To examine the associations of individual and food environmental factors with fruit and vegetable (F&V) intake in a city in a low-to-middle-income country (LMIC).

Cross-sectional.

Representative sample of the Brazilian Primary Care service known as the Health Academy Program (HAP) in Belo Horizonte, a Brazilian city.

Using a conceptual model as a guide, individual and food environment data were obtained through: (i) face-to-face interviews with participants aged 20 years or older; and (ii) F&V food store audits. A broad set of individual, household, and community and consumer nutrition environment variables was investigated. Multilevel linear regression was used to quantify area-level variations in F&V intake and to estimate associations with the factors.

Eighteen HAP centres were selected and 2944 participants and 336 food stores were included. F&V intake varied between contexts, being higher in areas with better socio-economic conditions and food store quality, such as specialised F&V markets. Individual-level factors, including age, income, food insecurity, stage of change, self-efficacy and decisional balance, were significantly associated with F&V intake. After controlling for individual-level characteristics, greater F&V intake was also associated with higher quality of food stores.

In one of the first studies to comprehensively assess the food environment in an LMIC, individual-level factors accounted for the largest variation in F&V intake; however, the food environment was also important, because area-level variables explained 10·5 % of the F&V intake variation. The consumer nutrition environment was more predictive of healthy eating than was the community nutrition environment. The findings suggest new possibilities for interventions.

To compare thyroid-stimulating hormone (TSH) levels in neonatal cord blood between study sites in Bangladesh, Guatemala and the United States. Also, to compare neonatal TSH results with indicators of iodine deficiency in school children.

Consecutive births and, in school children, cross-sectional surveys.

Savar, Bangladesh; San Pedro Sacatepequez, Guatemala; and Atlanta, United States.

In each study site, cord blood was spotted on to filter paper and TSH levels determined using a sensitive monoclonal assay. In the USA, heel stick blood specimens from newborns spotted on to filter paper were also obtained as well as exposure to iodine-containing antiseptics during the birthing process. Urine specimens were collected from mothers of newborns and tested for iodine concentration. School children in the same areas were surveyed for thyroid size by palpation and ultrasonography, and urine specimens collected for iodine concentration.

Between 141 and 243 cord blood specimens were collected from each study site. The prevalence of elevated cord blood TSH levels (>5 mU l−1) was high in all study sites, from 58% to 84%. All sites would be categorised as having ‘severe’ iodine deficiency based on WHO/UNICEF/ICCIDD criteria. Iodine-containing antiseptics were used during 98% of the births in the USA but not in Bangladesh or Guatemala. The neonatal TSH classification indicated more severe iodine deficiency levels than classifications based on urinary iodine and goitre in school children.

In the USA, elevated TSH levels may be partially attributed to use of beta-iodine-containing antiseptics prior to birth. We recommend the cautious interpretation of TSH results in newborns for the assessment of iodine deficiency disorders when iodine-containing antiseptics are used during the birthing process.

To examine: (i) the association between home availability of fruit and vegetables and children's fruit and vegetable intake; (ii) the association between parental perception of the local food shopping environment and the home availability of fruit and vegetables; and (iii) whether the home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable consumption.

Cross-sectional study.

A total of ninety-one primary schools in the Netherlands.

In total 1501 primary caregivers completed a questionnaire to measure children's fruit and vegetable consumption, home availability of fruit and vegetables, parental perceptions of the local food shopping environment (price, quality and availability), the child's socio-economic status, the child's ethnicity and maternal height and weight.

The home availability of fruit and vegetables was positively associated with children's fruit and vegetable intake (P < 0·01 and P < 0·001, respectively). Negative parental perceptions of the local food shopping environment were associated with less fruit available at home (P < 0·05, P < 0·01 and P < 0·05 for price, quality and availability of fruit, respectively). No significant associations were found between parental perception of the local food shopping environment and children's fruit and vegetable consumption. We found no evidence that home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable intake.

Interventions focusing on improving the home availability of fruit and vegetables may help to increase children's fruit and vegetable consumption. However, more data are required on factors influencing the home availability of fruit and vegetables.

Colorectal cancer shows large incidence variations worldwide that have been attributed to different dietary factors. We conducted a meta-analysis on the relationship between garlic consumption and colorectal cancer risk.

We systematically reviewed publications obtained by searching ISI Web of Knowledge, MEDLINE and EMBASE literature databases. We extracted the risk estimate of the highest and the lowest reported categories of intake from each study and conducted meta-analysis using a random-effects model.

The pooled analysis of all fourteen studies, seven cohort and seven case–control, indicated that garlic consumption was not associated with colorectal cancer risk (OR=0·93; 95 % CI 0·82, 1·06, P=0·281; I2=83·6 %, P≤0·001). Separate analyses on the basis of cancer sites and sex also revealed no statistically significant effects on cancer risk. However, when separately analysed on the basis of study type, we found that garlic was associated with an approximately 37 % reduction in colorectal cancer risk in the case–control studies (combined risk estimate=0·63, 95 % CI 0·48, 0·82, P=0·001; I2=75·6 %, P≤0·001).

Our results suggest that consumption of garlic is not associated with a reduced colorectal cancer risk. Further investigations are necessary to clarify the discrepancy between results obtained from different types of epidemiological studies.

To assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts.

A modified Delphi study involving three rounds of questionnaires.

European Union.

Public health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries.

A total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study.

Competencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.

To identify and compare suggested food portion sizes in UK schemes.

The study collated and compared suggested portion sizes from selected UK schemes intended both for general advice and weight-loss advice.

Portion size schemes were included if they were relevant to the UK, provided actual portion size information, were intended for adults and were obtainable from the public domain in November 2010. Included schemes were from the food industry, non-governmental organisations and health-care professionals. Suggested portion sizes of foods occurring in at least one scheme for general advice and at least one scheme for weight loss were included. Own brand on-pack portion size labelling from a large UK-wide supermarket was added to represent portion size advice from UK food retailers.

Not applicable.

The suggested portion sizes in the weight-loss advice schemes were often concordant, as were the general advice schemes, except one general advice scheme from a non-governmental organisation which was more closely aligned with the portion sizes for weight loss. Overall there were substantial discrepancies between suggested portion sizes for muesli and crunchy breakfast cereals, rice, pasta and potatoes, meat, fish and pulses, whereas portion sizes for cooked vegetables, dried fruit, some breakfast cereals and cheese were broadly consistent.

There is a lack of consistency in the portion sizes communicated to the public. An independent and authoritative scheme of suggested portion sizes for all foods, with distinct recommendations for general advice and for weight-loss advice, could be of benefit.

The present study aimed to examine the association between household income and the intake of foods and nutrients by Japanese schoolchildren, and any differences between days with and without school lunch.

This was a cross-sectional study. Children, with the support of their parents, kept dietary records with photographs for 4 d (2 d with school lunch and 2 d without). The socio-economic status of each family was obtained from a questionnaire completed by the parents.

Japan.

All students in 5th grade (10–11 years old) at nineteen schools in four prefectures and their parents (1447 pairs of students and parents) were invited to take part in the study; 836 pairs of complete data sets were analysed.

The average results of four days of dietary records showed that lower income level was associated with a lower intake of fish/shellfish, green vegetables and sugar at the food group level, a lower intake of protein and several micronutrients, and a higher energy intake from carbohydrates at the nutrient level among the children. These associations between income and food/nutrient intake were not significant on days with school lunches, but were significant on days without school lunch.

Our study confirmed an association between household income and the amount of foods and nutrients consumed by Japanese schoolchildren, and suggested that school lunches play a role in reducing disparities in the diets of children from households with various incomes.

To assess the validity and reproducibility of a self-administered FFQ with eighty-two food items (FFQW82) for assessing the habitual diet in female adolescents.

The validity of the FFQW82 for assessment of nutrient intake was evaluated by comparison with a 7 d weighed food record (7d-FRRI) reported as ‘gold standard’. Reproducibility of the FFQW82 was assessed at an interval of 1 month (test–retest method). The first survey (FFQW82 and 7d-FRRI) was conducted in April 2007 and the second FFQW82 survey was conducted in May 2007. Daily consumption of energy from eleven food groups and nine nutrients were calculated from both instruments for breakfast, lunch, dinner and the whole day. Crude and energy-adjusted Pearson correlation coefficients were calculated using log-transformed data.

Middle school, Tokyo, Japan.

Female adolescents aged 12–13 years.

Sixty-three female adolescents completed both surveys. The relative difference between the energy intake calculated by the FFQW82 and the 7d-FRRI for the whole day, breakfast, lunch and dinner was 8 %, 10 %, 15 % and 10 %, respectively. As for validity, the correlation coefficient of total energy intake for the whole day was 0·31. The result for breakfast was relatively higher (0·59) compared with that for lunch (0·40) and dinner (0·32). For macronutrients, the energy-adjusted correlation coefficient ranged from 0·28 (carbohydrates) to 0·53 (protein). Reproducibility of total energy intake was 0·62 and ranged from 0·46 (fat) to 0·69 (carbohydrate) for macronutrients.

These results suggest that the FFQW82 has proved to have some potential with regard to reproducibility among our study population.

To evaluate changes in ultra-processed food (UPF) intake and its major correlates during the first Italian lockdown (9 March–3 May 2020).

Retrospective observational study.

Italy.

We analysed 2992 subjects (mean age 57·9 ± 15·3 years, 40·4 % men). Individual participant data were pooled from two retrospective cohorts: (1) The Moli-LOCK cohort consists of 1501 adults, a portion of the larger Moli-sani study (n 24 325; 2005–2010) who were administered a phone-based questionnaire to assess lifestyles and psychological factors during confinement and (2) the Analysis of Long Term Risk of Covid-19 Emergency is a web-based survey of 1491 individuals distributed throughout Italy who self-responded to the same questionnaire by using Google forms.

UPF was defined according to NOVA classification based on degree of food processing. An UPF score was created by assigning 1 point to increased consumption, −1 to decreased and 0 point for unchanged intakes of nineteen food items, with higher values indicating an increase in UPF during confinement.

Overall, 37·5 % of the population reported some increase in UPF (UPF score ≥1). Adults were more likely to decrease UPF (multivariable regression coefficient β = −1·94; 95 % CI −2·72, −1·17 for individuals aged >75 years as compared with 18–39 years) as did individuals from southern Italian regions as compared with Northern inhabitants (β = −1·32; 95 % CI −1·80, −0·84), while UPF lowering associated with increased exercise (β = −0·90; 95 % CI −1·46, −0·35) and weight loss (β = −1·05; 95 % CI −1·51, −0·59) during confinement.

During the first Italian lockdown, about 40 % of our population switched to unfavourable eating as reflected by increased UPF intake and this may have long-term effects for health.

Children from low-income countries consuming predominantly plant-based diets but little animal products are considered to be at risk of Fe deficiency. The present study determined the Fe status of children from resource-limited rural households.

A cross-sectional study.

Twenty six kebeles (the smallest administrative unit) from six zones of the Amhara region, Ethiopia.

Children aged 54–60 months (n 628).

Grain, roots or tubers were the main dietary components consumed by 100 % of the study participants, followed by pulses, legumes or nuts (66·6 %). Consumption of fruit and vegetables (19·3 %) and meat, poultry and fish (2·2 %) was low. Children had a mean dietary diversity score of 2·1 (sd 0·8). Most children (74·8 %, n 470) were in the lowest dietary diversity group (1–2 food groups). Rate of any morbidity in the preceding 14 d was 22·9 % (n 114). Infection or inflammation (α1-acid glycoprotein >1·2 g/l) was present in 30·2 % (n 184) of children. Children had a high rate of stunting (43·2 %). Of the total sample, 13·6 % (n 82) of children were anaemic, 9·1 % (n 57) were Fe deficient and 5·3 % (n 32) had Fe-deficiency anaemia. Fe-deficiency erythropoiesis was present in 14·2 % (n 60) of children.

Despite consuming a predominantly plant-based diet and little animal-source foods, there was a low prevalence of Fe-deficiency anaemia. This illustrates that dietary patterns can be inharmonious with Fe biochemical status; thus, Fe-related interventions require biochemical screening.

This paper describes the development of an online questionnaire for testing nutrition professionals' perceptions of the ‘healthiness’ of individual foods and the results of administering that questionnaire. The questionnaire was designed to produce a standard ranking of foods that can be used as a tool for testing nutrient profile models.

The questionnaire asked respondents to categorise 40 foods (from a master list of 120) in one of six positions, ranging from less to more healthy. The 120 foods were selected to be representative of the British diet. The questionnaire was sent via email to nutrition professionals from the British Dietetic Association and the (British) Nutrition Society.

Eight hundred and fifty responses were received. These responses were used to rank the 120 foods by the average score which they received from the nutrition professionals. A regression analysis was also carried out to examine the relationship between the scores awarded by the nutrition professionals and various features of the foods: their nutritional content, their average serving size, their frequency of consumption, whether they were drinks or foods, etc. Nearly 50% of the variance in the average scores was explained by the nutritional content of the foods. When other variables were included in the analysis the percentage of variance that was explained increased to 64%.

The average scores of the foods produce a standard ranking, which can be used as a tool for validating and comparing nutrient profile models. The regression analysis provides some information about how nutrition professionals rank the ‘healthiness’ of individual foods.

Little is known about adolescents’ non-core food intake in the UK and the eating context in which they consume non-core foods. The present study aimed to describe types of non-core foods consumed by British adolescents in total and across different eating contexts.

A descriptive analysis, using cross-sectional data from food diaries. Non-core foods were classified based on cut-off points of fat and sugar from the Australian Guide to Healthy Eating. Eating context was defined as ‘where’ and ‘with whom’ adolescents consumed each food. Percentages of non-core energy were calculated for each food group in total and across eating contexts. A combined ranking was then created to account for each food’s contribution to non-core energy intake and its popularity of consumption (percentage of consumers).

The UK National Diet and Nutrition Survey 2008–2011.

Adolescents across the UK aged 11–18 years (n 666).

Non-core food comprised 39·5 % of total energy intake and was mostly ‘Regular soft drinks’, ‘Crisps & savoury snacks’, ‘Chips & potato products’, ‘Chocolate’ and ‘Biscuits’. Adolescents ate 57·0 % and 51·3 % of non-core food at ‘Eateries’ or with ‘Friends’, compared with 33·2 % and 32·1 % at ‘Home’ or with ‘Parents’. Persistent foods consumed across eating contexts were ‘Regular soft drinks’ and ‘Chips & potato products’.

Regular soft drinks contribute the most energy and are the most popular non-core food consumed by adolescents regardless of context, and represent a good target for interventions to reduce non-core food consumption.

To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.

Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.

United Kingdom.

2551 participants (aged 18–64 years); sub-sample (n 1949) used to investigate association between FI and overweight.

FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).

FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.

To assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.

Pre–post evaluation between two surveys.

Twenty-four villages in West Java.

Poor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baseline n 324/endline n 349), their infants aged 6–11 months (n 318/n 335) and children aged 12–59 months (n 469/477), and cohorts of children aged 5–9 years (n 186) and women aged 15–29 years (n 171), alongside food and oil consumption from dietary recall.

Fortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12–23 months, 24–59 months, 5–9 years, lactating and non-lactating women, respectively. Serum retinol was 2–19 % higher at endline than baseline (P<0·001 in infants aged 6–11 months, children aged 5–9 years, lactating and non-lactating women; non-significant in children aged 12–23 months; P=0·057 in children aged 24–59 months). Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 μg/dl) was 6·5–18 % across groups at baseline, and 0·6–6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6–59 months (P=0·003) and 5–9 years (P=0·03).

Although this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.

To examine snacking patterns, food sources and nutrient profiles of snacks in low- and middle-income Chilean children and adolescents.

Cross-sectional. Dietary data were collected via 24 h food recalls. We determined the proportion of snackers, snacks per day and energy from top food and beverage groups consumed. We compared the nutrient profile (energy, sodium, total sugars and saturated fat) of snacks v. meals.

South-east region of Chile.

Children and adolescents from two cohorts: the Food Environment Chilean Cohort (n 958, 4–6 years old) and the Growth and Obesity Cohort Study (n 752, 12–14 years old).

With a mean of 2·30 (se 0·03) snacks consumed daily, 95·2 % of children and 89·9 % of adolescents reported at least one snacking event. Snacks contributed on average 1506 kJ/d (360 kcal/d) in snacking children and 2218 kJ/d (530 kcal/d) in snacking adolescents (29·0 and 27·4 % daily energy contribution, respectively). Grain-based desserts, salty snacks, other sweets and desserts, dairy foods and cereal-based foods contributed the most energy from snacks in the overall sample. For meals, cereal-based foods, dairy beverages, meat and meat substitutes, oils and fats, and fruits and vegetables were the top energy contributors.

Widespread snacking among Chilean youth provides over a quarter of their daily energy and includes foods generally considered high in energy, saturated fat, sodium and/or total sugars. Future research should explore whether snacking behaviours change as the result of Chile’s national regulations on food marketing, labelling and school environments.

To analyse the association between food consumption according to the degree of processing and incidence of hypertension in CUME project participants.

Longitudinal study in which food consumption was evaluated according to the percentage contribution of daily energetic intake (%/d) of each NOVA classification group (unprocessed/minimally processed foods and culinary preparations (U/MPF&CP); processed foods and ultra-processed foods (UPF)). Hypertension was defined according to American College of Cardiology/American Heart Association (ACC/AHA) criteria. Adjusted relative risks (RR) and their 95% confidence intervals (95 % CI) were estimated by Poisson regression models with robust variances.

Brazil.

1221 graduates classified as non-hypertensive at baseline and monitored for 2 years.

Daily energetic percentage from each group according to degree of processing was 64·3 (sd 12) % for U/MPF&CP; 9·9 (sd 5·8) % for processed foods and 25·8 (sd 11) % for UPF. Incidence of hypertension was high (152/1000 person-years; n 113, 193/1000 person-years in males and n 257, 138/1000 person-years in females). After adjusting for potential confounders, participants in the upper quintile of daily energetic intake of U/MPF&CP presented a reduced risk of hypertension (RR: 0·72; 95 % CI 0·52, 0·98), while those in the upper quintile of daily energetic intake of UPF presented an increased risk of the outcome (RR: 1·35; 95 % CI 1·01, 1·81).

In this prospective cohort of Brazilian middle-aged adult university graduates, the highest consumptions of U/MPF&CP and UPF were associated with, respectively, reduced and increased risk of hypertension. Additional longitudinal studies are needed to confirm our results.

To determine whether the Mini Nutritional Assessment (MNA) can screen and diagnose for malnutrition in the Iranian elderly.

The MNA was administered to all volunteers. Each patient underwent anthropometric and serum albumin measurements. Reliability, validity, sensitivity, specificity, positive- and negative-predictive values were estimated. To identify optimal threshold values for predicting malnutrition, receiver-operating characteristic curve analysis was performed for MNA scores.

Kahrizak Charity Foundation (Tehran, Iran).

Two hundred and twenty-one consecutive elderly patients entered into the cross-sectional study. Amputees and patients with liver or renal disorders, oedema or any end-stage diseases were excluded.

According to MNA score, 3·2 % were malnourished, 43·4 % were at risk of malnutrition and 53·4 % were well nourished. The proportions in these categories according to ideal body weight and serum albumin were 2·3 %, 17·1 % and 80·6 %, respectively. Cronbach’s α coefficient (reliability) was 0·61. The correlations between total MNA score, anthropometric values and serum albumin (criterion-related validity) were all significant. There were significant differences in total MNA score between two BMI groups but not between two categories according to serum albumin and skin ulcers (construct validity). The sensitivity and specificity of the MNA according to its established cut-off points were 82 % and 63 %, respectively. Positive-predictive value was 35 % and negative-predictive value was 93 %. By using the best cut-off point (MNA score of 22 according to Youden index), the sensitivity, specificity, positive-predictive value and negative-predictive value were 88 %, 62 %, 57 % and 89 %, respectively.

The MNA with its established cut-off points may not be a good fit for Asian populations, including Iranian elderly.