To document the epidemiological features and influencing factors of obesity in the north-west of Iran, to provide baseline information for setting up a regional population-based centre to control and prevent obesity-related disorders in the area.

In this cross-sectional study, a total of 300 subjects were selected/studied in Tabriz, one of the major cities in Iran. Data on basic characteristics, anthropometric measurements, dietary assessment and physical activity were collected. Obesity was defined as body mass index ≥ 30 kg m− 2 for both women and men.

Total prevalence of obesity in the area was 22.4% (95% confidence interval (CI): 18.0–27.6). The prevalence of obesity was 24% (95% CI: 18.5–31.4) for women and 18% (95% CI: 12.5–25.6) for men. For both women and men obesity prevalence showed a positive association with age (P < 0.001), while there was a negative correlation of obesity with education and income (P < 0.001). Fruit consumption decreased the risk of obesity in both women and men (odds ratio (OR) = 0.60, 95% CI: 0.49–0.71 vs. OR = 0.62, 95% CI: 0.51–0.74, respectively). The same significant pattern was observed for the consumption of green vegetables (OR = 0.71, 95% CI: 0.57–0.63 vs. OR = 0.86, 95% CI: 0.77–0.98 for women and men, respectively), legumes (OR = 0.70, 95% CI: 0.59–0.84 vs. OR = 0.78, 95% CI: 0.66–0.91 for women and men, respectively) and dairy products (OR = 0.73, 95% CI: 0.61–0.91 vs. OR = 0.77, 95% CI: 0.63–0.93 for women and men, respectively).

Our study showed that educational attainment, higher income and consumption of certain food groups (i.e. vegetables, fruits, legumes and dairy products) may decrease the risk of obesity. Our findings also indicate the crucial necessity of establishing a population-based centre for obesity in the area. The essential information is now achieved to propose to local health authorities to act accordingly. However, more population-based investigations on dietary choices are needed to develop effective preventive strategies to control overweight and obesity disorders in different regions.

Insight into the role of energy balance-related behaviours (EBRB) is of great importance when it comes to prevention of weight gain and design of interventions tailored to target these behaviours.

First, the present study examines the longitudinal association of four EBRB in Norwegian adolescents. Second, it aims to examine whether clusters of EBRB are cross-sectionally associated with being overweight.

The present study is part of the ‘Fruits and Vegetables Make the Marks’ project. The study sample consists of twenty control schools in two Norwegian counties.

Survey questionnaires were completed by 884 pupils with an average age at baseline, September 2001, of 11·8 years. In the follow-up surveys in May 2002 and May 2005, a total of 809 and 724 adolescents participated, respectively. Four EBRB were measured: habitual fruit and vegetable intake, snacking and soda consumption, television and computer use and physical activity.

Results of the associations between EBRB were similar for boys and girls. The odds, ranging from 1·14 to 12·06, were mostly significant. One out of four clusters, the unhealthy cluster, was significantly and cross-sectionally associated with overweight and obesity.

Longitudinal associations of EBRB show that it is important to start early with interventions that aim to prevent unhealthy behaviours becoming habitual. These behaviours should be targeted at the same time as they tend to co-occur. More research, preferably longitudinal and more objective, is needed to investigate associations between health behaviours and body weight among adolescents.

To consider historical aspects of nuts in relation to origin and distribution, attributed medicinal benefits, symbolism, legends and superstitions.

Review of historical aspects of nuts.

Mediterranean region.

The varieties reviewed include almonds, walnuts, hazelnuts, pine nuts and pistachios.

Like other foods, nuts have a wide variety of cultural connections to the areas where they grow and to the people who live there or eat them. History, symbolism and legends reveal the ancient tradition of nuts and how they are related to the lives of our ancestors. Archaeological excavations in eastern Turkey have uncovered the existence of a non-migratory society whose economy centred on harvesting nuts. This shows that nuts have been a staple in the human diet since the beginnings of history. Moreover, since ancient times nuts have been used for their medicinal properties. They also play a role in many old legends and traditions.

To examine how household food insecurity is related to adolescent weight status and disordered eating.

Cross-sectional, population-based study. Adolescents self-reported unhealthy weight control behaviours, binge eating and meal frequency; weight status was measured. Household food insecurity was assessed by asking parents to respond to the validated six-item US Household Food Security Survey Module.

Adolescents surveyed within Minneapolis/St. Paul public middle and high schools completed surveys at school, and their parents/guardians were surveyed by mail during the 2009–2010 academic year.

Ethnically/racially diverse, primarily low-income adolescents (mean age: 14·4 years, range: 10–22 years) and their parents/guardians (n 2285 dyads).

More than one-third (38·9 %) of the adolescents experienced past-year household food insecurity, 43·2 % reported disordered eating and 39·6 % were overweight. Generalised regression models showed that food insecure (FI) compared with food secure (FS) adolescents had higher prevalence of overweight (FI: 42·3 % v. FS: 37·9 %, P = 0·039), lower breakfast consumption (FI: 4·1 times/week v. FS: 4·4 times/week, P = 0·005) and greater use of unhealthy weight control behaviours (FI: 49·0 % v. FS: 39·5 %, P < 0·001) in unadjusted models. Models adjusted for parental education, ethnicity/race, sex and age found that food insecurity was associated with higher prevalence of unhealthy weight control behaviours (FI: 44·5 % v. FS: 37·8 %, P = 0·007), but not with weight status or other eating behaviours.

These results suggest that food insecurity may be an independent risk factor for unhealthy weight control behaviours, indicating a need to approach these intersecting issues in a comprehensive manner.

Insulin resistance is a significant cross-point for the manifestation of several chronic diseases in children and adults. The aim of the present study was to investigate the possible relationship of certain dietary patterns and breakfast consumption habits with insulin resistance in children.

A representative sample of 1912 schoolchildren (aged 9–13 years) participated in a cross-sectional epidemiological study, the Healthy Growth Study, which was initiated in May 2007 and completed in June 2009.

It was conducted in seventy-seven primary schools in four large regions in Greece.

Dietary intake, breakfast consumption, anthropometric and physical examination data, biochemical indices and socio-economic information collected from parents were assessed in all children. Principal components analysis was used to identify dietary patterns.

A dietary pattern of increased consumption of margarine, sweets (candies, lollipops, jellies, traditional fruit in heavy syrup) and savoury snacks (chips, cheese puffs and not home-made popcorn) was associated with homeostasis model assessment of insulin resistance index (HOMA-IR; β = 0·08, P < 0·001) in multivariate models. Children in the third tertile of this dietary pattern had a 2·51 (95 % CI 1·30, 4·90) times higher risk of insulin resistance (HOMA-IR > 3·16) than those in the first tertile. Breakfast consumption had an inverse correlation with insulin resistance, but the correlation lost its significance after adjustments for waist circumference, birth weight, parental BMI and socio-economic status.

Increased consumption of margarine, sweets and savoury snacks, which is a common dietary pattern in childhood, was positively associated with insulin resistance, while breakfast consumption had an inverse association with HOMA-IR, in schoolchildren (aged 9–13 years). Identification of dietary behaviours that might affect insulin resistance in children offers valuable advice in cardiometabolic risk prevention strategies.

The aim was to review and update advances in genetics of obesity.

Analysis and interpretation of recent investigations about regulating the energy balance as well as about gene-nutrient interactions and current nutrigenomic research methods.

Obesity results from a long-term positive energy balance. However, its rising prevalence in developed and developing societies must reflect lifestyle changes, since genetic susceptibility remains stable over many generations. Like most complex diseases, obesity derives from a failure of adequate homoeostasis within the physiological system controlling body weight. The identification of genes that are involved in syndromic, monogenic and polygenic obesity has seriously improved our knowledge of body weight regulation. This disorder may arise from a deregulation at the genetic level (e.g. gene transcription or altered protein function) or environmental exposure (e.g. diet, physical activity, etc.).

In practice, obesity involves the interaction between genetic and environmental factors.

To study the differences between children’s self-reports and parents’ reports on environmental determinants of fruit and vegetable intake among 11-year-old children in the European country with the lowest reported consumption. A second objective was to examine the observed variance in fruit and vegetable intake among the children.

A cross-sectional survey was performed in Iceland as a part of the Pro Children cross-Europe survey. Children’s usual fruit and vegetable intake and its determinants were assessed through self-reports from the children (n 963) and their parents’ reports.

Children reported lower availability and accessibility of fruits at home than did their parents, while the reports of children and parents for vegetables were more in agreement. A larger proportion of the observed variance in children’s fruit and vegetable intake could be explained by the child’s perception than by the parent’s perception of determinants. The strongest determinants for fruit and vegetable intake according to the children’s reports were availability at home, modelling, demanding family rule and knowledge of recommendations. The strongest modelling determinant for fruit was the father’s fruit intake while for vegetables it was eating vegetables together with the family.

Eleven-year-old children should be asked themselves what determines their fruit and vegetable intake. However, children reported determinants in the physical and social environment, of which the parents are a part, as an important determinant for their intake. Interventions aiming to increase fruit and vegetable intake among children must therefore target the parents.

To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy.

A pre–post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project.

The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10?000 women and children aged < 5 years. A random sample of 210 mother–child (12–36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation.

After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235 ± 23 μg retinol activity equivalents (RAE) to 655 ± 144 μg RAE in mothers (41 to 120% of safe intake level), and from 164 ± 14 μg RAE to 514 ± 77 μg RAE in children (36 to 97%). Rates of serum retinol < 0.70 μmoll−1 decreased from 61.8 ± 8.0% to 28.2 ± 11.0% in mothers, and from 84.5 ± 6.4% to 66.9 ± 11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake.

Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area

To examine the feasibility of using point-of-sale data to assess dietary quality of food sales in remote stores.

A multi-site cross-sectional assessment of food and nutrient composition of food sales. Point-of-sale data were linked to Australian Food and Nutrient Data and compared across study sites and with nutrient requirements.

Remote Aboriginal Australia.

Six stores.

Point-of-sale data were readily available and provided a low-cost, efficient and objective assessment of food and nutrient sales. Similar patterns in macronutrient distribution, food expenditure and key food sources of nutrients were observed across stores. In all stores, beverages, cereal and cereal products, and meat and meat products comprised approximately half of food sales (range 49–57 %). Fruit and vegetable sales comprised 10·4 (sd 1·9) % on average. Carbohydrate contributed 54·4 (sd 3·0) % to energy; protein 13·5 (sd 1·1) %; total sugars 28·9 (sd 4·3) %; and the contribution of total saturated fat to energy ranged from 11·0 to 14·4 % across stores. Mg, Ca, K and fibre were limiting nutrients, and Na was four to five times higher than the midpoint of the average intake range. Relatively few foods were major sources of nutrients.

Point-of-sale data enabled an assessment of dietary quality within stores and across stores with no burden on communities and at no cost, other than time required for analysis and reporting. Similar food spending patterns and nutrient profiles were observed across the six stores. This suggests potential in using point-of-sale data to monitor and evaluate dietary quality in remote Australian communities.

To compare a widely used Australian food-frequency questionnaire (FFQ) with diet records and consider the results in relation to its use in nutrition surveillance.

Inter-method reliability study.

A randomised trial in subjects with past asbestos exposure.

Seventy-two adults living in Western Australia.

A semi-quantitative FFQ developed by the Commonwealth Scientific Industrial Research Organisation in South Australia was administered after the completion of four 7-day diet records (DRs).

Mean agreement between methods was not significantly different from 100% for many nutrients, but the limits of agreement indicated that, at the individual level, the FFQ over- or underestimated the DR by at least 50%. Mean agreement between methods decreased significantly with increasing intakes for the majority of nutrients. Pearson's correlation coefficients were less informative indicators of agreement compared with the limits of agreement.

These results indicate poor agreement between the FFQ and DR when estimating absolute intakes. Therefore, comparing intakes collected using this FFQ with specific cut-off points such as Recommended Dietary Intakes for nutrition surveillance may lead to seriously flawed conclusions about population intakes.

To describe macronutrient intakes and food sources of the adult population in the Republic of Ireland and Northern Ireland and to assess adherence of this population to current dietary recommendations.

A cross-sectional food consumption survey collected food intake data using a 7-day food diary.

Northern Ireland and the Republic of Ireland between October 1997 and October 1999.

One thousand three hundred and seventy-nine adults aged 18–64 years (662 males and 717 females).

Mean daily energy intakes in men were 11 MJ per day, 15.5% was derived from protein, 34.8% from fat, 43.5% from carbohydrate and 5.9% from alcohol. Corresponding figures for women were 7.6 MJ per day, 15.6%, 35.6%, 45.1% and 3.5%. When alcohol energy was excluded the contribution of fat and carbohydrate to energy did not differ between men and women. When compared with existing dietary recommendations, 93% of men and 86% of women had protein intakes above the Population Reference Intake. Two approaches were used to assess adherence to the fat and carbohydrate dietary recommendations: (1) the proportion of individuals in the population attaining these dietary targets and (2) the proportion of the population that was included in a 'compliers' group which had a group mean equal to these dietary targets. Thirty-three per cent of men and 34% of women met the target of 35% of food energy from fat and 78% of men and 80% of women comprised the ‘compliers’ group having a group mean of 35% of food energy from fat. Twentythree per cent of men and 27% of women met the target of 50% of food energy from carbohydrate and 56% of men and 62% of women made up the 'compliers' group. Meat and meat products were the main source of fat (23%) and protein (37%), and bread and rolls (25%) were the main source of carbohydrate.

A reduction in dietary fat intake remains an important public health issue in the Republic of Ireland and Northern Ireland. An increase in carbohydrate intake and attention to the rise in alcohol intake is also warranted.

To examine whether women’s knowledge of pregnancy-related risks and family support received during pregnancy are associated with adherence to maternal iron–folic acid (IFA) supplementation.

Secondary data analysis of the 2002–03, 2007 and 2012 Indonesia Demographic and Health Survey. Analysis of the association between factors associated with adherence (consuming ≥90 IFA tablets), including the women’s knowledge and family support, was performed using multivariate logistic regression.

National household survey.

Women (n 19 133) who had given birth within 2 years prior to the interview date.

Knowledge of pregnancy-related risks was associated with increased adherence to IFA supplementation (adjusted OR=1·8; 95 % CI 1·6, 2·0), as was full family (particularly husband’s) support (adjusted OR=1·9; 95 % CI 1·6, 2·3). Adequate antenatal care (ANC) visits (i.e. four or more) was associated with increased adherence (adjusted OR=2·2; 95 % CI 2·0, 2·4). However, ANC providers missed opportunities to distribute tablets and information, as among women with adequate ANC visits, 15 % reported never having received/bought any IFA tablets and 30 % had no knowledge of pregnancy-related risks. A significant interaction was observed between family support and the women’s educational level in predicting adherence. Family support significantly increased the adherence among women with <9 years of education.

Improving women’s knowledge of pregnancy-related risks and involving family members, particularly the husband and importantly for less-educated women, improved adherence to IFA supplementation. ANC visit opportunities must be optimized to provide women with sufficient numbers of IFA tablets along with health information (especially on pregnancy-related risks) and partner support counselling.

To assess the reproducibility and validity a 127-item, habitual intake, food-frequency questionnaire (FFQ), developed for low-income and low-literacy Brazilian workers, by comparison with a 24-hour dietary recall (24-HDR).

The FFQ and 24-HDR were interviewer-administered at the local workplace to each subject twice, with a period of 6 months between estimates; and four 24-HDRs were conducted during the 4-month period between the two FFQs (FFQ1 and FFQ2). Reproducibility was tested by comparing mean nutrient intakes from the two FFQs. Validity was determined by comparing the mean nutrient intakes from the FFQs with the corresponding averages of the six 24-HDRs (reference method).

Goiânia City, in Central West Brazil.

The study was based on 104 (62 women and 42 men) subjects, aged 18 to 60 years, who were randomly selected.

Dietary intake from the FFQ was higher than from the 24-HDR. Reproducibility was assessed by Pearson correlation coefficients for nutrients from FFQ1 and FFQ2, and ranged from 0.23 for retinol to 0.69 for total energy (mean 0.52). Intra-class coefficients for nutrients averaged by the 24-HDRs ranged from 0.29 for vitamin C to 0.76 for total energy; retinol was not significant. In the validation study, correlation between the FFQ and the 24-HDR ranged between 0.21 for vitamin C and 0.70 for total energy (mean 0.50). Adjusting for total energy lowered the coefficients, except for calcium, retinol and vitamin C. Coefficients increased with attenuation, ranging from 0.35 for carbohydrate to 0.65 for calcium.

Results indicate that this questionnaire had satisfactory reproducibility and reasonable validity.

To review the nutrition policies and efforts related to nutrition transition in China.

Design and setting: This paper reviews the nutrition policy and activities of China to prevent and control diet-related non-communicable diseases (DR-NCDs). Data came from the Ministry of Health, the Ministry of Agriculture, the State Council and some cross-sectional surveys.

China is undergoing a remarkable, but undesirable, rapid transition towards a stage of the nutrition transition characterised by high rates of DR-NCDs in a very short time. Some public sector Chinese organisations have combined their efforts to create the initial stages of systematic attempts to reduce these problems. These efforts, which focus on both under- and overnutrition, include the new Dietary Guidelines for Chinese Residents and the Chinese Pagoda and The National Plan of Action for Nutrition in China, issued by the highest body of the government, the State Council. There are selected agricultural sector activities that are laudable and few other systematic efforts that are impacting behaviour yet. In the health sector, efforts related to reducing hypertension and diabetes are becoming more widespread, but there is limited work in the nutrition sector. This paper points to some unique strengths from past Chinese efforts and to an agenda for the next several decades.

China is trying in its efforts to prevent and control the development of DR-NCDs but effects are limited. Systematic multi-sector co-operation is needed to effectively prevent and control DR-NCDs inside and outside the health sector.

To evaluate the ability of an FFQ, designed for use in Brazilian pregnant women, to estimate nutrient intakes during pregnancy.

A prospective study was conducted among 103 pregnant women attended by the Brazilian national health-care service. Food intake during pregnancy was evaluated by three 24 h dietary recalls (24hR), one per trimester of pregnancy, and also by two FFQ. The FFQ with eighty-five food items included questions about frequency of intake and portion sizes during two periods: the first 24 weeks of pregnancy and the pregnancy period as a whole. Deattenuated Pearson's correlation coefficients and joint classification into quartiles of nutrient intake were applied.

Ribeirão Preto, São Paulo State, Brazil.

One hundred and three pregnant women, aged 18–35 years.

Acceptable correlation coefficients (r > 0·35) were found for Ca, K, Zn, Mg, fibre, vitamin C, niacin and folic acid for intake for the first 24 weeks; and for energy, lipids, protein, carbohydrate, Fe, K, Zn, fibre, vitamin B6, riboflavin and niacin for the gestational period as a whole. A high proportion of study participants (≥70 %) were categorized into the same or adjacent quartiles for estimated energy, carbohydrate, Ca, K, fibre, Zn, cholesterol, vitamin A, riboflavin, niacin, vitamin C, vitamin E and folic acid. Gross misclassification ranged from 2·3 % (dietary fibre) to 12·5 % (vitamin A, thiamin and SFA).

The FFQ is a useful tool for assessing categories of nutrient intake during pregnancy, since a high proportion of women were classified into the same or adjacent quartiles.

To measure and describe the prevalence and severity of household food insecurity in a remote on-reserve First Nations community using the Household Food Security Survey Module (HFSSM) and to evaluate the perceived relevance of the HFSSM for this population.

Household food security status was determined from the eighteen-item HFSSM following the classifications developed by Health Canada for the Canadian Community Health Survey, Cycle 2·2 Nutrition. One adult from each household in the community was invited to complete the HFSSM and to comment on its relevance as a tool to measure food security for First Nations communities.

Sub-Arctic Ontario, Canada.

Households (n 64).

Seventy per cent of households were food insecure, 17 % severely and 53 % moderately. The prevalence of food insecurity in households with children was 76 %. Among respondents from homes rated as having severe food insecurity, all (100 %) reported worrying that food would run out, times when food didn't last and there wasn't money to buy more, and times when they couldn't afford to eat balanced meals. The majority of respondents felt the HFSSM did not capture an accurate picture of food security for their situation. Aspects missing from the HFSSM included the high cost of market food and the incorporation of traditional food practices.

A high prevalence of household food insecurity was reported in this community. On-reserve remote First Nations communities may be more susceptible to food insecurity than off-reserve Aboriginal populations. Initiatives that promote food security for this vulnerable population are needed.

To assess the level of agreement amongst a panel of public health nutrition leaders regarding the key descriptors used to define the field of public health nutrition.

Cross-sectional survey requiring quantitative and qualitative responses representing the first round of a consensus development Delphi technique.

International.

Expert panel of 24 public health nutrition leaders from nine countries in the European Union, the USA and Australia.

All but one of the panel agreed it was important to have a consensus definition for public health nutrition to describe the field consistently. Opinion about the length and complexity of this definition tended to vary depending on the intended use of the definition. The large majority (18/24) supported the inclusion of specific reference to physical activity in a definition of public health nutrition, although there was not consensus (>83% agreement as criterion) on this point. Consensus descriptors regarded as important in a definition of public health nutrition included: population-based, focus on health promotion, food and nutrition systems focus, wellness maintenance, primary prevention, applies public health principles, education, environmental and political descriptors. Treatment as a descriptor was rated as unimportant by a majority (14/24) of panellists, delineating public health nutrition from clinical practice.

There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of descriptors that can be used to define public health nutrition. The limitations of using word-for-word definitions between and within countries may be overcome by explicit use of the consensus descriptors identified in this process.

To describe out-of-home consumption according to the purpose and extent of industrial processing and also evaluate the association between eating out and ultra-processed food consumption, taking account of variance within and between individuals.

Cross-sectional study.

Brazil.

The study was based on the Individual Food Intake of the Brazilian Household Budget Survey, carried out with 34 003 individuals aged 10 years or more, between May 2008 and May 2009. All food items were classified according to food processing level. The habit of eating out was evaluated through the frequency of days each individual reported eating out, described according to sociodemographic characteristics. The contribution of food energy per group and subgroup was estimated according to the frequency of eating out. In addition, multilevel modelling was employed to evaluate the association between eating out and ultra-processed food consumption.

In Brazil, culinary preparations accounted for most of the energy eaten out. However, it was possible to observe a higher contribution of ultra-processed foods, especially sugary beverages and ready-to-eat meals, as the frequency of out-of-home consumption increased. Compared with food consumption exclusively at home, eating out increased the consumption of ultra-processed foods by 0·41 percentage points within and between individuals.

In Brazil, the same individual and different individuals had greater consumption of ultra-processed foods when they ate out of home compared with when they ate at home. So, it is necessary to implement public policies which discourage the out-of-home consumption of ultra-processed foods and that provide affordable and accessible less-processed food options.

To evaluate the prevalence of food and beverage marketing on Twitch.tv (Twitch), a social media platform where individuals broadcast live audiovisual material to millions of daily users.

Observational analysis of the prevalence of 238 food and beverage brands in five distinct categories (processed snacks; food delivery services and restaurants; candies, energy drinks/coffees/teas; and sodas and other sugar-sweetened beverages) over the course of 18 months.

Twitch streamer profiles and stream titles between January 2018 and July 2019. Twitch chat room messages during July 2019.

None.

There was a significant increase in brand exposure on Twitch both in stream titles (sodas and candies, P < 0·05) and on streamer profiles (sodas, restaurants/food delivery services, candies, and energy drinks/coffees/teas, P < 0·05) over the 18-month study period. Energy drinks, coffees and teas had the most exposure with 1·08 billion exposure hours from profiles and 83 million exposure hours from titles. Restaurants/food delivery services and sugar-sweetened beverages were the most frequently mentioned products in chat rooms with 1·24 million messages and 1·10 million messages, respectively.

This study is the first to demonstrate the extent by which food and beverage brands garner millions of hours of exposure on Twitch. Future studies should evaluate the impact that this level of exposure to nutrient-poor, energy-dense products may have on behavioural and health outcomes.

To demonstrate the feasibility of applying the Healthy Eating Index-2010 (HEI-2010) to the hunger relief setting, specifically by assessing the nutritional quality of foods ordered by food shelves (front-line food provider) from food banks (warehouse of foods).

This Healthy FOOD (Feedback On Ordering Decisions) observational study used electronic invoices detailing orders made by 269 food shelves in 2013 and analysed in 2015 from two large Minnesota, USA food banks to generate HEI-2010 scores. Initial development and processing procedures are described.

The average total HEI-2010 score for the 269 food shelves was 62·7 out of 100 with a range from 28 to 82. Mean component scores for total protein foods, total vegetables, fatty acids, and seafood and plant proteins were the highest. Mean component score for whole grains was the lowest followed by dairy, total fruits, refined grains and sodium. Food shelves located in micropolitan areas and the largest food shelves had the highest HEI-2010 scores. Town/rural and smaller food shelves had the lowest scores. Monthly and seasonal differences in scores were detected. Limitations to this approach are identified.

Calculating HEI-2010 for food shelves using electronic invoice data is novel and feasible, albeit with limitations. HEI-2010 scores for 2013 identify room for improvement in nearly all food shelves, especially the smallest agencies. The utility of providing HEI-2010 scores to decision makers in the hunger relief setting is an issue requiring urgent study.