The use of food packaging as a vehicle for marketing to children is under investigated. Our objective was to determine the prevalence and types of child-directed promotional techniques used on food packaging in Australia.

Based on existing literature and regulations, we developed a framework to classify on-pack child-directed promotional techniques involving the use of characters and other elements that appeal to children. We analysed the packaging of all products in eight food categories available for sale from supermarkets in 2019 and recorded the use of child-directed promotions on pack. We assessed the number and proportion of products displaying child-directed promotional techniques overall and assessed the healthiness of products using child-directed promotions against four indicators of healthiness to provide summary data overall and for the manufacturers who most frequently employed child-targeted strategies.

Data were collected from the FoodSwitch database in Sydney, Australia.

901/8006 (11·3 %) products displayed one or more child-directed on-pack element. Most frequent was on foods for infants and young children (n 315), confectionery (n 283), snack foods (n 172) and dairy (n 168). Personified characters were the most commonly used element (n 512). Products using child-directed promotional techniques scored poorly on all four indicators of healthiness: mean health star rating 2·34 (out of 5); 81 % ultra-processed and 6·1 % and 4·5 % products eligible to market to children under Western Pacific and Mexican nutrient profiling schemes, respectively.

Australian children are targeted by promotional techniques on the packaging of unhealthy food products. Stronger regulation of these techniques is warranted to protect children’s health.

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.

It is unknown whether the nutritional quality of children’s menus varies depending on the cuisine type. This study aimed to investigate differences in the nutritional quality of children’s menus by cuisine type in restaurants located in Perth, Western Australia (WA).

Cross-sectional study

Perth, WA.

Children’s menus (n 139) from the five most prevalent restaurant cuisine types in Perth (i.e. Chinese, Modern Australian, Italian, Indian and Japanese) were assessed using the Children’s Menu Assessment Tool (CMAT; range -5–21 with lower scores denoting lower nutritional quality) and the Food Traffic Light system, evaluated against Healthy Options WA Food and Nutrition Policy recommendations. Non-parametric ANOVA was used to test for a significant difference in total CMAT scores among cuisine types.

Total CMAT scores were low for all cuisine types (range -2–5), with a significant difference between cuisine types (Kruskal–Wallis H = 58·8, P < 0·001). The highest total CMAT score by cuisine type was Modern Australian (mean = 2·27, sd = 1·41) followed by Italian (mean = 2·02, sd = 1·02), Japanese (mean = 1·80, sd = 2·39), Indian (mean = 0·30, sd = 0·97) and Chinese (mean = 0·07, sd = 0·83). When using the Food Traffic Light for assessment, Japanese cuisine had the highest percentage of green food items (44 %), followed by Italian (42 %), Modern Australian (38 %), Indian (17 %) and Chinese (14 %).

Overall, the nutritional quality of children’s menus was poor regardless of cuisine type. However, children’s menus from Japanese, Italian and Modern Australian restaurants scored better in terms of nutritional quality than children’s menus from Chinese and Indian restaurants.

To examine whether ready meals and equivalent home-cooked meals differ in nutritional quality indicators, greenhouse gas emissions (GHGE) and cost.

We performed a cross-sectional analysis of meal data from the National Diet and Nutrition Survey (NDNS) nutrient databank (2018/19). Additional data on nutrient composition, cost and cooking-related GHGE were calculated and compared between fifty-four ready meals and equivalent home-cooked meals.

The UK.

Not applicable.

Ready meals, overall and those that were animal-based, had significantly higher levels of free sugar compared with equivalent home-cooked meals (P < 0·0001 and P < 0·0004, respectively). Animal-based ready meals had significantly higher levels of GHGE (P < 0·001), whereas the cost of ready meals, overall, was significantly higher (P < 0·001), compared with equivalent home-cooked meals. Animal-based meals, whether ready meals or equivalent homemade meals, had significantly higher levels of protein (P < 0·0001), contained significantly more kilocalories (P = 0·001), had significantly higher levels of GHGE (P < 0·0001) and were significantly more expensive (P < 0·0001), compared with plant-based meals. Overall, plant-based meals home-cooked on the gas or electric stove had the lowest GHGE and cost, whereas animal-based oven-cooked ready meals had the highest levels of GHGE and were most expensive.

Ready meals have lower nutritional quality and higher GHGE and are more expensive than equivalent home-cooked meals, especially those meals that are animal-based and prepared in an oven.

To characterise the nutritional quality of food products targeted to children, we aimed: (1) to determine if the nutritional composition of child-targeted food products is different from those for the general population and (2) to verify differences in the nutrient content of child-targeted food products between three selected food categories.

The present study is part of the work conducted by the Food Quality Observatory, created in 2016 in the province of Quebec (Canada). Ready-to-eat (RTE) breakfast cereals (n 331), granola bars (n 310) and yoghurts and dairy desserts (n 380) were the food categories analysed.

Nutritional values and all packaging information were obtained by purchasing every product available in supermarkets, grocery stores and specialty grocery stores. Free sugars were manually differentiated from total sugars for each product. Products were classified according to two targeted consumer groups: children or general population.

The nutrient profile of RTE breakfast cereals, granola bars and yoghurts and dairy desserts targeted to children differed from that of products intended at the general population. Child-targeted RTE breakfast cereals had the least favourable nutritional composition, with significantly higher content of carbohydrates, total sugars, free sugars and Na compared with breakfast cereals for the general population as well as child-targeted granola bars and yoghurts and dairy desserts. All child-targeted products analysed contained free sugars.

The current study supports the relevance to further regulate marketing to children on food product packages to ensure that such marketing is not present on food products with poor nutritional quality.

The present study aimed at surveying the nutritional quality of prepacked biscuits and sweet snacks sold on the Italian market, and at identifying whether the product type and other information reported on the pack could discriminate the overall quality of products analysed.

Data on energy, nutrient and salt content of the products from two different categories of prepacked sweet cereal products (i.e. biscuits and sweet snacks) were collected from thirteen retailers present on the Italian market. Based on the product type, nutrition and health claim (NHC) and gluten-free (GF) declaration, a comparison of nutrient profile within each category was performed.

This work is part of the Food Labelling of Italian Products (FLIP) study that aims at systematically investigating the overall quality of the prepacked foods sold on the Italian market.

A total of 1290 products were analysed (63 % biscuits and 37 % sweet snacks). After comparing different product types within each category, a high intra-type product variability was evidenced, which was more pronounced for biscuits. Overall, NHC-carrying products seemed to have a better nutrition profile than those without claims, except for salt content. Conversely, a comparison between GF and gluten-containing products did not show consistent results within the two categories analysed.

Due to the high intra-type variability within each category, the different characteristics and regulated information reported on the pack do not seem to be a clear marker of the overall nutritional quality of biscuits and snacks.

The present study analysed and compared the nutritional qualities of private brand (PB) and national brand (NB) ready meal (RM) products in South Korea.

Data on RM products were collected via a food information database (EatSight) between February and May of 2017. A total of ninety-one PB products from a leading discount store chain in South Korea and 415 NB products were selected and divided into four main categories of ‘refrigerated soups/stews’, ‘refrigerated noodles’, ‘frozen rice/noodles’ and ‘frozen dumplings’. Nutritional information was extracted for each product and analyses were performed to compare nutritional differences.

South Korea.

A total of 506 RM products.

PB products explained the highest percentage of refrigerated RM products while NB products occupied the highest percentage of frozen ones. Notably, main PB and NB products showed evident nutritional problems. Among PB products, refrigerated soups/stews were significantly higher in energy, fat, Na, saturated fat and trans-fat. Likewise, in the case of NB products, frozen rice/noodles were significantly higher in Na and saturated fat. Particularly, overall Na contents were high. When the Korean guidance on traffic-light labelling was applied, a mere 0·2 and 5·9 % of total RM products showed all four and three green lights, respectively. Meanwhile, those with no green lights accounted for 42·3 %.

Although it is difficult to draw a definitive conclusion on the comparative nutritional qualities due to the lack of consistency in the results, the study suggests that there is room to improve the nutritional qualities of overall RM products.

To identify differences in dietary quality, dietary greenhouse gas (GHG) emissions and food consumption over 20 years in a Dutch cohort.

Participants (n 8932) filled out an FFQ in 1993–1997 and in 2015. The Dutch Healthy Diet index 2015 (DHD15-index) score, GHG emissions and consumption of food groups (g/4184 kJ (1000 kcal)) were compared between the time points with paired t tests.

The Netherlands.

European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) cohort, aged 18–65 years at baseline.

Total energy intake decreased by –678 (95 % CI –4908, 3377) kJ/d (–162 (95 % CI –1173, 807) kcal/d) for men and –372 (95 % CI –3820, 3130) kJ/d (–89 (95 % CI –913, 748) kcal/d) for women. DHD15-index scores increased by 11 % (from 64·8 to 71·9 points) and 13 % (from 65·2 to 73·6 points) in men and women, respectively (P < 0·0001), mainly due to an increased (shell)fish and nuts/seeds/nut paste consumption. After energy intake adjustment, dietary-related GHG emissions increased by 5 % in men (2·48–2·61 kg CO2-eq/4184 kJ (1000 kcal), P < 0·0001) and were similar in women (0·4 %, 2·70–2·71 kg CO2-eq/4184 kJ (1000 kcal), P = 0·3930) due to the increased consumption of (shell)fish, nuts/seeds/nut paste, poultry and higher GHG-intensive red meats such as beef.

This Dutch cohort analyses showed more healthy diets without mitigated GHG emissions over a 20-year period, at similar energy intakes. Higher consumption of (shell)fish and poultry was not yet at the expense of red and processed meat. Lower consumption of animal-based foods is needed to achieve healthier as well as environmentally friendly diets.

To determine if US household food purchases with lower levels of red meat spending generate lower life-cycle greenhouse gas emissions (GHGE), greater nutritional quality and improved alignment with the Dietary Guidelines for Americans. Affordability of purchasing patterns by red meat spending levels was also assessed.

Household food purchase and acquisition data were linked to an environmentally extended input–output life-cycle assessment model to calculate food GHGE. Households (n 4706) were assigned to quintiles by the share of weekly food spending on red meat. Average weekly kilojoule-adjusted GHGE, total food spending, nutrients purchased and 2010 Healthy Eating Index (HEI-2010) were evaluated using ANOVA and linear regression.

USA.

Households participating in the 2012–2013 National Household Food Acquisition and Purchase Survey.

There was substantial variation in the share of the household food budget spent on red meat and total spending on red meat. The association between red meat spending share and total food spending was mixed. Lower red meat spending share was mostly advantageous from a nutritional perspective. Average GHGE were significantly lower and HEI-2010 scores were significantly higher for households spending the least on red meat as a share of total food spending.

Only very low levels of red meat spending as a share of total food spending had advantages for food affordability, lower GHGE, nutrients purchased and diet quality. Further studies assessing changes in GHGE and other environmental burdens, using more sophisticated analytical techniques and accounting for substitution towards non-red meat animal proteins, are needed.

To evaluate the association between ultra-processed food intake and all-cause mortality and CVD mortality in a nationally representative sample of US adults.

Prospective analyses of reported frequency of ultra-processed food intake in 1988–1994 and all-cause mortality and CVD mortality through 2011.

The Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994).

Adults aged ≥20 years (n 11898).

Over a median follow-up of 19 years, individuals in the highest quartile of frequency of ultra-processed food intake (e.g. sugar-sweetened or artificially sweetened beverages, sweetened milk, sausage or other reconstructed meats, sweetened cereals, confectionery, desserts) had a 31% higher risk of all-cause mortality, after adjusting for demographic and socio-economic confounders and health behaviours (adjusted hazard ratio=1·31; 95% CI 1·09, 1·58; P-trend = 0·001). No association with CVD mortality was observed (P-trend=0·86).

Higher frequency of ultra-processed food intake was associated with higher risk of all-cause mortality in a representative sample of US adults. More longitudinal studies with dietary data reflecting the modern food supply are needed to confirm our results.

Hunger relief agencies have a limited capacity to monitor the nutritional quality of their food. Validated measures of food environments, such as the Healthy Eating Index-2010 (HEI-2010), are challenging to use due to their time intensity and requirement for precise nutrient information. A previous study used out-of-sample predictions to demonstrate that an alternative measure correlated well with the HEI-2010. The present study revised the Food Assortment Scoring Tool (FAST) to facilitate implementation and tested the tool’s performance in a real-world food pantry setting.

We developed a FAST measure with thirteen scored categories and thirty-one sub-categories. FAST scores were generated by sorting and weighing foods in categories, multiplying each category’s weight share by a healthfulness parameter and summing the categories (range 0–100). FAST was implemented by recording all food products moved over five days. Researchers collected FAST and HEI-2010 scores for food availability and foods selected by clients, to calculate correlations.

Five food pantries in greater Minneapolis/St. Paul, Minnesota, USA.

Food carts of sixty food pantry clients.

The thirteen-category FAST correlated well with the HEI-2010 in prediction models (r = 0·68). FAST scores averaged 61·5 for food products moved, 63·8 for availability and 62·5 for client carts. As implemented in the real world, FAST demonstrated good correlation with the HEI-2010 (r = 0·66).

The FAST is a flexible, valid tool to monitor the nutritional quality of food in pantries. Future studies are needed to test its use in monitoring improvements in food pantry nutritional quality over time.