Evaluation of California Department of Public Health’s three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen’s social marketing framework was used to outline the development and evaluation of the campaign.

Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers’ fruit and vegetable (FV) consumption and facilitative actions towards their children’s health behaviours.

CalFresh Healthy Living (California’s SNAP-Ed).

Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18–59) self-identified as White, Latina, African American or Asian/Pacific Islander participated.

Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers’ FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children’s FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0·1 to 0·7).

The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California’s Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.

Limited research is available on how motivations to adopt plant-based diets and nutrition literacy influence diet quality. This study assessed diet quality, diet motives and nutrition literacy in vegans, vegetarians and semi-vegetarians and investigated predictors of dietary quality.

Cross-sectional study, participants completed an online survey about diet-related motives and nutrition literacy. Dietary intake was assessed with the Diet History Questionnaire III, and diet quality was calculated with the Healthy Eating Index (HEI)-2015. A one-way ANCOVA was used to compare diet quality, nutrition literacy and diet motives among diets. Hierarchical regression analysis was performed to identify significant predictors of diet quality.

Online survey, participants were recruited through paid targeted social media (Facebook/Instagram) advertising.

Adults following a plant-based diet, including 117 (52·5 %) vegans, 51 (22·9 %) vegetarians and 55 (24·6 %) semi-vegetarians.

Vegans had higher HEI-2015 scores (80·8 (sd 6·5), P < 0·001) compared to vegetarians (75·1 (sd 9·1)) and semi-vegetarians (76·8 (sd 7·5)). Most participants (74 %) had good nutrition literacy scores. Total nutrition literacy did not differ between groups, but vegans had higher vegetarian nutrition literacy than vegetarians and semi-vegetarians (P < 0·001). Ecological welfare, health and sensory appeal were highly important to all participants. Motives accounted for 12·8 % of the variance in diet quality scores. HEI-2015 scores were positively associated with motives of health and natural content, but negatively associated with weight control motivation (all P < 0·05).

Individuals following plant-based dietary patterns have high diet quality and nutrition literacy. Messages valuing intrinsic over extrinsic factors may facilitate healthier dietary adherence in this population.

Night shift workers are at a 20 to 40 % increased risk of metabolic diseases, which may be associated with their disrupted eating patterns. This qualitative study explores factors that influence night shift workers’ eating habits, within and outside of the workplace, to identify target areas for health promotion strategies.

Eligible participants resided in Australia, working at least three overnight shifts per month.

The photovoice method was used, whereby participants were asked to take photos that represent their typical eating habits. These photos were incorporated as prompts in a semi-structured interview, which explored factors influencing eating habits on night shifts and days-off and perceptions and enablers to healthy eating.

Ten participants completed the study. Thematic analysis generated four main themes, which were mapped onto the Social Ecological Model (SE Model). Aligned with the SE Model, our results show night shift workers’ eating habits are influenced by intrapersonal, interpersonal and (work) organisational levels. Participants reported that at work, appropriate food preparation facilities are required to enable healthy food choices. Poor shift work rostering leads to prolonged fatigue on days-off, limiting their ability and motivation to engage in healthy eating. Consequently, night shift workers seem to require additional supports from their social networks and enhanced food literacy skills, in order to adopt/ maintain healthy eating behaviours.

Night shift work creates individual and environmental barriers to healthy eating, which are present during and outside of work. Health promotion strategies for this population should include multiple approaches to address these barriers.

To nutritionally analyse lunches provided for 3–4-year-old children attending school nurseries. Energy and nutrient content are compared with nutrient frameworks underpinning voluntary guidelines for early years settings (EYS) and mandatory standards for infant schools (4–7-year-olds).

A cross-sectional study, recording all main meals, vegetarian meals, jacket potato options, sandwich options and all desserts and accompaniments provided over 5 consecutive days in each school. Two portions of each meal were collected each day and weighed. Recipe and portion weight data were entered into nutrient analysis software.

School nurseries where lunch was provided by the school.

Nine schools, providing a total of 161 meals.

Lunches contained more energy (1881 kJ/450 kcal), fat (15·5 g), free sugars (10·5 g) and Na (424 mg) than suggested by the nutrient framework for EYS. Carbohydrate (60·6 g), protein (16·8 g), fibre (6·7 g), Fe (2·4 mg), Zn (2·0 mg), Ca (202 mg), vitamin A (304 µg) and vitamin C (19 mg) also exceeded minimum recommendations. Compared with a revised nutrient framework for infant schools, energy was within range, whilst saturated fat, free sugars and Na were above maximum recommendations for this age group, and Zn was below. Sandwich meals were lower in vitamin C (P < 0·001–P = 0·05) and Fe (P = 0·012–P = 0·017) and higher in Na (P < 0·001–P = 0·003) and Ca (P < 0·001–P = 0·05).

Lunches provided for children attending school nurseries are more in line with the framework for 4–7-year-olds. Free sugars, saturated fat and Na are areas of concern consistent with previous studies. Protein is three times more than recommended. Large portions of cakes and biscuits contribute to excess energy provision.

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 three age intervals (ages 0–6, 6–12 and 12–24 months) with dual-energy X-ray absorptiometry-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 to 6 and 6 to 12 months was not associated with bone mass, but every sd increase in cWAZ between 12 and 24 months was associated with greater BMC (7·6 g; 95 % CI: 3·2, 12·0) and aBMD (0·008 g/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.

To identify the optimal weight gain at the end of the second trimester.

This was a population-based cohort study from the antenatal care system in Tianjin, China. We calculated gestational weight gain (GWG) based on the weight measured in the first trimester and the end of the second trimester. Restricted cubic spline analysis was performed to model the possible non-linear relationships between GWG and adverse outcomes. The optimal GWG was defined as the value of the lowest risk. Non-inferiority margins and the shape of the spline curves identified the recommended ranges in Chinese-specific BMI categories.

Tianjin Maternal and Child Health Cohort.

Singleton pregnant women aged 18–45 years.

In total, 69 859 pregnant women were included. Adverse outcome (including stillbirth, preterm birth, hypertensive disorders of pregnancy, gestational diabetes mellitus, small and large for gestational age) was significantly associated with GWG at the end of the second trimester. The risk score was non-linearly correlated with GWG in the underweight, normal weight and overweight groups. GWG at the end of the second trimester should not be < 7 kg in underweight group. For most normal-weight women, a GWG of about 8 kg is optimal. Pregnant women who are overweight should not have a GWG of more than 9 kg. We advised women with overweight and obesity to keep positive growth of GWG (> 0 kg) in the first and second trimesters.

According to the comprehensive adverse maternal and infant outcomes, we recommend the optimal GWG at the end of the second trimester. This study may provide a considerable reference for weight management.

Switching regular salt (sodium chloride) to salt enriched with potassium chloride (25 % potassium chloride, 75 % sodium chloride) has been shown to reduce blood pressure and the risk of cardiovascular diseases. We sought to define the potential for the current production of sodium chloride and potassium chloride to support a global switch to the use of potassium-enriched salt.

We summarised data from geological surveys, government reports and trade organisations describing the global production and supply of sodium chloride and potash (the primary source of potassium chloride) and compared this to potential requirements for potassium-enriched salt.

Global.

Not applicable.

Approximately 280 million tonnes of sodium chloride were produced in 2020 with China and the USA the main producers. Global production of potash from which potassium chloride is extracted was about forty-four million tonnes with Canada, Belarus, Russia and China providing 77 % of the world’s supply. There were forty-eight countries in which potassium-enriched salt is currently marketed with seventy-nine different brands identified. Allowing for loss of salt between manufacture and consumption, a full global switch from regular salt to potassium-enriched salt would require about 9·7 million tonnes of sodium chloride to be replaced with 9·7 million tonnes of potassium chloride annually.

Significant upscaling of the production of potassium chloride and the capacity of companies able to manufacture potassium-enriched salt, as well as a robust business case for the switch to potassium chloride, would be required.

To evaluate the impact of increased availability of healthier options on purchasing of different types of vending snack products sold in English leisure (sports) centres.

An evaluation of an intervention using pre-post methods and interrupted time series analysis. Products within the vending machines were altered over three phases to increase the availability of healthier options, using agreed nutrition criteria – Government Buying Standards for Food and Catering Services (GBSF) for England – as a guide, as well as product availability. The primary outcome was the change in mean weekly purchased energy between the first and third phase. Secondary outcomes included changes by phase and by week in weekly number of purchases, fats, sugars and salt for all products combined and by individual product categories.

Fifteen sports centres in the city of Leeds, West Yorkshire, UK.

Snack products sold in eighteen vending machines.

Energy purchased reduced from baseline to phase 2, for all product categories combined, by 47·25 MJ (95 % CI (−61·22, −33·27)) per machine and by 279 kJ, (95 % CI (−325, −266)) per product unit. There were reductions in most nutrients purchased in all individual product categories except chocolate confectionery. Nutrients per product unit decreased for all product categories except saturated fat in chocolate confectionery. Minimal underlying trends in the baseline phase were identified, indicating changes in outcomes were likely to be due to the intervention.

Introducing standards to increase availability of healthier snack products in vending machines is feasible without substantially affecting sales.

Eating a variety of nutritious foods is fundamental to good nutrition. However, this principle is challenged when recommendations seeking to improve the environmental sustainability of diets call for avoidance of foods considered to have a higher environmental footprint, such as animal-sourced foods. Our objective was to assess the implications for nutritional adequacy of protein choice across Australian adult diets preselected as having higher quality and lower environmental impact scores.

Each individual diet was assessed for variety of food choice within the ‘Fresh meat and alternatives’ food group defined in the Australian Dietary Guidelines, which includes protein-rich foods such as eggs, nuts, tofu and legumes in addition to animal meats. Diets were grouped according to variety score and whether they included only animal meats, only alternatives or a variety of meat and alternatives. Nutrient content was assessed relative to estimated average requirements (EAR).

Australia.

1700 adults participating in the Australian Health Survey

For diets with higher diet quality and lower environmental impact, the likelihood of achieving nutrient EAR significantly increased as variety of food choice in the ‘Fresh meat and alternatives’ food group increased (P < 0·001). Variety score and number of serves were also correlated (r = 0·52, P < 0·001) which is relevant since most diets did not meet the recommended minimum number of serves for this food group.

Greater variety within the ‘Fresh meat and alternatives’ food group is beneficial to meeting EAR and lower environmental impact diets can include three or more selections including foods of animal origin.

Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed.

The 2001–2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed.

The 2001–2002 NAHSIT for elementary schoolchildren.

Totally, 2274 schoolchildren aged 6–13 years.

Compared to normal height (−2< height for age z-score (HAZ) <2), shorter girls (HAZ ≤ −2) had a lower OSC (8·87 v. 10·5, P < 0·05) and taller girls (HAZ ≥ 2) had a better OSC (12·3 v. 10·5, P < 0·001). Maternal education and household income each contributed more than 5 % of OSC variance. OSC and HAZ among girls were positively associated and emotional disturbance negatively associated. Shortness-associated lower OSC underwent remediation with advancing school grade. Stature and OSC were not evidently related in boys.

Shorter stature can compromise OSC among school girls. The major determinants in shorter girls are less household income and limited parental education.

Consideration of future consequences (CFC) distinguishes individuals who adopt behaviours based on immediate needs and concerns from individuals who consider the future consequences of their behaviours. We aimed to assess the association between CFC and diet, and testing the mediating role of food choice motives on this relationship.

Individuals (aged ≥ 18 years) completed the CFC-12 questionnaire in 2014, at least three 24-h dietary records, and a food choice motive questionnaire. A multiple mediator analysis allowed to assess the mediating effect of food choice motives on the cross-sectional association between CFC and diet, adjusted for socio-demographic factors.

Data from the NutriNet-Santé cohort study.

27 330 participants.

CFC was associated with all food choice motives (P < 0·001), with the strongest positive associations for avoidance for environmental reasons, absence of contaminants and health motives and the strongest negative associations for innovation and convenience. Positive total effects were found between CFC and the consumption of healthy food groups (fruits and vegetables, whole-grain foods, legumes), and negative total effects for alcohol, meat and poultry and processed meat (P < 0·001). CFC was positively associated with diet quality (P < 0·001). Across food groups, major mediators of these relationships were higher health (8·4–32·6%), higher environmental (13·7–22·1 %) and lower innovation (7·3–25·1 %) concerns.

CFC was associated with healthier dietary intake, essentially mediated by a greater motivation of future-oriented participants for self-centred and altruistic outcomes, including health and environment. Focusing on the awareness of future benefits in public health interventions might lead to healthier dietary behaviours.

Sweden updated its legislation on universal free school meals in 2011 and nutrition was explicitly mentioned. The current study (i) describes cross-sectional changes in school lunch nutritional quality during the following eight years and (ii) examines if repeated self-auditing, using a fully automated, online tool (School Food Sweden), based on the implementation strategy of audit and feedback, was associated with improvements.

Both repeated cross-sectional and longitudinal design. Factors associated with meeting nutritional criteria were examined using variance weighted least squares regression and logistic regression.

Sweden.

Primary schools who self-selected to audit meal quality between March 2012 and July 2019.

Almost half of all (ca 4800) primary schools signed up to use the tool and 1500 audited nutritional quality at least once. Repeated cross-sectional analyses showed the proportion meeting the nutritional criteria increased significantly between 2012/13 (11 %) and 2018/19 (34 %). Longitudinally, each additional audit completed increased the odds of meeting the nutritional criteria by 1·30 (CI 1·20, 1·41), controlling for region and time elapsed since the legislative change. In 774 schools with repeat audits, both number of audits and frequency of accessing feedback predicted meeting the nutritional criteria (OR 2·02, CI 1·23, 3·31), even after adjusting for time since the legislative change and days elapsed since previous audit.

Both legislation and self-audit with automatic feedback appear effective in helping schools to improve school meal quality. Self-audit with feedback may be an effective complement to legislation, or a promising alternative in settings where regulation is not an option.

To develop a child- and adolescent-appropriate physical activity frequency questionnaire (PAFQ) in Tunisia, North Africa.

A PAFQ was developed from a physical activity (PA) inventory that comprised major activity components (at home, preparing meals, school time, transport, non-sport leisure, sports, prayer and sleeping time). Then, type and duration of each activity undertaken during the past week were estimated. Total energy expenditure (TEE) estimated by the PAFQ was compared with data derived from two criterion methods: heart-rate monitoring (HRM) and a 24 h PA recall (24h-R), both collected during a 3 d period including one weekday and two weekend days.

Two elementary schools and two high schools of the most developed and urbanized area, Greater Tunis.

One hundred and forty-two volunteer children and adolescents aged 10–19 years.

The PAFQ strongly was correlated with both HRM (r = 0·70; 95 % CI 0·62, 0·76) and 24h-R (r = 0·81; 95 % CI 0·77, 0·84). It featured acceptable agreement with both criterion measures, slightly underestimating TEE compared with 24h-R (−2·8 %, mean of individual differences −272·7 kJ/d; 95 % CI −490·6, −57·4 kJ/d) and moderately overestimating it compared with HRM (+11·3 %, mean of individual differences +1106·2 kJ/d; 95 % CI 845·8, 1366·6 kJ/d). Reliability ranged from moderate to good (weighted kappa coefficients from 0·47 to 0·78 and intra-class correlation coefficients between 0·79 and 0·86 for energy expenditure by PA categories), indicating strong agreement between the two assessments.

This PAFQ could be useful in the description and surveillance of PA patterns or for the evaluation of population-based interventions directed at promoting PA in Tunisian children and adolescents.

This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore.

This analysis utilised data from the Singapore Mental Health Study (SMHS 2016).

SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents.

Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay.

The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency.

The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

To establish a baseline understanding of whether consuming food with the highest nutritional quality, lowest greenhouse gas emissions (GHGE) and cost differs between different UK demographic and socio-economic population groups.

Multiple linear regression models were fitted to evaluate the relationship between predictor socio-demographic variables in this study (i.e. sex, ethnic group, age, BMI and level of deprivation) and the response variables (i.e. consumption of items considered most nutritious, with a low GHGE and price, as a proportion of total items consumed).

The UK.

1374 adult (18–65 years) participants from the National Diet and Nutrition Survey latest waves 9–11 (2016–2017 and 2018–2019).

Based on the total energy consumption in a day, the average diet-based GHGE was significantly higher for participants with a higher BMI. Non-white and most deprived participants spent significantly (P < 0·001) less money per total energy consumption. Participants with a BMI between 18·6 and 39·9 kg/m2 and those living in the least deprived areas consumed a significantly (P < 0·001) higher amount of those items considered the most nutritious, with the lowest GHGE and cost per 100 kcal.

Consumption of food with the highest nutritional quality, lowest GHGE and cost in the UK varies among those with different socio-demographic characteristics, especially the deprivation level of participants. Our analysis endorses the consideration of environmental sustainability and affordability, in addition to the consideration of nutritional quality from a health perspective, to make current dietary guidelines more encompassing and equitable.