There are concerns that price promotions encourage unhealthy dietary choices. This review aims to answer the following research questions (RQ1) what is the prevalence of price promotions on foods in high-income settings, and (RQ2) are price promotions more likely to be found on unhealthy foods?

Systematic review of articles published in English, in peer-review journals, after 1 January 2000.

Included studies measured the prevalence of price promotions (i.e. percentage of foods carrying a price promotion out of the total number of foods available to purchase) in retail settings, in upper-mid to high-income countries.

‘Price promotion’ was defined as a consumer-facing temporary price reduction or discount available to all customers. The control group/comparator was the equivalent products without promotions. The primary outcome for this review was the prevalence of price promotions, and the secondary outcome was the difference between the proportions of price promotions on healthy and unhealthy foods.

Nine studies (239 344 observations) were included for the meta-analysis for RQ1, the prevalence of price promotions ranged from 6 % (95 % CI 2 %, 15 %) for energy-dense nutrient-poor foods to 15 % (95 % CI 9 %, 25 %) for cereals, grains, breads and other starchy carbohydrates. However, the I-squared statistic was 99 % suggesting a very high level of heterogeneity. Four studies were included for the analysis of RQ2, of which two supported the hypothesis that price promotions were more likely to be found on unhealthy foods.

The prevalence of price promotions is very context specific, and any proposed regulations should be supported by studies conducted within the proposed setting(s).

To investigate whether implementation of a universal salt iodization (USI) programme has sufficient effects on pregnant women in Chongqing, the present study evaluated the iodine nutritional status of pregnant women living in Chongqing by spot urinary iodine concentration (UIC), to provide scientific suggestions to better meet the specific iodine needs of this vulnerable group.

Cross-sectional design.

A random spot urine sample and household table salt sample were provided by each participant.

A total of 2607 pregnant women from twenty-six of thirty-nine districts/counties in Chongqing participated.

The overall median UIC of pregnant women was 171·80 μg/l (interquartile range (IQR) = 113·85–247·00 μg/l) and 40·97 % (n 1057) of participants were iodine insufficient. The median iodine in table salt samples was 25·40 mg/kg (IQR = 23·10–28·30 mg/kg); 93·26 % (n 2406) of samples examined were found to be adequately iodized. Iodine nutritional status was not significantly different according to table salt iodization category. Trimester was identified to be statistically associated with UIC (P < 0·01). Seven districts/counties had median UIC below 150 μg/l and one district had median UIC of 277·40 μg/l.

The USI programme in Chongqing prevents iodine deficiency generally, but does not maintain iodine status within adequate and recommended ranges throughout pregnancy. Usage of non-iodized or unqualified iodized salt and the slight change of dietary habits of iodized salt in Chongqing may present a substantial challenge to fight iodine-deficiency disorders; more efforts are needed to ensure adequate iodine intake during pregnancy besides the USI programme.

To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants.

Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology.

Telephone interview with babies’ mothers or fathers.

Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007).

We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and <1 % of babies, respectively, were exclusively breast-feeding. We also found early introduction of solid foods (after the 4th month of age). Maternity hospital practices favouring breast-feeding were more prevalent in 2017, but still suboptimal (63 % experienced rooming-in; 51 % experienced skin-to-skin contact in the first hour after birth; 19 % received free sample of infant formula on discharge).

We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates – particularly rates of exclusive breast-feeding – remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding ‘culture’ and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

To evaluate differences in food consumption of Brazilian adults according to the presence of children and adolescents in the household.

Averages of two non-consecutive days of food records from the first Brazilian National Dietary Survey were analysed and classified into eighteen food groups according to nutritional characteristics and use in diet. We compared the mean percentage contribution to total daily energy intake of each food group according to three groups of household composition: adults living alone or with other adults (32·7 %), adults living with children (35·6 %) and adults living with adolescents (31·7 %).

Brazilian nationwide survey, 2008–2009.

Adults aged 20–59 years (n 6312; 52·1 % female).

Women living alone or with other adults had higher consumption of vegetables, milk and other drinks, and lower consumption of beans and rice, compared with those living with children or adolescents. Men living alone or with other adults had higher consumption of sweets & desserts and vegetables, and lower consumption of beans, compared with those living with children or adolescents. According to household income, adults in the highest tertile who lived with children or adolescents presented a mixed consumption of healthy and unhealthy foods, whereas their counterparts in the first income tertile presented a marked consumption of foods considered traditional of the Brazilian population.

There are differences in food consumption based on the presence of children and adolescents in the household, with greater variation according to gender and household income.

To study the extent and nature of free-to-air television advertisements for non-core products (e.g., fast food or soda) directed at children in Hong Kong.

Television programs from two major Hong Kong free-to-air television channels airing between 06.00 and 24.00 hours from October 2018 to January 2019 were recorded. Eight nonconsecutive days (four weekdays and four weekend days) were selected for analysis. Pearson’s χ2 tests were conducted to compare the pattern of food advertisements by program categories, days of the week, television viewing periods and persuasive marketing techniques.

Free-to-air television programs.

Not applicable.

Of the 10 348 commercials identified, 18·4 % were for foods, and 35·2 % of these were for non-core items. Baby and toddler milk formula (19·5 %) were the most advertised food products, while the most frequently advertised non-core food was fast foods (12·3 %). There was a higher non-core to core product ratio during prime time than the children’s time slot (7 v. 1·7). Non-sports celebrity endorsement (27·1 %) was the most frequently used persuasive marketing technique overall, while that for non-core products was sensory characteristics (38·2 %). Most food product placements recorded were non-core products, mentions of local and fast food restaurants and recipe additions.

Non-core products were highly advertised in Hong Kong, while core product advertising was infrequent. Regulations on junk food advertising in Hong Kong should focus on prime time, as well as on food product placement, to reduce children’s exposure to persuasive junk food marketing.

Little is known about the diet quality of preschool children in Canada. We adapted an established diet quality index for European preschool children to align with the Canadian context and applied the index to dietary data of 3-year-old children to assess patterns of diet quality.

Our diet quality index (DQI-C) consists of four components that align with Canada’s Food Guide (Vegetables and Fruit, Grain Products, Milk and Alternatives and Meat and Alternatives) and two components that account for less healthy intakes (Candy/Snacks, and Sugar-Sweetened Beverages (SSB)). The ratio between consumption v. recommended intakes is calculated for each component and summed to give a total score from 0 to 6.

Alberta, Canada.

The DQI-C was applied to FFQ data from 1260 3-year-old children.

Mean DQI-C was 3·69 (sd 0·6). Most children met recommendations for Vegetables and Fruit (73 %) and Meat and Alternatives (70 %); however, fewer met recommendations for Milk and Alternatives (38 %) and Grain Products (13 %). Children in the lowest quartile for DQI-C score consumed a mean of 82 g of Candy/Snacks and 193 g of SSB daily, whereas those in the highest quartile consumed 45 g/d and 17 g/d of Candy and Snacks and SSB, respectively.

This DQI-C score is useful for ranking Canadian preschool children according to their overall diet quality. There is room for improvement for consumptions of Grain Products, Meat and Alternatives, Candy/Snacks and SSB, which could be a target for initiatives to improve diet quality of preschool children in Canada.

To compare the sugar content of items at four multinational fast-food chains, across three countries.

Total sugar (g)/per serving was extracted from online nutrition information, and sugar/100 g serving was calculated. Foods were categorised as: breakfast sandwiches, burgers, sandwiches, desserts and condiments. Beverages were categorised as fountain, frozen or pre-packaged. Sugar (g) was compared across countries using linear mixed-effects models. Pairwise comparisons were performed with Tukey–Kramer adjustments.

USA, Germany and Australia.

Burger King™ (Hungry Jack’s™), Kentucky Fried Chicken™, McDonald’s™ and Subway™.

Differences in total sugar/100 g or ml were observed across countries for burgers (n 104), desserts (n 110), sandwiches (n 178), pre-packaged beverages (n 36) and frozen beverages (n 72). Comparing identical items across countries (e.g. BigMacTM from McDonalds in USA, Germany and Australia), burgers (n 10 available in all three countries) had lower sugar content in Australia (3·4 g/100 g) compared with the USA (4·7 g/100 g, P = 0·02) or Germany (4·6 g/100 g, P = 0·04), yet no differences were observed in other food categories. Comparing the same beverages across countries (e.g. chocolate shake from Burger King), frozen beverages (n 4 available in all three countries) had lower sugar content in Australia (14·2 g/100 ml), compared with the USA (20·3 g/100 ml, P = 0·0005) or Germany (17·8 g/100 ml, P = 0·0148), yet no differences were observed in other beverage categories.

Heterogeneity in fast-food sugar content across countries suggests that reductions are possible and should be implemented to reduce health risks associated with excess added sugar intake.

This study aimed to report the WHO infant and young child feeding (IYCF) indicators from Kuwait and to investigate the associations between these indicators and anthropometric measurements.

The Kuwait Nutritional Surveillance System uses observational cross-sectional approach to collects data by face-to-face interviews with mothers or child guardians using a structured questionnaire that was developed based on the WHO IYCF indicators. The weight and height of infants and young children were measured using digital scales in a standardised manner.

Vaccination centres in all governorates (provinces) of Kuwait.

Infants and young Kuwaiti children aged 0–23 months (N 5839).

The prevalence of exclusive breastfeeding and age-appropriate breastfeeding were 8·0 and 7·4 %, respectively. The prevalence of stunting and wasting was 7·5 and 2·4 %, respectively, while the prevalence of overweight and obesity was 6·5 and 1·6 %, respectively. In the multivariable analysis, exclusive breastfeeding and age-appropriate breastfeeding were more common in children with stunted growth (AOR 1·71 (95 % CI 1·08, 2·70; P = 0·021) and 1·44 (95 % CI 1·01, 2·06; P = 0·046), respectively). The introduction of solid/semisolid or soft foods was inversely associated with stunting (AOR 0·52; 95 % CI 0·30, 0·90; P = 0·021). Only age-appropriate breastfeeding was inversely associated with overweight (AOR 0·62; 95 % CI 0·39, 0·98; P = 0·043).

Our findings showed that indicators of breastfeeding are low in Kuwait. Our findings suggest that the associations between different WHO IYCF indicators and stunting as well as overweight is complex, which highlights the need for a better understanding of WHO IYCF indicators in both low- and high-income countries.

To use Internet search data to compare duration of compliance for various diets.

Using a passive surveillance digital epidemiological approach, we estimated the average duration of diet compliance by examining monthly Internet searches for recipes related to popular diets. We fit a mathematical model to these data to estimate the time spent on a diet by new January dieters (NJD) and to estimate the percentage of dieters dropping out during the American winter holiday season between Thanksgiving and the end of December.

Internet searches in the USA for recipes related to popular diets over a 15-year period from 2004 to 2019.

Individuals in the USA performing Internet searches for recipes related to popular diets.

All diets exhibited significant seasonality in recipe-related Internet searches, with sharp spikes every January followed by a decline in the number of searches and a further decline in the winter holiday season. The Paleo diet had the longest average compliance times among NJD (5.32 ± 0.68 weeks) and the lowest dropout during the winter holiday season (only 14 ± 3 % dropping out in December). The South Beach diet had the shortest compliance time among NJD (3.12 ± 0.64 weeks) and the highest dropout during the holiday season (33 ± 7 % dropping out in December).

The current study is the first of its kind to use passive surveillance data to compare the duration of adherence with different diets and underscores the potential usefulness of digital epidemiological approaches to understanding health behaviours.

To analyse the extent and nature of food and beverage advertising on the three major Brazilian free-to-air television (TV) channels.

Cross-sectional study. A protocol developed for the International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support was applied for data collection. A total of 432 h of TV programming was recorded from 06.00 to 24.00 hours, for eight non-consecutive and randomly selected days, in April 2018. All TV advertisements (ads) were analysed, and food-related ads were classified according to the NOVA classification system. Descriptive analyses were used to describe the number and type of ads, food categories and the distribution of ads throughout the day and time of the day.

The three most popular free-to-air channels on Brazilian TV.

The study did not involve human subjects.

In total, 14·2 % (n 1156 out of 7991) of ads were food related (858 were specific food items). Approximately 91 % of food items ads included ultra-processed food (UPF) products. The top three most promoted products were soft drinks, alcoholic beverages and fast-food meals. Alcoholic beverage ads were more frequently broadcast in the evening.

The high risk of exposure of the Brazilian population to UPF ads should be considered a public health concern given the impact of unhealthy food advertising on people’s food choices and health.

To summarise the findings from this supplemental issue on the distribution of malnutrition (stunting/short stature, anaemia and overweight) by wealth, education and ethnicity within and between ten Latin American countries.

We retrieved information from each country’s article and estimated the average difference in the prevalence of malnutrition between groups. We estimated the associations between countries’ malnutrition prevalence and GDP, percentage of women with high education and percentage of non-indigenous ethnicity.

Nationally representative surveys from ten Latin American countries conducted between 2005 and 2017.

Children (<5 years), adolescent women (11–19 years) and adult women (20–49 years).

Socially disadvantaged groups (low wealth, low education and indigenous ethnicity) had on average 15–21 (range across indicators and age groups) percentage points (pp) higher prevalence of stunting/short stature and 3–11 pp higher prevalence of anaemia. For overweight or obesity, adult women with low education had a 17 pp higher prevalence; differences were small among children <5 years, and results varied by country for adolescents by education, and for adults and adolescents by wealth and ethnicity. A moderate and strong correlation (–0·58 and –0·71) was only found between stunting/short stature prevalence and countries’ GDP per capita and percentage of non-indigenous households.

Overweight was equally distributed among children; findings were mixed for ethnicity and wealth, whereas education was a protective factor among adult women. There is an urgent need to address the deep inequalities in undernutrition and prevent the emerging inequalities in excess weight from developing further.

To assess the differences in healthy, environmentally sustainable and safe food consumption by education levels among adults aged 19–69 in the Netherlands.

This study used data from the Dutch National Food Consumption Survey 2007–10. Food consumption data were obtained via two 24-h recalls. Food consumption data were linked to data on food composition, greenhouse gas emissions (GHGe) and concentrations of contaminants. The Dutch dietary guidelines (2015), dietary GHGe and dietary exposure to contaminants were used as indicators for healthy, environmentally sustainable and safe food consumption, respectively.

The Netherlands.

2106 adults aged 19–69 years.

High education groups consumed significantly more fruit (+28 g), vegetables (men +22 g; women +27 g) and fish (men +6 g; women +7 g), and significantly less meat (men –33 g; women –14 g) compared with low education groups. Overall, no educational differences were found in total GHGe, although its food sources differed. Exposure to contaminants showed some differences between education groups.

The consumption patterns differed by education groups, resulting in a more healthy diet, but equally environmentally sustainable diet among high compared with low education groups. Exposure to food contaminants differed between education groups, but was not above safe levels, except for acrylamide and aflatoxin B1. For these substances, a health risk could not be excluded for all education groups. These insights may be used in policy measures focusing on the improvement of a healthy diet for all.

To estimate the prevalence of high, marginal, low and very low food security among a sample of college students and identify characteristics associated with the four different food security status levels and note differences in associations from when food security status is classified as food-secure v. food-insecure.

Cross-sectional online survey.

A large public university in North Carolina.

4829 college students who completed an online survey in October and November 2016.

Among study participants, 56·2 % experienced high, 21·6 % experienced marginal, 18·8 % experienced low and 3·4 % experienced very low food security. Characteristics significantly associated with food security status when using the four-level variable but not two-level variable were age, international student status and weight status. Characteristics that significantly differed between the marginal and high food security groups included age, race/ethnicity, year in school, international student status, employment status, financial aid receipt, perceived health rating, cooking frequency and participation in an on-campus meal plan. Characteristics with differences in significant associations between the low and very low food security groups were gender, international student status, having a car, weight status and participation in an on-campus meal plan. Even where similarities in the direction of association were seen, there were often differences in magnitude.

We found differences in characteristics associated with food security status when using the four-level v. two-level food security status variable. Future studies should look separately at the four levels, or at least consider separating the marginal and high food-secure groups.

To assess the prevalence of partially hydrogenated oils (PHO), hydrogenated oils (HO) and/or both in Canadian packaged foods in 2013 and 2017 and to determine the mean trans-fatty acid (TFA) content of products declaring such oils.

Repeated cross-sectional study of the Food Label Information Program.

Food labels (n 32 875) were collected from top Canadian grocery retailers in 2013 and 2017. Proportions of products declaring PHO, HO and/or both in the Ingredients List were calculated by year and food category. The percentage contribution of TFA (g) to total fat (g) was calculated and compared against the voluntary TFA limits, defined as <2 % of total fat content for fats and oils, and <5 % for all other foods. Foods exceeding limits were identified. The mean TFA content (in g/serving and per 100 g) was calculated for products with these oils.

The use of PHO, HO and/or both significantly decreased in Canadian foods from 2013 to 2017 (0·8 to 0·2 %, 5 to 2·4 % and 5·7 to 2·6 %, respectively, for PHO, HO and/or both). The mean TFA content of products containing PHO increased (0·34 to 0·57 g TFA/serving); although it was not statistically significant, it is still concerning that TFA content increased. The TFA content significantly decreased in foods with HO (0·24 to 0·16 g TFA/serving, P < 0·05) during 2013–2017.

Products with PHO continue to be present in the Canadian marketplace, despite voluntary efforts to eliminate them. Products with HO should also be monitored, as they can also contribute to TFA content in foods.

To determine the prevalence and sociodemographic factors associated with food insecurity in the state of New South Wales (NSW), Australia.

Cross-sectional analysis of food insecurity data collected by the NSW Population Health Survey between 2003 and 2014. Multiple logistic regression was used to examine associations with key sociodemographic variables.

NSW, Australia.

212 608 survey participants responded to the food insecurity survey question between 2003 and 2014. 150 767 of them were aged ≥16 years. The survey sample was randomly selected and weighted to be representative of the NSW population.

On average 6 % of adults aged ≥16 years experienced food insecurity in NSW. The odds of food insecurity appeared to increase from one survey year to the next by a factor of 1·05. Food insecurity was found to be independently associated with age, sex, marital status, household size, education, employment status, household income, smoking status, alcohol intake and self-rated health. The association with income, smoking status and self-rated health appeared to be the strongest among all covariates and showed a gradient effect. Food insecurity appeared to increase significantly between the age of 16 and 19 years.

The prevalence of food insecurity appears to be rising over time. Given the negative health consequences of food insecurity, more rigorous measurement and monitoring of food insecurity in NSW and nationally is strongly recommended. The findings provide support for interventions targeting low-income and younger population groups.

To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples.

A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics.

Iranian adults recruited in 2014–2015.

Healthy volunteer adults aged ≥18 years.

With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (−469 to −708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (–151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50).

In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.