Growth faltering is widespread in many low- and middle-income countries, but its effects on childhood bone mass accrual are unknown. The objective of this study was to estimate associations between length (conditional length-for-age z-scores, cLAZ) and weight (conditional weight-for-age z-scores, cWAZ) gain in 3 age intervals (ages 0-6, 6-12, 12-24 months) with dual-energy x-ray absorptiometry (DEXA)-derived measures of bone mass (total-body-less-head (TBLH) bone mineral content (BMC), areal bone mineral density (aBMD), and bone area) at 4 years of age.

Associations between interval-specific growth parameters (cLAZ and cWAZ) and bone outcomes were estimated using linear regression models, adjusted for maternal, child, and household characteristics.

Data collection occurred in Dhaka, Bangladesh.

599 healthy children enrolled in the BONe and mUScle Health in Kids Study.

cLAZ in each age interval was positively associated with TBLH BMC, aBMD, and bone area at 4 years; however, associations attenuated towards null upon adjustment for concurrent height-for-age z-scores (HAZ) at age 4 years and confounders. cWAZ from 0-6 and 6-12 months was not associated with bone mass, but every SD increase in cWAZ between 12-24 months was associated with greater BMC (7.6g; 95%CI:3.2, 12.0) and aBMD (0.008g/cm2; 95%CI:0.003, 0.014) after adjusting for concurrent WAZ, HAZ, and confounders.

Associations of linear growth (birth to 2 years) with bone mass at age 4 years were explained by concurrent HAZ. Weight gain in the second year of life may increase bone mass independently of linear growth in settings where growth faltering is common.

This study examined changes food and drink purchasing during the first three months of the COVID-19 pandemic in England, and if changes varied by population subgroups.

We investigated changes in take-home food and drink purchasing and frequency of out-of-home purchasing using an interrupted time series analysis design. The start of pandemic restrictions (the intervention) was defined as 16th March 2020, when first announced in the UK.

London and the North of England.

1,245 households reporting take-home and 226 individuals reporting out-of-home purchases between January 2019 and mid-June 2020 from the GB Kantar Fast Moving Consumer Goods Panel.

The marginal mean estimate of total take-home energy purchased was 17.4% (95% CI 14.9, 19.9) higher during the pandemic restriction period compared to the counterfactual. Increases of 35.2% (95% CI 23.4, 47.0) in take-home volume of alcoholic beverages and 1.2% (95% CI 0.1, 2.4) in foods and drinks high in fat, salt and sugar were observed. Reductions in purchased energy from fruit and vegetables (-7.3%, 95% CI -10.9, -3.6), ultra-processed foods (-4.0%, 95% CI -5.2, -2.8), and in out-of-home purchasing frequency (-44.0%, 95% CI -58.3, -29.6) were observed. Changes in chocolate and confectionery, soft drink and savoury snack purchases levelled off over time. Changes in all studied outcomes varied by sociodemographic characteristics and usual purchasing.

Pandemic restrictions were associated with positive and negative changes in food and drink purchasing, which differed by individual characteristics. Future research should ascertain if changes persist and translate into changes in health.

Child undernutrition among under 5 aged children is a prevalent global issue, especially in Bangladesh. This study aimed to explore relationships of household environmental conditions (HECs) with child under-nutrition in Bangladesh, with a specific focus on rural-urban differences.

We analysed children’s data from the 2017/18 Bangladesh Demographic Health Survey (BDHS). The outcome variable considered were measures of child under-nutrition, including stunting, wasting, and underweight. The major exposure variable considered was indicators of HECs. We used a hierarchical Poisson regression model to explore the association between outcomes and exposures adjusted for potential confounders.

Nationally representative cross-sectional survey.

8,057 under-5 aged children.

The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8% and 22%, respectively, with significant urban-rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1.17), exposed to household air pollution (HAP) (aPR: 1.37), had unimproved drinking water sources (aPR: 1.28), or had poor handwashing facilities (aPR: 1.24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, varying significantly across urban-rural areas.

The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs. Therefore, policies and programs aimed at reducing child undernutrition need to account for household environmental conditions, with a particular focus on children in poor household environments.

Orthorexia has been widely studied, but recently, a new conceptualisation was proposed to distinguish its healthy characteristics from its pathological ones. The objective of this study was to differentiate healthy orthorexia (HeOr) from orthorexia nervosa (OrNe) by exploring their sociodemographic, psychological, health, and dietary characteristics using comparative and correlational statistical methods.

Cross-sectional analysis. Participants completed an online, self-administered questionnaire assessing their sociodemographic characteristics, orthorexia, exercise dependence, personality, health anxiety, food choice motives, emotional competences, and eating disorders.

Data were collected between May 2021 and September 2022.

1,515 French females (meanage = 37.67). Responses from men were excluded.

While OrNe was mainly associated with weight control motives in food choices (r = .42), HeOr was more strongly correlated with natural content (r=.60) and health motives (r = .49). In relation to exercising, OrNe showed its highest association with weight control (r = 41). Health anxiety was more strongly associated with OrNe than with HeOr. Both OrNe and HeOr were related to diet adherence and regular exercise, but the association was stronger for the latter. Orthorexia scores, mainly OrNe, were higher in participants at the risk of eating disorders. Participants who were afraid to gain weight showed higher OrNe scores.

HeOr seems to be part of a healthy lifestyle in general. In contrast, OrNe falls into the category of an eating disorder and is associated with more problematic psychological functioning. Particular attention should be given to individuals who are beginning to control and reduce their food intake to prevent them from developing OrNe.

To investigate the association between food insecurity (FI) and diet quality in private sector service workers.

Data were collected via electronic questionnaires (2019) and the national register data (2018–2019). FI was measured using Household Food Insecurity Access Scale (HFIAS), and diet quality using a food frequency questionnaire and a modified Healthy Food Intake Index (mHFII). The associations between HFIAS and mHFII were studied using ANOVA and ordinal regression analysis.

Cross-sectional survey and register data for all municipalities in Finland in 2018 - 2019.

Individuals (n=6435) belonging to the Finnish Service Union United (PAM). The members are predominantly women and work mainly in retail trade, tourism, restaurant and leisure services, property maintenance, and security services.

Overall diet quality, measured by mHFII, was significantly lower in those experiencing severe FI than in those who were food secure (8.0 vs. 9.1). Additionally, those with severe FI were less likely to have higher (more optimal) scores in sugar-sweetened beverages (OR: 0.67), fibre-rich grains (OR: 0.79), vegetables (OR: 0.54), fruits and berries (OR: 0.61), vegetable oil (OR: 0.80), fish (OR: 0.65), milk (OR: 0.89), and nuts and seeds (OR: 0.66) than food-secure participants. Severe FI was associated with higher odds for less frequent consumption of red and processed meat (OR: 1.15, higher score represents less frequent consumption).

Severe FI was linked to both lower overall diet quality and suboptimal consumption of several food groups. Individuals experiencing severe FI may be predisposed to accumulating dietary risk factors for chronic diseases.

School-based interventions encouraging children to replace sugar-sweetened beverages (SSBs) with water show promise for reducing child overweight. However, students with child food insecurity (CFI) may not respond to nutrition interventions like children who are food-secure.

The Water First cluster randomized trial found that school water access and promotion prevented child overweight and increased water intake. This secondary analysis used mixed-effects regression to evaluate the interaction between the Water First intervention and food insecurity, measured using the Child Food Security Assessment, on child weight status (anthropometric measurements) and dietary intake (student 24-hour recalls).

Eighteen elementary schools (serving ≤ 50% children from low-income households), in which drinking water had not been previously promoted, in the San Francisco Bay Area.

Students in fourth-grade classes (n=1056).

Food insecurity interacted with the intervention. Among students with no CFI, the intervention group had a lower prevalence of obesity from baseline to 7 months (-0.04, confidence interval [CI] -0.08 to 0.01) compared to no CFI controls (0.01, CI -0.01 to 0.04) (p=0.04). Among students with high CFI, the intervention group had a pronounced increase in the volume of water consumed between baseline and 7 months (86.2%, CI 21.7 to 185.0%) compared to high CFI controls (-13.6%, CI -45.3 to 36.6%) (p=0.02).

Addressing food insecurity in the design of water promotion interventions may enhance the benefit to children, reducing the prevalence of obesity.

This study examined the relationship between reformulation and food price in Canadian packaged foods and beverages between 2017 and 2020.

Matched foods and beverages in the University of Toronto Food Label Information and Price 2017 and 2020 databases were analyzed (n=5774). Price change by food category and by retailer were compared using Wilcoxon signed-rank tests. The proportion of products with changes in calories and nutrient levels were determined and mixed-effects models were used to examine the relationship between reformulation and price changes. The Food Standards Australia New Zealand (FSANZ) nutrient profiling model was applied to calculate nutritional quality scores and mixed-effects models were used to assess if changes in nutritional quality score were associated with price changes.

Large grocery retailers by market share in Canada.

Foods and beverages available in 2017 and 2020.

Food price changes differed by retailer and by food category (e.g., increased in Bakery, Snacks etc; decreased in Beverages, Miscellaneous etc.). Nutrient reformulation was minimal and bidirectional with the highest proportion of products changing in sodium (17.8%; 8.4% increased and 9.4% decreased). The relationship between nutrient reformulation and price change was insignificant for all nutrients overall and was not consistent across food categories. Average FSANZ score did not change (7.5 in both years). For Legumes and Combination dishes, improvements in nutritional quality were associated with a price decrease and increase, respectively.

Stronger policies are required to incentivize reformulation in Canada. Results do not provide evidence of reformulation impacting food prices.

We aimed to analyze the evolving trends in macronutrient intake and dietary composition among Korean children and adolescents over a 10-year period.

We utilized cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) spanning the years 2010–2020. Overall, the study included 11,861 participants aged 6–18 years who completed the 24-h dietary recall survey. Subsequently, we assessed trends in energy consumption and macronutrient intake across population subgroups, including age, sex, and obesity status. Survey-weighted linear regression was employed to determine the beta coefficient and p-value for trends in dietary nutrient consumption, treating the survey year as a continuous variable.

KNHANES from 2010 to 2020.

11,861 children and adolescents aged 6–18 years.

Total energy intake significantly decreased across the 10-year survey period, with a corresponding decline in the percentage of energy intake from carbohydrates. Conversely, the proportion of energy intake from fat increased during the same period. Subgroup analysis revealed changes in the composition of energy intake across age, sex, and obesity status, with a consistent increase in total fat intake observed across all subgroups. Upon analyzing data on dietary fibers, total sugars, and fat subtypes intake, we found insufficient dietary fiber intake and increased intake of all fat subtypes.

This study underscores the gradually changing dietary intake patterns among Korean children and adolescents. Our findings revealed that these transitions in dietary nutrient consumption may pose potential risks of diet-related diseases in the future.

Over recent decades, the commercial ultra-processed food industry has grown, making snacks high in energy, added sugar, saturated fat and sodium affordable and accessible to consumers. Dietary patterns high in ultra-processed snacks are concerning as this can result in negative health outcomes. This study aims to provide insight on available snack products in South African supermarkets, and the marketing thereof, which can be used to support policy development aimed at improving the healthfulness of the food supply and consumption patterns.

This was an observational cross-sectional, mixed-method study.

Secondary data from six major supermarket chains (eight stores) in three different suburbs in Cape Town, South Africa was analysed to evaluate the nutritional composition of snack products (n=3837). The same eight supermarkets were revisited to obtain information on marketing via an observational checklist. Qualitative interviews were also conducted with store managers.

Majority (89%) of the products assessed either contained non-sugar sweeteners or were high in sugar, saturated fat, or sodium. These snack items that are high in nutrients of concern to limit were available at checkout areas in all stores, were found in high traffic areas and several in-store promotional strategies such as branded displays, special offers and combo-deals were commonly found.

The current South African supermarket environment encourages consumers to purchase unhealthy snacks. Most snacks assessed in this study cannot be recommended for regular consumption due to the nutritional composition being high in nutrients linked to poor health outcomes. There is a need for regulation of the in-store marketing of unhealthy snacks in South Africa. Retail settings are potential intervention points for limiting exposure to these unhealthy products.

The objective of our study was to determine the prevalence of anemia among 14-19 years school going girls, risk factors for it and profile of micronutrient status among rural girls from western state of India.

Using a cross-sectional design, we obtained information on socio-demography, menstruation, dietary habits, knowledge and daily consumption of the government recommended iron and folic acid (IFA) tablets, and anthropometry. Blood was collected to assess haemoglobin, red blood cell indices, serum iron, folate and vitamin B12 levels.

Nagpur district, Maharashtra, India

A total of 221 girls aged 14-19 years studying in 24 government institutes included.

57% girls were anaemic, 84% had deficiency of one or more micronutrients and 60% were malnourished based on Body Mass Index (BMI). The prevalence of iron, vitamin B12 and folate deficiency was 37.7%, 69.8% and 1.4% respectively. Among anaemic girls, iron and vitamin B12 deficiency was observed in 45.5% and 67.5% respectively, vs. among non-anaemic girls it was 27% and 73% respectively. Iron deficiency was a predictor of anaemia and its severity. Girls residing in non-nuclear family were more likely to have anaemia. The consumption of daily non-vegetarian food and green leafy vegetables was 3% and 3.6% respectively. Only 9% consumed IFA tablets in the past two weeks.

Anemia is common in adolescent girls, particularly associated with iron and vitamin B12 deficiency. There is need to reconsider the approach to prevention of anaemia in adolescent girls, particularly before they become pregnant.

To determine the associations among iron status, depressive/anxiety symptoms, and quality of life (QoL) throughout pregnancy.

This longitudinal study recruited participants in their 1st trimester (< 13 weeks; n=116) and followed in their 2nd (n=71) and 3rd (n=71) trimesters. Sociodemographic, food security, anxiety, depressive symptoms, and QoL questions were collected. Hemoglobin (Hb), ferritin (Ft), and transferrin saturation (TSAT) were determined. Women were categorized as iron improvers or non-improvers based on changes in iron status. Associations were assessed using difference-in-difference analyses.

Cape Coast, Ghana between October 2017 to September 2018.

Pregnant women, 18-38 years.

Improvement in Ft levels from the 1st to 2nd trimester were associated with reduced depressive symptoms (-2.96 vs -0.58, p=0.028), and higher overall QoL (13.99 vs 1.92, p=0.006) particularly role physical (23.32 vs -2.55, p=0.025) and role emotional (27.50 vs 10.06, p=0.025) subscales. Improvement in Hb levels during the same period were linked to less anxiety, particularly fear factor (-2.62 vs -0.51, p=0.020); and worsened physical health aspect of QoL (-21.80 vs -3.75, p=0.005). Improvement in TSAT levels from 2nd to 3rd trimester were associated with increased total anxiety (1.56 vs -0.64, p=0.030) and panic factor (0.45 vs -0.26, p=0.004) and decreased total QoL (-1.08 vs 7.94, p=0.017), specifically role physical (-10.98 vs 11.93, p=0.018).

Increases in iron status from first to second trimester were related to improvements in psychosocial wellbeing, implying potential benefit of iron supplementation on affect in early pregnancy. Larger studies are needed to confirm these findings.

Technological innovations in the online food delivery sector include the use of autonomous delivery vehicles. The aim of the present study was to investigate consumers’ intentions to use these services once they are widely available and their motivations for using them to access unhealthy food.

Online survey including a vignette describing a future world where autonomous food deliveries are in common use in both metropolitan and non-metropolitan areas.

Australia

1078 Australians aged 18 years and older, nationally representative by sex, age, and location (metropolitan versus non-metropolitan residence).

Around half of the sample reported intending to use an autonomous food delivery service at least once per week for fast food (53%) and/or healthy pre-prepared food (50%). Almost two-thirds (60%) intended using autonomous vehicle deliveries to receive groceries. Around one in five (17%) anticipated an increase in their fast food intake as a result of access to autonomous delivery services compared to one in two (46%) expecting others’ total fast food intake to increase. The most common reason provided for using autonomous food deliveries was increased convenience. More frequent current fast food ordering, higher socioeconomic status, younger age, and regional location were significantly associated with an anticipated increase in fast food consumption.

The emergence of autonomous food delivery systems may bring both benefits and adverse consequences that in combination are likely to constitute a substantial regulatory challenge. Proactive efforts will be required to avoid negative public health nutrition outcomes of this transport evolution.

This study examined drivers and barriers to iron and folic acid (IFA) supplementation and consumption of iron- and vitamin A-rich foods among women of reproductive age (WRA) and adolescent girls in Niger.

This was an exploratory qualitative study using focus group discussions and semi-structured interviews.

This study was conducted in the rural areas of three districts in Maradi and Zinder regions of southern Niger.

The study included a purposive sample of 56 WRA (15–49 years), 34 non-pregnant adolescent girls (10–14 years), 105 family members and community leaders, 32 health workers, and 12 national and regional level stakeholders.

Respondents demonstrated widespread knowledge of recommendations for IFA during pregnancy and had positive attitudes toward supplements. However, supply barriers were significant, and adherence was limited by side effects, among other constraints. Despite knowledge about and positive attitudes towards micronutrient source foods, respondents reported that limited food access was an overriding constraint to increasing consumption. WRA were seen as nutritionally vulnerable, however husbands were often not able to provide sufficient nutritious food and there was a cultural expectation that wives serve themselves food last. Adolescent girls were not seen as nutritionally vulnerable and there was little family support for their consumption of nutritious foods.

Projects should work with local actors to develop multi-pronged solutions that address supply and access barriers for IFA and micronutrient-rich foods and to improve social support for nutrition.

Evaluate knowledge and beliefs about dietary nitrate among United Kingdom (UK)-based adults.

An online questionnaire was administered to evaluate knowledge and beliefs about dietary nitrate. Overall knowledge of dietary nitrate was quantified using a 21-point Nitrate Knowledge Index. Responses were compared between sociodemographic groups.

UK.

A nationally representative sample of three hundred adults.

Only 19% of participants had heard of dietary nitrate prior to completing the questionnaire. Most participants (∼70%) were unsure about the effects of dietary nitrate on health parameters (e.g., blood pressure, cognitive function, cancer risk) or exercise performance. Most participants were unsure of the average population intake (78%) and acceptable daily intake (ADI) (83%) of nitrate. Knowledge of dietary sources of nitrate was generally low, with only ∼30% of participants correctly identifying foods with higher/lower nitrate contents. Almost none of the participants had deliberately purchased, or avoided purchasing, a food based around its nitrate content. Nitrate Knowledge Index scores were generally low (median[IQR]: 5[8]), but were significantly higher in individuals who were currently employed vs. unemployed (median[IQR]: 5[7]vs.4[7]; p<0.001), in those with previous nutrition education vs. no nutrition education (median[IQR]: 6[7]vs.4[8]; p=0.012), and in individuals who had heard of nitrate prior to completing the questionnaire vs. those who had not (median [IQR]: 9[8]vs.4[7]; p<0.001).

This study demonstrates low knowledge around dietary nitrate in UK-based adults. Greater education around dietary nitrate may be valuable to help individuals make more informed decisions about their consumption of this compound.

The high availability of energy-dense nutrient-poor discretionary foods in large serving and package sizes may have shifted portion size norms (described as a typical perception of how much people choose to eat from a given food at a single eating occasion) towards larger sizes. Few public health recommendations exist around appropriate discretionary food portion sizes. This qualitative study aimed to explore the underlying rationale of portion size norms of discretionary foods among Australian adults 18-65 years.

Four focus group sessions were conducted. Collected data were analysed using inductive thematic analysis.

Focus groups were held online via Zoom between September and October 2023.

Thirty-four participants were recruited in the study (mean age 38 years, 19 females).

The key themes raised from inductive analysis were personal factors, eating context factors, and food environment factors relevant to the portion size norms. A framework was established to illustrate the interaction across these themes during the conceptualisation of the norms. For serving size availability, consumers found that there were limited serving size choices when making portion size selections and lacked the knowledge and skills in portion control.

These findings highlight the need to make positive changes to the current food environment and develop relevant public health guidelines around appropriate portion sizes to promote healthier portion size norms and enable better portion control.

Māori, the Indigenous population of Aotearoa New Zealand, face a substantial burden of nutrition-related diseases, especially obesity and type 2 diabetes. Weight loss, through dietary change, is a central component of obesity and diabetes prevention and management; however, most approaches have not been designed with or evaluated specifically for Māori. The aim of this study was to review literature on the enablers and barriers to dietary change, for Māori.

Relevant literature published from January 2000 to May 2024 was identified by searches in Medline (Ovid), Embase (Ovid), Scopus, Indigenous health (informit), CINAHL (EBSCO), Web of Science and NZResearch. Studies included Māori and reflected enablers and barriers to dietary change for individuals/whānau (families). Data identifying the aims, methods, interventions, location, population studied and identified enablers and barriers to dietary change and responsiveness to Māori were extracted. Enablers and barriers to dietary change were mapped to a New Zealand indigenous health framework, the Meihana model.

Settings included studies based in Aotearoa New Zealand, where participants were free living and able to determine their dietary intake.

Studies included at least 30% Māori participants.

Twenty two of 77 identified records met the inclusion criteria. Records included a diverse range of research approaches.

Using a relevant Indigenous model, this study highlights that multiple and diverse enablers and barriers to dietary change exist for Māori and the critical importance of developing interventions, in close partnership with Indigenous communities, grounded in Indigenous understandings of health.

This study aims to determine differences in food consumption by the NOVA food categories in South Africa and Ghana and how they relate to poverty and food supply systems.

This study used a cross-sectional design to assess household food acquisition and lived poverty index.

The study was conducted in Khayelitsha and Mount Frere, urban and rural communities in South Africa, respectively, and Ahodwo and Ejuratia, urban and rural communities in Ghana, respectively.

An adult in charge of or knowledgeable about household food acquisition and consumption was selected to participate in the study.

A total of 1299 households participated in the study. Supermarkets were a prominent source of ultra-processed foods for households in South Africa, while informal outlets were an important source of ultra-processed foods in Ghana. Consumption of unprocessed foods was higher among South African households (58.2%) than Ghanaian households (41.8%). In South Africa, deprivation was associated with increased odds of infrequent consumption of both unprocessed foods (OR 3.431 p<0.001) and ultra-processed foods (OR 2.656 p<0.001) compared to non-deprivation. In Ghana, no significant associations were observed between household deprivation and consumption of the NOVA food classes.

Different food supply systems and poverty are associated with household acquisition of the different NOVA food classes. Policies should be geared towards formal shops in South Africa and informal shops in Ghana to reduce the consumption of key obesogenic foods.

This study develops successful ageing profiles across six low and middle-income countries (LMICs) and examines associations with fruit and vegetable (F&V) intake.

A cross-sectional analysis was conducted in mid-aged and older adults from the WHO Study of Global Ageing. Participants without chronic disease, cognitive impairment, depression or disability and with good physical, cardiovascular and respiratory function were considered to have successfully aged. Associations between F&V intake (serves/day) and successful ageing were examined using log-binomial regression adjusting for key confounders.

China, Ghana, India, Mexico, Russia and South Africa.

A total of 28785 men and women aged aged 50 years and over.

Successful ageing ranged from 4% in Mexico to 15% in China. After adjustment, only Ghana showed an association between fruit intake and successful ageing, with an inverse association identified (Prevalence Ratio [PR]=0.87, 95% Confidence Interval [CI]: 0.78-0.98). An inverse association between vegetable intake and successful ageing was found in China (0.97, 0.95-0.98) but no other country. An inverse association was shown for both China (0.98, 0.96-0.99) and Ghana (0.92, 0.84-1.00) when considering fruit and vegetables combined.

Associations between F&V intake and successful ageing are inconsistent. Further studies on LMIC countries are needed to meet the challenges of the ageing population.

To develop a web-based food frequency questionnaire (FFQ) measuring intake of plant-based protein foods (PBPs) among older adults from the province of Quebec, Canada.

The questionnaire was adapted from an existing self-administered FFQ and first underwent expert panel evaluation for face and content validity. Then, three phases of cognitive testing were conducted in French, using the probe and think aloud approaches. Between each phase, the questionnaire was modified based on participants’ feedback to improve the clarity and comprehension of the questions.

Quebec City, Quebec, Canada.

Twenty adults aged 65 years and older. Purposive sampling was used to maximize variation in sociodemographic characteristics, including gender, age, education level, and PBP consumption.

The expert panel found the 28-item questionnaire to be a comprehensive measure of PBP intake and suggested minor changes to improve its clarity. The cognitive interviews showed that our PBP-FFQ was generally well understood and identified issues requiring modifications to improve comprehension and accuracy.

Our FFQ provides a comprehensive measure of PBP intake, is well understood by older adults in Québec, and will support rigorous assessment of PBP intake in this population, but requires further validation to confirm validity and reproducibility.

To establish the prevalence of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among mother-child pairs in Malawi and explore their geographical distribution and associated multilevel factors.

Cross-sectional study using secondary data from the 2015-16 Malawi Demographic and Health Survey using a mixed effects binomial model to identify multilevel factors associated with DBM and TBM. Georeferenced covariates were used to map the predicted prevalence of DBM and TBM.

All 28 districts in Malawi.

Mother-child pairs with mothers aged 15 to 49 years and children aged below 59 months (n=4,618 pairs) for DBM and between 6 and 59 months (n=4,209 pairs) for TBM.

Approximately 5.5% [95% confidence interval (CI): 4.7%, 6.4%] of mother-child pairs had DBM and 3.1% [95% CI: 2.5%, 4.0%] had TBM. The subnational-level prevalence of DBM and TBM was highest in cities. The adjusted odds of DBM were threefold higher [Adjusted Odds Ratio, AOR: 2.8, 95% CI: 1.1, 7.3] with a higher proportion of wealthy households in a community. The adjusted odds of TBM were 60% lower [AOR: 0.4; 95% CI: 0.2, 0.8] among pairs where the women had some education compared to women with no education.

Although the prevalence of DBM and TBM is currently low in Malawi, it is more prevalent in pairs with women with no education and in relatively wealthier communities. Targeted interventions should address both maternal overnutrition and child undernutrition in cities and these demographics.