To analyse serum folate levels in women of childbearing age in the Metropolitan Region (MR) of Chile.

Cross-sectional design as part of the 2016–2017 National Health Survey (Encuesta Nacional de Salud, ENS 2016–2017), using a household-based multistage stratified random sample. Serum folate levels measured by electrochemiluminescence immunoassay in fasting venous blood samples were classified as deficient (<4·4 ng/ml), normal (4·4–20 ng/ml) or supraphysiological (>20 ng/ml).

The MR of Chile.

Women of reproductive age (15–49 years, n 222) from the MR participated in the ENS 2016–2017.

The mean, median and range of serum folate were 14·2 (se 0·4), 13·9 and 2·1–32·2 ng/ml, respectively. Folate deficiency was detected in 0·9 % of women, while 7·0 % had supraphysiological levels of the vitamin. No significant effects of age, educational level, marital status, parity, smoking status or nutritional status on serum folate levels were detected by univariate or multivariate analyses. Intake of folic acid supplements showed a significant association with serum folate levels, but only 1·2 % of women used supplements.

Folate deficiency in women of reproductive age living in the MR of Chile is almost inexistent according to the ENS 2016–2017, suggesting that the current population-wide mandatory folic acid fortification of flour is an effective and equitable measure to prevent folate deficiency. These results support the option of maintaining current folic acid fortification in Chile, particularly based on the low adherence to supplementation regimes evidenced in other populations.

Low socio-economic groups (SEG) in Australia suffer poorer diet-related health than the rest of the population. Therefore, it is expected that low SEG are less likely to consume diets conforming to Australian Dietary Guidelines (ADG) than higher SEG. However, dietary intake of low SEG in Australia has not been synthesised methodically. This systematic scoping review aims to explore detailed dietary intake of low SEG in Australia in comparison to higher SEG.

A systematic search of peer-reviewed literature and websites, since 1999. Data were extracted, synthesised and analysed in relation to study populations, dietary assessment methods, food groups studied, socio-economic measures and dietary intake.

Australia.

Persons of any age and gender, differentiated by a socio-economic measure.

Results from thirty-three included studies confirmed that overall dietary nutritional value/quality tended to be lower in low SEG than higher SEG in Australia. However, findings were inconsistent across studies for all food groups or all socio-economic measures. Large variations were found between study metrics, definitions, dietary assessment methods, granularity of results and conclusions. Quantitative intakes of all ADG food groups by SEG were not reported in most studies and, where reported, were not comparable.

The review showed detailed dietary data are lacking to inform policy and practice and help develop targeted interventions to improve diet-related health of Australian low SEG. There is urgent need for regular, granular assessment of population dietary data to enable comparison of intake between SEG in the context of national food-based dietary guidelines in Australia.

To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico.

We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status and anxiety.

ENCOVID-19 is a monthly telephone cross-sectional survey collecting information on the well-being of Mexican households during the pandemic lockdown. Surveys used probabilistic samples, and we used data from April (n 833), May (n 850) and June 2020 (n 1674).

Mexicans 18 years or older who had a mobile telephone.

ELCSA had an adequate model fit and food insecurity was associated, within each wave, with more poverty and anxiety. The COVID-19 lockdown was associated with an important reduction in food security, decreasing stepwise from 38·9 % in 2018 to 24·9 % in June 2020 in households with children.

Telephone surveys were a feasible strategy to monitor reductions in food security during the COVID-19 lockdown.

Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic.

Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 – consistently low, 2 – become low during the quarantine, 3 – become high during the quarantine or 4 – consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine.

Brazil.

Brazilian adults (nationally representative).

Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption.

Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine.

This study aims to evaluate the validity and reliability of the Turkish version of the Child Three-Factor Eating Questionnaire for primary and secondary school students.

A methodological, descriptive and correlational study design was adopted.

The study was conducted in the western and central regions of Turkey.

This methodological–descriptive–correlational study was conducted with 351 children between July 2018 and August 2018. The mean age of children is 10·74 ± 1·79 (8–14).

The scale consists of seventeen items and three sub-dimensions (restraint, uncontrolled eating and emotional eating), which explained 52·88 % of the total variance. All the factor loadings were >0·40 in both exploratory factor analysis and confirmatory factor analysis (CFA). In CFA, all of the fit indices were >0·85, and root mean square error of approximation was <0·08. For the whole of the scale, Cronbach’s α was 0·81 and it was found that Cronbach’s α values of all sub-dimensions were >0·70.

The results of the study show that the Child Three-Factor Eating Questionnaire for primary and secondary school students is a valid and reliable measurement tool for Turkish sampling.

To adapt a short FFQ (SFFQ) and evaluate its relative validity and reproducibility to assess food group intake in a population resident in the Basque Country. Moreover, the possible influence of associated variables (such as education level) on its validity and reproducibility was determined.

Nine-day 24-h recalls (24HR) were used as a reference to explore validity over the course of 1 year. The degree of misclassification in the SFFQ was evaluated by a contingency table of quartiles and by Bland–Altman plots comparing SFFQ2 and 24HR. SFFQ was administered twice to explore reproducibility at 1 year.

Basque Autonomous Community.

Adults aged ≥21 years (n 99). The sample was randomly selected and representative of the target population.

For validity, statistically significant correlations were observed for more than half of the food groups, with the lowest correlations (r or ρ) for fat (–0·008) and the highest for other foods (0·963). The mean percentage of the subjects’ food intake that was classified into the same or adjacent quartile in both methods was 75·2 %. Reproducibility was explored by the correlation coefficient and ranged from 0·201 to 0·809, and 82·6 % of participants were in the same or adjacent quartile in both SFFQ. The associated variables did not seem to influence the validity and reproducibility of the SFFQ.

An adapted SFFQ presented good reproducibility and validity for measuring most food groups in the target population, and these results did not seem to be influenced by the associated variables.

To propose malnutrition screening methods for the elderly population using predictive multivariate models. Due to the greater risk of nutrition deficiencies in ageing populations, nutritional assessment of the elderly is necessary in primary health care.

This was a cross-sectional study. Multivariate models were obtained by means of discriminant analysis and binary logistic regression. The diagnostic accuracy of each multivariate model was determined and compared with the Chang method based on receiver operating characteristic curves. The optimal cut-point, sensitivity, specificity and Youden index were estimated for each of the models.

The province of Cordoba, Spain.

Two hundred fifty-five patients over the age of 65 years from three health centres and three nursing homes.

Fourteen models for predicting risk of malnutrition were obtained, six by discriminant multivariate analysis and eight by binary logistic regression. Sensitivity ranged from 55·6 to 93·1 % and specificity from 64·9 to 94 %. The maximum and minimum Youden indexes were 0·77 and 0·49, respectively. We finally selected a model which does not require a blood test.

The proposed models simplify nutritional assessment in the elderly and, except for number 2 of those calculated by binary logistic regression, have better diagnostic accuracy than the Spanish version of the Mini Nutritional Assessment screening tool. The selected model, whose validation is necessary for the future with other different samples, provides good diagnostic accuracy, and it can be performed by non-medical personnel, making it an accessible, easy and rapid tool in daily clinical practice.

To evaluate the performance of mid-upper arm circumference (MUAC) to identify thinness in the late adolescence period (aged 15–19 years) in Ethiopia.

We conducted a school-based cross-sectional study. The receiver operating characteristics curve was used to examine the validity of MUAC compared with BMI Z-score to identify adolescents with thinness (BMI Z-score <−2 sd).

Fifteen high schools (grade 9–12) located in Addis Ababa, Ethiopia.

A total of 851 adolescent (456 males and 395 females) were included in the study.

The prevalence of thinness and severe thinness among high-school adolescents in Addis Ababa was 9·5 % (95 % CI 7·7, 11·7 %). The overall AUC for MUAC against BMI Z-score <−2 SD was 0·91 (95 % CI 0·88, 0·93). The optimal MUAC cut-offs to identify thinness were 23·3 cm for males and 22·6 cm for females. These cut-off points give high sensitivity and specificity for both males (a sensitivity of 87·9 % and a specificity of 75·9 %) and females (a sensitivity of 100 % and a specificity 88·2 %).

MUAC has a comparable level of accuracy with BMI Z-score to identify thinness in adolescents aged 15–19 years. Hence, MUAC could be used as an alternative tool for surveillance and screening of thinness among adolescents aged 15–19 years. The optimum cut-off proposed by this study may incorrectly include a large number of adolescents when used in a relatively well-nourished population. In this situation, it would be necessary to choose a cut-off with greater positive predictive value.

The aim of this study was to assess body shape trajectories in childhood and midlife in relation to subsequent risk of breast cancer (BC) in a Mediterranean cohort.

The ‘Seguimiento Universidad de Navarra’ (SUN) Project is a dynamic prospective cohort study of university graduates initiated in 1999. With a group-based modelling approach, we assessed body shape trajectories from age 5 to 40 years. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for BC after the age of 40 years according to the body shape trajectory.

City of Pamplona, in the North of Spain.

6498 women with a mean age of 40 years (sd 9).

We identified four distinct body shape trajectories (‘childhood lean-midlife increase’ (19·9 %), ‘childhood medium-midlife stable’ (53 %), ‘childhood heavy-midlife stable’ (21 %) and ‘childhood heavy-midlife increase’ (6·1 %)). Among 54 978 women-years of follow-up, we confirmed eighty-two incident cases of BC. Women in the ‘childhood lean-midlife increase’ group showed a higher risk of BC (HR = 1·84, 95 % CI 1·11, 3·04) compared with women in the ‘childhood medium-midlife stable’ category. This association was stronger for postmenopausal BC (HR = 2·42, 95 % CI 1·07, 5·48).

Our results suggest a role for lifetime adiposity in breast carcinogenesis.

Our understanding of the nutrient contribution of fish and other aquatic species to human diets relies on nutrient composition data for a limited number of species. Yet particularly for nutritionally vulnerable aquatic food consumers, consumption includes a wide diversity of species whose nutrient composition data are disparate, poorly compiled or unknown.

To address the gap in understanding fish and other aquatic species’ nutrient composition data, we reviewed the literature with an emphasis on species of fish that are under-represented in global databases. We reviewed 164 articles containing 1370 entries of all available nutrient composition data (e.g. macronutrients, micronutrients and fatty acids) and heavy metals (e.g. Pb and Hg) for 515 species, including both inland and marine species of fish, as well as other aquatic species (e.g. crustaceans, molluscs, etc.) when those species were returned by our searches.

We highlight aquatic species that are particularly high in nutrients of global importance, including Fe, Zn, Ca, vitamin A and docosahexaenoic acid (DHA), and demonstrate that, in many cases, a serving can fill critical nutrient needs for pregnant and lactating women and young children.

By collating the available nutrient composition data on species of fish and other aquatic species, we provide a resource for fisheries and nutrition researchers, experts and practitioners to better understand these critical species and include them in fishery management as well as food-based programmes and policies.

The number of states in the USA that allows sales of raw milk for human consumption has been trending upwards and reached thirty-eight in 2016. These legislative changes could encourage raw milk consumption. The current study examined the determinants of weekly raw milk use by at-home meal preparers in the USA.

Using the 2014–2016 American Time Use Survey – Eating and Health Module, multivariate logit regressions and average marginal associations were estimated to examine how at-home meal preparer characteristics, time use and shopping choices, underlying health and the presence of at-risk individuals in households and raw milk legalisation status are associated with the probability an at-home meal preparer consumed or served raw milk during an average week.

USA.

At-home meal preparers aged 18 years and above.

Estimated average marginal associations suggested younger at-home meal preparers, male at-home meal preparers, larger sized households and households located in non-metropolitan areas were more likely to use raw milk during an average week. Married households and households with a person aged 62 years or above were less likely to use raw milk. Variables indicating health characteristics of at-home meal preparers or the presence of an at-risk individual in the household were not statistically significant.

There are many government-sponsored information resources about the risks of raw milk currently available. Additional education may be needed to prevent illnesses from raw milk.

Job-related chronic stress has been discussed as a risk factor for weight change and metabolic disorders. The current study was conducted to understand the situations in which stress-induced eating occurs among office workers and how workers perceive stress to influence their daily eating practices and weight change.

In-depth, one-on-one interviews were conducted with office workers.

Metropolitan areas in South Korea.

Twenty-two office workers from thirteen companies participated in the study.

Most participants mentioned that they often felt work-related stress and reported various levels of perceived stress, as measured with open-ended questions. The main sources of work stress were (i) the nature of job characteristics, (ii) performance evaluations and (iii) relationships within the organisation. Participants linked stress with increased food consumption and cravings for sweet, savoury and greasy foods. Many participants emphasised the links between multiple health behaviours and stress. Not only dietary choices but also alcohol consumption, sleeping difficulty and insufficient physical activity were related to coping with work stress and demands. Finally, most participants who perceived work stress believed that their weight gain in adulthood was triggered by work stress.

It is necessary to consider promoting behavioural modifications to support weight management and providing a means for stress management and the minimisation of stress-inducing working environments for workers to maintain or achieve a healthy weight and to prevent chronic disease incidence.

It is known that social isolation process has an impact on individuals’ eating behaviours. Continuing nutritional behaviour resulting from emotional eating, uncontrolled eating and cognitive restriction may turn into eating disorders in the future. The purpose of this study is to evaluate the possible effects of Corona Virus Disease-2019 (COVID-19) pandemic and social isolation process on individuals’ nutritional behaviours and body weight changes.

Retrospective cohort study.

Nutritional behaviours of the participants before the COVID-19 pandemic and in the social isolation process were evaluated with the Three Factor Nutrition Questionnaire. The changes in individuals’ body weight during this period were also evaluated.

A total of 1036 volunteer individuals (827 women, 209 men) aged 18 years and over participated in the study.

During the COVID-19 pandemic and social isolation process, there was an increase in emotional eating and uncontrolled eating behaviours of individuals, but no significant change in cognitive restriction behaviour occurred (P = <0·00; P = <0·00 and P = 0·53, respectively). It was reported that the body weight of 35 % of the individuals who participated in the study increased during this period.

Social isolation process practiced as a result of COVID-19 pandemic may lead to changes in some nutritional behaviours. Some precautions should be taken to prevent this situation that occurs in nutritional behaviours from causing negative health problems in the future.

To examine how food insecurity is related to emerging adults’ food behaviours and experiences of neighbourhood safety and discrimination and to identify resources needed to support their health during the COVID-19 outbreak.

Rapid response online survey. Participants completed the six-item US Household Food Security Survey Module, a brief measure of food insufficiency, and measures of food behaviours, neighbourhood safety and discrimination. Open-ended questions were used to assess changes in eating behaviours during COVID-19 and needed resources.

C-EAT (COVID-19 Eating and Activity over Time) study invitations were sent by email and text message to a longitudinal cohort.

A total of 218 emerging adults (mean age = 24·6 (sd 2·0) years, 70·2 % female) completed a survey in April–May 2020 during a stay-at-home order in Minnesota.

The past year prevalence of food insecurity was 28·4 %. Among food-insecure respondents, 41·0 % reported both eating less and experiencing hunger due to lack of money in the past month. Food-insecure respondents were less likely than those who were food secure to have fruits/vegetables at home and more likely to have frequent fast-food restaurant meals, feel unsafe in their neighbourhood and experience discrimination during the stay-at-home order. Food-insecure adults reported changes including eating more food prepared at home, eating more take-out restaurant meals and purchasing more energy-dense snacks as a result of events related to COVID-19. Resources most needed to support their health included eligibility for more food assistance and relief funds.

Food-insecure emerging adults experience many barriers to maintaining healthful eating patterns during COVID-19.

Food intolerances are commonly reported and are predicted to have gastrointestinal health implications. We aimed to quantify the prevalence of food intolerances among US adults and identify culprit foods through a brief web-based survey.

We invited participation in an online cross-sectional survey involving a single questionnaire. Data were summarised using percentages or medians and interquartile range. Participant characteristics by self-reported food intolerance were compared using the Wilcoxon rank sum test and Pearson’s χ2 test. Adjusted analyses were performed using multivariable logistic regression.

The survey was internet-based via Amazon’s mechanical Turk, a crowdsourcing website for the completion of requester directed tasks.

Adults who were US-based internet users were invited at ages 18–80.

We collected 2133 survey responses (ages 18–79 years). The rate of food intolerance was 24·8 % (95 % CI 23·0, 26·6) in US adults. Younger (P < 0·01), female (P = 0·05) and Asian, African American or multiple race individuals (P < 0·01) predominated. Lactose intolerance was most common. Frequency of a non-lactose food intolerance was 18·1 % (95 % CI 16·5, 19·8). When categorised broadly, grains, fruit, lactose, fish, vegetables, alcohol and nuts were most troublesome for individuals in that order.

Self-reported food intolerance is common in US internet users. The effect of food on gastrointestinal symptoms and avoidant behaviours deserves further attention.

Supplemental Nutrition Assistance Program (SNAP) benefits are rapidly depleted after distribution. This phenomenon, known as the benefit cycle, is associated with poor nutrition and health outcomes. However, to date, no study has evaluated trends in food expenditures before and after households receive benefits using prospective data, and whether these trends vary by household characteristics.

Generalised estimating equations were used to model weekly household food expenditures during baseline (pre-benefit) and intervention months by vendor (restaurants and food retailers). Food retailer expenditures were further evaluated by food category (fruits and vegetables and foods high in added sugar). All expenditures were evaluated by household composition, demographics and economic means.

Minneapolis-St. Paul, Minnesota, metropolitan area.

Low-income households (n 249) enrolled May 2013–August 2015.

Weekly food retailer expenditures did not vary during baseline (pre-benefit), but demonstrated a cyclical pattern after households received benefits across all household characteristics and for both food categories, particularly for fruits and vegetables. Households with greater economic resources spent more throughout the month compared with those with fewer resources. Households with lower food security status experienced more severe fluctuations in spending compared with more food secure households.

Cyclical food purchasing was observed broadly across different household characteristics and food categories, with notable differences by household economic means and food security status. Proposed SNAP policy changes designed to smooth food expenditures across the benefit month, such as increased frequency of benefit distribution, should include a focus on households with fewest resources.

Food delivery apps represent an important and emerging dimension of the digital food environment. This study aimed to examine food availability and the use of marketing strategies by two food delivery apps in a Brazilian metropolis.

An exploratory study was conducted in the city of Belo Horizonte, Minas Gerais. Food groups were identified and the use of price discounts and photos by the apps was observed.

Eighteen neighbourhoods and the ten best rated restaurants in each app.

Three hundred sixty-two commercial food establishments.

The proportion of ultra-processed beverages on offer in the apps (78·45 %) was much higher in comparison with water (48·89 %), natural juices or smoothies (27·07 %). Ultra-processed ready-to-eat meals represented almost 70 % of the food offered in the establishments’ menus, while traditional meals and vegetables represented just over 30 % of the offering. Ice cream, candies and salty packaged snacks were nine times more frequently presented than fruits. The use of photos and price discounts prevailed predominantly among ultra-processed beverages, sandwiches and ice cream, candies and salty packaged snacks. These marketing strategies were least used for promoting fruits and vegetables.

Restaurants registered on food delivery apps offered a significant amount of ultra-processed foods with price discounts and photos in comparison with unprocessed and minimally processed foods.

To develop and implement a community-tailored, food agency-based cooking programme at a community health centre (CHC) and evaluate the effect of the intervention on cooking confidence and food waste.

This study used an exploratory, sequential mixed methods design. Focus groups (n 38) were conducted to inform the development of a cooking intervention, then six cooking classes (n 45) were planned and piloted in the health centre’s teaching kitchen. Changes in cooking confidence and related outcomes were assessed using pre- and post-class surveys. Follow-up interviews (n 12) were conducted 2–4 months post-intervention to assess satisfaction and short-term outcomes.

A CHC in Detroit, MI.

Spanish- and English-speaking adults aged ≥18 years recruited at the CHC.

In the formative focus groups, patients identified multiple barriers to cooking healthy meals, including trade-offs between quality, cost and convenience of food, chronic disease management and lack of time and interest. Each cooking class introduced a variety of cooking techniques and food preservation strategies. Participants demonstrated increased confidence in cooking (P 0·004), experimenting with new ingredients (P 0·006) and knowing how to make use of food before it goes bad (P 0·017). In post-class interviews, participants reported that they valued the social interaction and participatory format and that they had used the recipes and cooking techniques at home.

A community-tailored, hands-on cooking class was an effective way to engage patients at a CHC and resulted in increased cooking confidence.

This study aimed to identify diets with improved nutrient quality and environmental impact within the boundaries of dietary practices.

We used Data Envelopment Analysis to benchmark diets for improved adherence to food-based dietary guidelines (FBDG). We then optimised these diets for dietary preferences, nutrient quality and environmental impact. Diets were evaluated using the Nutrient Rich Diet score (NRD15.3), diet-related greenhouse gas emission (GHGE) and a diet similarity index that quantified the proportion of food intake that remained similar as compared with the observed diet.

National dietary surveys of four European countries (Denmark, Czech Republic, Italy and France).

Approximately 6500 adults, aged 18–64 years.

When dietary preferences were prioritised, NRD15·3 was ~6 % higher, GHGE was ~4 % lower and ~85 % of food intake remained similar. This diet had higher amounts of fruit, vegetables and whole grains than the observed diet. When nutrient quality was prioritised, NRD15·3 was ~16 % higher, GHGE was ~3 % lower and ~72 % of food intake remained similar. This diet had higher amounts of legumes and fish and lower amounts of sweetened and alcoholic beverages. Finally, when environmental impact was prioritised, NRD15·3 was ~9 % higher, GHGE was ~21 % lower and ~73 % of food intake remained similar. In this diet, red and processed meat partly shifted to either eggs, poultry, fish or dairy.

Benchmark modelling can generate diets with improved adherence to FBDG within the boundaries of dietary practices, but fully maximising health and minimising GHGE cannot be achieved simultaneously.