To investigate the attitudes, experiences and beliefs of advanced-level public health nutritionists with respect to public health nutrition workforce composition, core functions, competency requirements and existing workforce capacity.

Qualitative study using structured interviews.

Australia.

Forty-one advanced-level public health nutritionists employed in academic and senior technocratic positions in state health systems.

Advanced-level public health nutritionists recognise the diversity of the public health nutrition workforce but clearly identify the need for a specialist public health nutrition workforce tier to provide workforce leadership. Nominated core functions for public health nutrition reflect broader public health core functions but, in the context of nutrition, specific problem resolution. Opinions about competency needs were similar to many of the cross-cutting competencies identified in the public health field but with specific application to nutrition problems. Competency in the scientific underpinning of nutrition was considered particularly important and delineated this public health nutrition workforce from the broader public health workforce. Public health nutrition was identified as a specialisation within public health and dietetics. Workforce capacity assessments by this group indicate a need for workforce development.

Qualitative data from a large proportion of the Australian public health nutrition leadership group have identified core functions, competencies and workforce development priorities that can be a basis for further systematic research and workforce strategy development.

To explore the factors affecting intra-household food allocation practices to inform the development of interventions to prevent low birth weight in rural plains of Nepal.

Qualitative methodology using purposive sampling to explore the barriers and facilitating factors to improved maternal nutrition.

Rural Dhanusha District, Nepal.

We purposively sampled twenty-five young daughters-in-law from marginalised groups living in extended families and conducted semi-structured interviews with them. We also conducted one focus group discussion with men and one with female community health volunteers who were mothers-in-law.

Gender and age hierarchies were important in household decision making. The mother-in-law was responsible for ensuring that a meal was provided to productive household members. The youngest daughter-in-law usually cooked last and ate less than other family members, and showed respect for other family members by cooking only when permitted and deferring to others’ choice of food. There were limited opportunities for these women to snack between main meals. Daughters-in-law’ movement outside the household was restricted and therefore family members perceived that their nutritional need was less. Poverty affected food choice and families considered cost before nutritional value.

It is important to work with the whole household, particularly mothers-in-law, to improve maternal nutrition. We present five barriers to behaviour change: poverty; lack of knowledge about cheap nutritional food, the value of snacking, and cheap nutritional food that does not require cooking; sharing food; lack of self-confidence; and deference to household guardians. We discuss how we have targeted our interventions to develop knowledge, discuss strategies to overcome barriers, engage mothers-in-law, and build the confidence and social support networks of pregnant women.

Junk-food marketing contributes significantly to childhood obesity, which in turn imposes major health and economic burdens. Despite this, political priority for addressing junk-food marketing has been weak in many countries. Competing interests, worldviews and beliefs of stakeholders involved with the issue contribute to this political inertia. An integral group of actors for driving policy change are parliamentarians, who champion policy and enact legislation. However, how parliamentarians interpret and portray (i.e. frame) the causes and solutions of public health nutrition problems is poorly understood. The present study aimed to understand how Australian parliamentarians from different political parties frame the problem of junk-food marketing.

Framing analysis of transcripts from the Australian Government’s Parliamentary Hansard, involving development of a theoretical framework, data collection, coding transcripts and thematic synthesis of results.

Australia.

None.

Parliamentarian framing generally reflected political party ideology. Liberal parliamentarians called for minimal government regulation and greater personal responsibility, reflecting the party’s core values of liberalism and neoliberalism. Greens parliamentarians framed the issue as systemic, highlighting the need for government intervention and reflecting the core party value of social justice. Labor parliamentarians used both frames at varying times.

Parliamentarians’ framing was generally consistent with their party ideology, though subject to changes over time. This project provides insights into the role of framing and ideology in shaping public health policy responses and may inform communication strategies for nutrition advocates. Advocates might consider using frames that resonate with the ideologies of different political parties and adapting these over time.

Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP).

In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models.

USA in 2008–2009.

Sixty child-care providers participating in CACFP in King County, Washington State.

In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively).

The results indicate that improving the nutritional quality of foods in child care may require higher food spending.

The increasing prevalence of obesity worldwide is a major health concern. Our study, which is part of the First National Epidemiological Study of Obesity in Greece, aimed to assess (i) breakfast habits and their relationship to BMI in Greek adolescents, as well as (ii) breakfast skipping in relation to other health behaviours.

Epidemiological survey throughout Greece. Participants completed a questionnaire concerning breakfast habits and many lifestyle parameters.

The survey was conducted in schools throughout Greece.

Anthropometric measurements were performed on 6500 boys and 7778 girls, aged 13–19 years, from schools throughout Greece.

Among both boys and girls, breakfast consumers had a lower BMI than breakfast skippers. Moreover, breakfast skippers among both boys and girls were found to smoke more than breakfast consumers. The proportion of boys and girls who ate breakfast was found to be greater among those who had never been on a diet than among those who had already experienced dieting. Leisure-time activity was greater in breakfast consumers than breakfast skippers; among boys, 71·8 % of breakfast consumers walked compared with 66·4 % of breakfast skippers, whereas 38·4 % and 35·0 %, respectively, exercised. Among girls, these percentages were 73·1 % v. 68·7 % for walking and 36·7 % v. 31·5 % for exercising.

We found that breakfast skipping can be part of a constellation of several unhealthy lifestyle parameters and is related to higher BMI in Greek adolescents.

To provide an overview of beverage consumption patterns using the first nationally representative survey of dietary intake in Brazil.

Beverage consumption data were obtained by 1 d food records in an individual dietary survey.

Nationwide cross-sectional survey, 2008–2009.

Nationally representative sample of individuals aged ≥10 years (n 34 003).

Beverages contributed 17·1 % of total energy consumption. Caloric coffee beverages provided the greatest level of energy overall (464 kJ (111 kcal)/d). Individuals aged 10–18 years (243 kJ (58 kcal)/d) and 19–39 years (230 kJ (55 kcal)/d) consumed a higher proportion of energy from sugar-sweetened soft drinks than individuals over this age (142 kJ (34 kcal)/d for those aged 40–59 years and 79 kJ (19 kcal)/d for those aged ≥60 years).

Overall, the contribution of beverages, particularly sugary beverages, to total energy consumption in Brazil represents an important public health challenge and is comparable with those from other countries.

To investigate the knowledge, attitudes and practices (K-A-P) about food safety and nutrition in Chinese adults who were recruited to the online survey during the epidemic of corona virus disease 2019 (COVID-19).

Participants were recruited by an online snowball sampling method. An electronic questionnaire was sent to our colleagues, students, friends, other professionals and their referrals helped us recruit more participants. The questionnaire included socio-demographic information, the attention paid to COVID-19, K-A-P about food safety and nutrition. Multiple and logistic regression analyses were used to explore related factors of K-A-P.

Totally, 2272 participants aged 24·09 ± 9·14 years, from twenty-seven provinces, autonomous districts or municipalities, with 18·3 % male and 83·4 % with a medical background.

The total possible knowledge score was 8·0, the average score was 5·2 ± 1·6 and 4·2 % obtained 8·0. The total possible attitudes score was 8·0, the average score was 6·5 ± 1·4 and 36·1 % obtained 8·0. The total possible food safety practices score was 5·0, the average score was 3·7 ± 1·0 and 20·7 % obtained 5·0. During this public emergency, 79·4 % participants changed diet habits, including increasing vegetables, fruit and water intake and reducing sugary drinks and snacks. Gender, age, educational and professional background, disease history, the attention paid to COVID-19 and related knowledge were associated with K-A-P.

There was room for the improvement of K-A-P in participants during this public health emergency and further strengthening education about food safety and nutrition is needed. Findings indicate that education should address biased or misleading information and promote nutritious food choices and safe food practices.

Maternal nutrition knowledge has frequently been identified as an important target for nutrition promotion interventions. The aim of the present study was to investigate whether maternal nutrition knowledge is more strongly associated with the mother's own diet or that of her child.

Cross-sectional multivariate linear regression with interactions analyses of survey data.

Socio-economically disadvantaged neighbourhoods in Victoria, Australia.

Five hundred and twenty-three mothers and their children who participated in the Resilience for Eating and Physical Activity Despite Inequality (READI) study, a cross-sectional survey study conducted in 2009 among women and their children residing in socio-economically disadvantaged neighbourhoods.

In adjusted models, for three (vegetable, chocolate/lollies and soft drink consumption) out of the seven dietary outcomes assessed, there was a significant association between maternal nutrition knowledge and maternal diet, whereas for the children's diets none of the seven outcomes were associated with maternal nutrition knowledge. Statistical comparison of regression coefficients showed no difference between the maternal nutrition knowledge–maternal diet association and the maternal nutrition knowledge–child diet association.

Promoting maternal nutrition knowledge may represent an important avenue for improving diet in mothers from socio-economically disadvantaged neighbourhoods, but more information is needed on how and when this knowledge is translated to benefits for their children's diet.

Taxation of unhealthy food is considered a regulation tool to improve diets. In 2011 Denmark introduced a tax on saturated fat in food products, the first country in the world to do so. The objective of the present paper is to investigate the effects of the tax on consumers’ intake of saturated fat within three different types of food product group: minced beef, regular cream and sour cream.

We use an augmented version of the Linearized Almost Ideal Demand System (LAIDS) functional form for econometric analysis, allowing for tax-induced structural breaks.

Data originate from one of the largest retail chains in Denmark (Coop Danmark) and cover January 2010 to October 2012, with monthly records of sales volume, sales revenue and information about specific campaigns from 1293 stores.

The Danish fat tax had an insignificant or small negative effect on the price for low- and medium-fat varieties, and led to a 13–16 % price increase for high-fat varieties of minced beef and cream products. The tax induced substitution effects, budget effects and preference change effects on consumption, yielding a total decrease of 4–6 % in the intake of saturated fat from minced beef and regular cream, and a negligible effect on the intake from sour cream.

The Danish introduction of a tax on saturated fat in food in October 2011 had statistically significant effects on the sales of fat in minced beef and cream products, but the tax seems to have reduced the beyond-recommendation saturated fat intake to only a limited extent.

To assess the magnitude and determinants of vitamin A deficiency (VAD) and coverage of vitamin A supplementation (VAS) among pre-school children.

A community-based cross-sectional study was carried out by adopting a multistage, stratified, random sampling procedure.

Rural areas of eight states in India.

Pre-school children and their mothers were covered.

A total of 71 591 pre-school children were clinically examined for ocular signs of VAD. Serum retinol concentrations in dried blood spots were assessed in a sub-sample of 3954 children using HPLC. The prevalence of Bitot spots was 0·8 %. The total ocular signs were significantly higher (P < 0·001) among boys (2·6 %) compared with girls (1·9 %) and in older children (3–4 years) compared (P < 0·001) with younger (1–2 years), and were also high in children of labourers, scheduled castes and illiterate mothers. The odds of having Bitot spots was highest in children of scheduled caste (OR = 3·8; 95 % CI 2·9, 5·0), labourers (OR = 2·9; 95 % CI 2·1, 3·9), illiterate mothers (OR = 2·7; 95 % CI 2·2, 2·3) and households without a sanitary latrine (OR = 5·9; 95 % CI 4·0, 8·7). Subclinical VAD (serum retinol level <20 μg/dl) was observed in 62 % of children. This was also relatively high among scheduled caste and scheduled tribe children. The rate of coverage of VAS was 58 %.

The study revealed that VAD is a major nutritional problem and coverage of VAS was poor. The important determinants of VAD were illiteracy, low socio-economic status, occupation and poor sanitation. Strengthening the existing VAS programme and focused attention on dietary diversification are essential for prevention of VAD.

Climate change is projected to increase the burden of food insecurity (FI) globally, particularly among populations that depend on subsistence agriculture. The impacts of climate change will have disproportionate effects on populations with higher existing vulnerability. Indigenous people consistently experience higher levels of FI than their non-Indigenous counterparts and are more likely to be dependent upon land-based resources. The present study aimed to understand the sensitivity of the food system of an Indigenous African population, the Batwa of Kanungu District, Uganda, to seasonal variation.

A concurrent, mixed methods (quantitative and qualitative) design was used. Six cross-sectional retrospective surveys, conducted between January 2013 and April 2014, provided quantitative data to examine the seasonal variation of self-reported household FI. This was complemented by qualitative data from focus group discussions and semi-structured interviews collected between June and August 2014.

Ten rural Indigenous communities in Kanungu District, Uganda.

FI data were collected from 130 Indigenous Batwa Pygmy households. Qualitative methods involved Batwa community members, local key informants, health workers and governmental representatives.

The dry season was associated with increased FI among the Batwa in the quantitative surveys and in the qualitative interviews. During the dry season, the majority of Batwa households reported greater difficulty in acquiring sufficient quantities and quality of food. However, the qualitative data indicated that the effect of seasonal variation on FI was modified by employment, wealth and community location.

These findings highlight the role social factors play in mediating seasonal impacts on FI and support calls to treat climate associations with health outcomes as non-stationary and mediated by social sensitivity.

Public health decision makers not only consider health benefits but also economic implications when articulating and issuing lifestyle recommendations. Whereas various estimates exist for the economic burden of physical inactivity, excess body weight and smoking, estimates of the economic burden associated with our diet are rare. In the present study, we estimated the economic burden attributable to the inadequate consumption of vegetables and fruit in Canada.

We accessed the Canadian Community Health Survey to assess the inadequacy in the consumption of vegetables and fruit and published meta-analyses to assemble risk estimates for chronic diseases. Based on these inadequacy and risk estimates, we calculated the population-attributable fraction and avoidable direct and indirect costs to society. Direct costs include those for hospital care, physician services and drugs in 2015.

About 80 % of women and 89 % of men consume inadequate amounts of vegetables and fruit. We estimated this to result in an economic burden of $CAN 3·3 billion per year, of which 30·5 % is direct health-care costs and 69·5 % is indirect costs due to productivity losses. A modest 1 percentage point annual reduction in the prevalence of inadequate vegetables and fruit consumption over the next 20 years would avoid approximately $CAN 10·8 billion, and an increase of one serving of vegetables and fruit per day would avoid approximately $CAN 9·2 billion.

Further investments in the promotion of vegetables and fruit will prevent chronic disease and substantially reduce direct and indirect health-care costs.

To investigate how the priorities of high consumers of fruit and vegetables differ from those of low consumers, with respect to food choice motivations, and to identify what value high and low consumers place on different aspects of food choice behaviour.

A 4-day food diary and a questionnaire, including The Food Choice Questionnaire (FCQ) and a measure of Stage of Change (SOC) for fruit and vegetable consumption, were administered to subjects. Motivation scores from the FCQ were compared with fruit and vegetable intake and SOC data.

Nine hundred and ninety-eight females, aged 35–69 years, participating in the UK Women's Cohort Study.

In a multiple linear regression model, including age, education level and all FCQ motivations, the strongest motivations specifically affecting fruit and vegetable intake were health and natural content. It was found that, for a one point increase (measured on a scale of 0–4) in health and natural content scores, fruit and vegetable consumption increased by 1.11 portions (95% confidence interval (CI) 0.5–1.7) and 0.84 portions (95% CI 0.4–1.3), respectively (P>0.01). The SOC evaluation showed significant associations with portions of fruit and vegetables consumed (P>0.01). Women whose SOC was classed as maintenance phase were found to score higher on health, natural content, weight control and ethical concern factors (P>0.01). These women also scored lower on convenience questions (P>0.01).

In this particular group of women the most important motivating factors for food choice, within the high fruit and vegetable consumers, were health and natural content of the food.

To assess the nutritional quality of food packages offered in the Food Distribution Program on Indian Reservations (FDPIR) using the Healthy Eating Index 2010 (HEI-2010).

Data were collected from the list of the food products provided by the US Department of Agriculture’s Food and Nutrition Handbook 501 for FDPIR. Nutritional quality was measured through a cross-sectional analysis of five randomly selected food packages offered through FDPIR. HEI-2010 component and total scores were calculated for each food package. ANOVA and t tests assessed significant differences between food packages and HEI-2010 maximum scores, respectively.

This study took place in the USA.

Study units included food products offered through FDPIR.

The mean total HEI-2010 score for the combined FDPIR food packages was significantly lower than the total HEI-2010 maximum score of 100 (66·38 (sd 11·60); P<0·01). Mean scores for total fruit (3·52 (sd 0·73); P<0·05), total vegetables (2·58 (sd 0·15); P<0·001), greens and beans (0·92 (sd 1·00); P<0·001), dairy (5·12 (sd 0·63); P<0·001), total protein foods (4·14 (sd 0·56); P<0·05) and refined grains (3·04 (sd 2·90); P<0·001) were all significantly lower than the maximum values.

The FDPIR food package HEI-2010 score was notably higher than other federal food assistance and nutrition programmes. Study findings highlight opportunities for the FDPIR to modify its offerings to best support lifestyles towards prevention of diet-related chronic disease.

To compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age.

Diagnostic test accuracy study.

Paediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India.

Hospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome.

One hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P<0·001) and WHZ<−3 (2·0 (1·37, 2·99), P<0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC=0·698, WHZ=0·541, P<0·001). MUAC<11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ<−3 and/or MUAC<11·5 cm did not significantly improve the predictive value over that of MUAC/WHZ, assessed individually.

MUAC<11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ<−3. It should be measured in all emergency settings to identify the children at higher risk of death.

To evaluate the long-term effect on micronutrient status of a β-carotene-, iron- and iodine-fortified biscuit given to primary school children as school feeding.

Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years (n=108); in addition, cross-sectional data from three subsequent surveys conducted in the same school are reported.

A rural community in KwaZulu-Natal, South Africa.

Children aged 6–11 years attending the primary school where the biscuit was distributed.

There was a significant improvement in serum retinol, serum ferritin, haemoglobin, transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention. However, when the school reopened after the summer holidays, all variables, except urinary iodine, returned to pre-intervention levels. Serum retinol increased again during the next 9 months, but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays; this pattern was repeated in two further cross-sectional surveys. Haemoglobin gradually deteriorated at each subsequent assessment, as did serum ferritin (apart from a slight increase at the 42-month assessment at the end of the school year).

This study has shown that fortification of a biscuit with β-carotene at a level of 50% of the Recommended Dietary Allowance (RDA) was enough to maintain serum retinol concentrations from day to day, but not enough to sustain levels during the long school holiday break. Other long-term solutions, such as local food production programmes combined with nutrition education, should also be examined. The choice of the iron compound used as fortificant in the biscuit needs further investigation.

The present study aimed to review the literature on micronutrient deficiency and other factors influencing a deficiency status among children living in China.

A systematic review was performed to analyse the literature.

Studies were identified through a search of PubMed and secondary references.

Children living in China aged less than 18 years.

Sixty-one articles were included. The prevalence of vitamin A deficiency decreased to approximately 10 % in 1995–2009. It increased with age but no significant difference was found between genders. The prevalence of thiamin and vitamin B12 deficiency was 10·5 % in Yunnan and 4·5 % in Chongqing provinces, respectively. Higher vitamin D deficiency rates were seen in spring and winter. The incidence of bleeding due to vitamin K deficiency was 3·3 % in 1998–2001 and more prevalent in rural areas. Both iodine deficiency and excess iodine intake were observed. Goitre rates were reported in Tibet, Jiangxi, Gansu and Hong Kong (3·5–46 %). Anaemia rates ranged from 20 % to 40 % in 2007–2011. High Se deficiency rates were found in Tibet, Shaanxi and Jiangsu. High Zn deficiency rates were also found (50–70 %) in 1995–2006. Few studies reported Ca deficiency rates (19·6–34·3 %). The degrees of deficiency for vitamin A, vitamin B12, Fe and Zn were more substantial in rural areas compared with urban areas.

The prevalence of micronutrient deficiency rates varied. Socio-economic status, environmental factors and the Chinese diet may influence micronutrient deficiency. Public health policies should consider implementing programmes of supplementation, food fortification and nutrition education to address these deficiencies among Chinese children.

To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.

An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.

Twenty-two higher education institutions.

College students (n 17 686) enrolled at one of twenty-two participating universities.

Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).

College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.

The current study aimed to address the key areas of concern for child nutrition, both during and after the COVID-19 pandemic, and proposes strategic responses to reduce child undernutrition in the short and long term.

A descriptive literature review was performed. The search of the literature was conducted through using electronic databases including PubMed, Web of Science, Google Scholar and Cochrane library.

A wide range of published articles focused on child malnutrition were reviewed.

The study was focused on children especially those under 5 years.

The current study proposes strategic responses to reduce child undernutrition. These responses include strengthening access to community-based nutrition services that support the early detection and treatment of undernourished children and emergency food distribution, including fortified foods with vitamins and minerals, to vulnerable households, particularly those with children under 5 years. Moreover, counseling and promotion programmes should be reinforced to revitalise community nutrition education in areas such as gestation, exclusive breast-feeding and complementary feeding, and hygienic practices involving handwashing, proper sanitation and other basic behavioural changes.

The COVID-19 pandemic has affected many countries especially those in the regions of South Asia and sub-Saharan Africa in which there has been an ongoing burden of child undernutrition. However, malnutrition is preventable and can be eliminated through a multisectoral strategic approach. The effective execution of a multisectoral approach towards preventing childhood malnutrition will require not only a financial investment but also the collective efforts from different ministries of the governments, UN-affiliated agencies and non-governmental organisations.