing ER(estrogen receptor)− BC, particularly in postmenopausal women. Then, we performed another pairwise and network meta-analysis and determined that the recommended daily doses were 2–3 cups/d of coffee or ≥5 cups/d of tea, which contained a high concentration of caffeine, particularly in postmenopausal women.

Coffee and tea consumption is not associated with a reduction in the overall BC risk in postmenopausal women and is associated with a potentially lower risk of ER− BC. And the highest recommended dose is 2–3 cups of coffee/d or ≥5 cups of tea/d. They are potentially useful dietary protectants for preventing BC.

The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies.

We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate.

Low-, middle- and high-income countries.

Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age.

Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects.

Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.

To develop and test a tool to assess the price and availability of low-carbon footprint and nutritionally balanced dietary patterns in retail food environments in Ontario, Canada.

Availability and price of selected food from discount and regular grocery stores (n 23) in urban/rural areas of northern/southern Ontario were assessed with the Sustainable Nutrition Environment Measures Survey in 2017.

Ontario, Canada.

Inter-rater reliability was high for price (intra-class correlation coefficients = 0·819) and for availability (Cohen’s κ = 0·993). The tool showed 78 % of the selected food items were available in all stores. Overall, price differences were small between urban and rural locations, and northern and southern Ontario. The greatest price difference was between discount and regular stores.

The tool showed excellent inter-rater agreement. Researchers and public health dietitians can use this tool for research, practice and policy to link consumer-level health outcomes to the retail environment.

To estimate the proportion of products meeting Fiji government labelling regulations, assess compliance with national Na reformulation targets and examine the Na and total sugar levels in packaged foods sold in selected major supermarkets.

We selected five major supermarkets in 2018 and collected the product information and nutritional content from the labels of all packaged foods sold. We organised 4278 foods into fourteen major food categories and thirty-six sub-categories and recorded the proportion of products labelled in accordance with the Fiji labelling regulations. We looked at the levels of Na and total sugar in each food category and assessed how many products complied with the Fiji reformulation targets set for Na. We also listed the companies responsible for each product.

Suva, Fiji.

Fourteen percentage of packaged foods in fourteen major categories met Fiji national labelling regulations. Na was labelled on 95·4 % products, and total sugar labelled on 92·4 %. The convenience foods category had the highest Na levels (1699 mg/100 g), while confectionery had the highest content of total sugar (52·6 g/100 g). Forty percentage of eligible products did not meet the proposed voluntary Na reformulation targets.

Our findings indicate significant room for improvement in nutrient labelling, as well as a need for further enforcement of reformulation targets and monitoring of changes in food composition. Through enacting these measures and establishing additional regulations such as mandatory front-of-pack labelling, government and food industry can drive consumers towards healthier food choices and improve the nutritional quality of packaged foods in Fiji.