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.

To evaluate the application of front-of-package (FOP) labelling regulations to menu labelling in the Canadian restaurant sector by assessing the proportion of menu items that would be required to display the ‘high-in’ FOP symbol if the policy were extended to the restaurant sector.

Nutrition information of 18,760 menu items were collected from 141 chain restaurants in Canada. Menu items were evaluated using the mandatory FOP labelling regulations promulgated in Canada Gazette II by Health Canada in July of 2022.

Chain restaurants with ≥20 establishments in Canada.

Canadian chain restaurant menu items including beverages, desserts, entrées, sides, and starters.

Overall, 77% of menu items in the Canadian restaurant sector would display a ‘high-in’ FOP symbol. Among these menu items, 43% would display ‘high-in’ one nutrient, 54% would display ‘high-in’ two, and 3% would display ‘high-in’ all three nutrients-of-concern. By nutrient, 52% were ‘high-in’ sodium, and 24% and 47% were ‘high-in’ total sugars and saturated fat, respectively.

Given the poor nutritional quality of restaurant foods, the current regulations, if applied to restaurant foods, would result in most menu items displaying a FOP symbol. Therefore, expanding the Canadian FOP labelling regulations to the restaurant sector can be key to ensuring a healthy food environment for Canadians. Furthermore, menu labelling along with other multi-faceted approaches such as reformulation targets are necessary to improve the dietary intake of Canadians from restaurant foods.

This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African–PREDICT) study according to ethnicity and socioeconomic status (SES).

Cross–sectional analysis of baseline nutrient intakes in the African–PREDICT study.

North West Province, South Africa

Black and white adults (n=1153), aged 20–30 years, were classified into three SES groups. Dietary data were collected using three multiple–pass 24–hour dietary recalls.

Among all participants, over 70% failed to meet the Estimated Energy Requirements and the Estimated Average Requirements (EAR) for 17 of the 19 reported micronutrients. Across SES groups, more than 50% of participants consistently did not meet the EAR for calcium, magnesium, folate, pantothenic acid, and biotin, as well as vitamins A, C, D, and E. Participants’ distribution by nutrient pattern tertiles showed high adherence to two patterns: one rich in animal protein and saturated fat, and the other in magnesium, potassium, calcium, phosphorus, and fiber. This was seen only in white participants and high SES. Black participants and low SES showed higher adherence to a plant protein, B-vitamins, zinc, and iron nutrient pattern.

The dietary intake of young adults in this study was restricted, with none of the groups meeting nutrient requirements for essential nutrients. Further research is needed to establish a direct link between nutrient patterns and the early detection and identification of cardiovascular diseases and hypertension.

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.

This study aimed to measure urinary sodium and potassium as a measure of sodium and potassium intake concerning the knowledge, attitude, and practice (KAP) toward sodium intake among a group of healthy residents in the UAE.

A cross-sectional study on a sample of healthy adults in the UAE. In addition to the KAP questionnaire, sodium and potassium excretions, and food records were taken.

The United Arab Emirates

A sample of 190 healthy individuals aged between 20-60 years.

The mean (± SD) age of the sample was 38.6 (± 12.5) years and 50.5% were females. The mean urinary sodium and potassium intake were 2816.2± 675.7 mg /day and 2533.3± 615 mg/day, respectively. The means were significantly different compared to the World Health Organization (WHO) recommendation of sodium and potassium, (p < 0.001). About 65% of the participants exceeded the WHO recommendations for salt intake, and participants’ knowledge classification for health-related issues was fair while food-related knowledge was poor (P=0.001). A two-stage stepwise multiple regression analysis revealed that KAP scores were negatively associated with urinary sodium excretion (r = -0.174; p = 0.017) and those older participants and females had lower urinary sodium excretion (p<0.001).

These findings may suggest an increase in the risk of hypertension in the UAE population. Moreover, these findings emphasize the need to establish education and public awareness programs focusing on identifying the sodium contents of foods and establishing national regulations regarding food reformulation, particularly for staple foods such as bread.

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.

To assess the availability and marketing of ultra-processed foods (UPFs) in modern retail food outlets (supermarkets and minimarts) in Kenya and associated factors.

This cross-sectional study was conducted in Kenya from August 2021 to October 2021. Variables included; the geographic location and the socioeconomic status levels (SES), the food items displayed for sale and advertised in the stores, and locations in the stores such as the entrance.

Three counties in Kenya (Nairobi - urban, Mombasa - coastal tourist, and Baringo- rural). Each county was stratified into high and low SES using national poverty indices.

Food outlets that offered a self-service, had at least one check-out, and had a minimum of two stocked aisles were assessed.

Of 115 outlets assessed, UPFs occupied 33% of the cumulative shelf space. UPFs were the most advertised foods (60%) and constituted 40% of foods available for sale. The most commonly used promotional characters were cartoon characters (18%). UPFs were significantly more available for sale in Mombasa (urban) compared to Baringo (rural) (Adjusted prevalence rate ratios (APRR): 1.13, 95% confidence interval (CI): 1.00-1.26, p=0.005). UPFs advertisements were significantly higher in Mombasa ((APRR): 2.18: 1.26-3.79, p= 0.005) compared to Baringo and Nairobi counties. There was a significantly higher rate of advertisement of UPFs in larger outlets ((APRR): 1.68: 1.06-2.67 p=0.001) compared to smaller outlets.

The high marketing and availability of UPFs in modern retail outlets in Kenya calls for policies regulating unhealthy food advertisements in different settings in the country.

This study aimed to assess the association between emotional attitudes toward diabetes, eating behavior styles, and glycemic control in outpatients with type 2 diabetes.

Observational study.

Endocrinology Division of Hospital de Clínicas de Porto Alegre, Brazil.

91 outpatients diagnosed with type 2 diabetes. Baseline assessments included data on clinical parameters, lifestyle factors, laboratory results, eating behavior styles, and emotional attitudes. All patients received nutritional counseling following diabetes recommendations. A follow-up visit was scheduled approximately 90 days later to evaluate changes in weight, medication dosages, and glycated hemoglobin values. Patients were categorized based on their emotional attitude scores towards diabetes (positive or negative), and their characteristics were compared using appropriate statistical tests.

At baseline, no differences were observed in the proportion of patients with good glycemic control, eating behavior styles, and emotional attitudes. However, patients with a positive attitude towards the disease exhibited a significantly better response in glycemic control compared to the reference group (OR=3.47; 95%CI=1.12-10.75), after adjusting for diabetes duration, sex, and medication effect score. However, when BMI was included in the model, the association did not reach statistical significance. Therefore, these results should be interpreted with caution.

Patients with a positive attitude towards diabetes showed a greater reduction in glycated hemoglobin levels following nutritional counseling. However, baseline BMI could be a potential confounding factor.

Provide an in-depth examination of consumers’ food safety beliefs and practices to draw implications for interventions to improve nutrition and food safety in Ethiopia.

Adapted Focused Ethnographic Study approach using in-person semi-structured interviews and free-listing exercises, in two iterative phases.

A traditional food market in Hawassa, a mid-sized city.

Forty-six market shoppers, selected randomly in line with quotas for age and gender.

Consumers did not clearly differentiate between quality and safety, seeing them through connected concepts such as ‘freshness’. While most respondents had some understanding of the causes of unsafe food, they did not generally worry about becoming ill themselves and felt food safety risks were easily mitigated through in-home behaviors. Thus, food safety practices were not a main motivator of market or vendor choice. There was no evidence that food safety concerns led consumers to prefer packaged, processed food or to avoid consuming fresh foods.

Discussion: The study offers novel depth and detail on a topic of strong policy relevance. While building on an encouraging base of understanding of food safety, there remains considerable scope for increasing knowledge, particularly with regards to the need to procure safe food as opposed to expecting household-level practices to mitigate all safety risks. Motivating customers to give food safety factors more consideration when making food purchasing decisions, such as by leveraging emotion-based communication from trusted messengers to elevate the issue’s salience in their minds, may contribute to improvements in food safety in low-income countries such as Ethiopia.

(1) To develop a new regression equation for estimating fat mass percentage (%FM) from anthropometric measurements in a heterogeneous Caucasian population and (2) to compare it with the Durnin and Womersley equation, which is one of the most used anthropometric equations for fat mass assessment.

Body mass, stature, and four skinfolds (biceps, triceps, subscapular, and supracrestal) were assessed by an accredited anthropometrist, according to the International Society for Advancement in Kinanthropometry. Participants completed a dual-energy X-ray absorptiometry (DXA) whole-body scan to determine their %FM. A new anthropometric equation to estimate %FM was developed using multiple forward regression analyses with DXA as the reference method. Tests for the accuracy of the different equations included mean differences, coefficient of determination, standard error of the estimate (SEE), concordance correlation coefficient (CCC), and Bland–Altman plots.

Spain.

Two hundred and eighteen healthy Caucasian participants aged 18–65 years participated in this cross-sectional study.

Our proposed equation explained 89.9% of the variance in the DXA-derived %FM, with a low random error (SEE = 3.00%), a very strong agreement (CCC = 0.93), no fixed or proportional bias, and a relatively low individual variability (5.84%). However, the Durnin and Womersley equations obtained a fixed bias of –3.65% when compared to DXA and a greater individual variability (6.74%).

The proposed equation can accurately estimate %FM in a heterogeneous Caucasian population with a wide age range (18–65 years). Additionally, the Durnin and Womersley equation was inadequate when applied to our participants.

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.

While many Asian countries undergo dietary transitions, little is known about Japan’s dietary pattern changes and their impact on nutritional intake. We aimed to examine 17-year trends in dietary patterns and nutrient intakes in Japan.

Principal component analysis was used to derive dietary patterns. The nutrient intake of subjects with principal component scores in the highest quartiles of each dietary pattern was assessed using the NRF9.3 which is a scale that evaluates the entire diet in terms of nutrient density.

Japan.

We used data from the National Survey 2003–2019 (67,066 women, 55,133 men).

Two common dietary patterns were identified in both sexes: the ‘Japanese style’ and the ‘bread and dairy’ pattern. Additionally, two other patterns: ‘meat and oil’ and ‘noodles’, were pronounced in men. Over the 17 years, the scores of the ‘Japanese style’ pattern decreased while the ‘meat and oil’ and the ‘bread and dairy’ patterns increased. The nutrition assessment result showed that the highest quartiles of the ‘Japanese style’ pattern had higher NRF scores (women: 716.0, men: 670.5) (p<0.001), whereas those of the ‘bread and dairy’ pattern had a lower score (636.9 in women, 661.2 in men) (p<0.001).

Trend analysis in this study suggests the ongoing Westernization of diet in Japan. A decreasing trend of the dietary pattern with the most preferable nutrient profile (i.e., the ‘Japanese style’) might indicate a potential decrease in beneficial nutrient intake and, thus, a deterioration of the nutritional status of the Japanese population.

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.

SEANUTS II Vietnam aims to obtain an in-depth understanding of the nutritional status and nutrient intake of children between 0.5-11.9 years old

Cross-sectional survey

A multistage cluster systematic random sampling method was implemented in different regions in Vietnam: North Mountainous, Central Highlands, Red River Delta, North Central and Coastal Area, Southeast and Mekong River Delta.

4001 children between 6 months and 11.9 years of age

Prevalence of stunting and underweight was higher in rural than in urban children, whereas overweight and obese rates were higher in urban areas. 12.0% of the children had anemia and especially children 0.5-1-year-old were affected (38.6%). Low serum retinol was found in 6.2% of children ≥ 4 years old. Prevalence of vitamin D insufficiency was 31.1% while 60.8% had low serum zinc. For nutrient intake, overall, 80.1% of the children did not meet the estimated energy requirements. For calcium intake, ∼60% of the younger children did not meet the RNI while it was 92.6% in children >7 years old. For vitamin D intake, 95.0% of the children did not meet RNI.

SEANUTS II Vietnam indicated that overnutrition was more prevalent than undernutrition in urban areas, while undernutrition was found more in rural areas. The high prevalence of low serum zinc, vitamin D insufficiency and the inadequate intakes of calcium and vitamin D are of concern. Nutrition strategies for Vietnamese children should consider three sides of malnutrition and focus on approaches for the prevention malnutrition.