Limiting the intake of added sugars in the diet remains a key focus of global dietary recommendations. To date there has been no systematic monitoring of the major types of added sugars used in the Australian food supply. The present study aimed to identify the most common added sugars and non-nutritive sweeteners in the Australian packaged food supply.

Secondary analysis of data from the Australian FoodSwitch database was undertaken. Forty-six added sugars and eight non-nutritive sweetener types were extracted from the ingredient lists of 5744 foods across seventeen food categories.

Australia.

Not applicable.

Added sugar ingredients were found in 61 % of the sample of foods examined and non-nutritive sweetener ingredients were found in 69 %. Only 31 % of foods contained no added sugar or non-nutritive sweetener. Sugar (as an ingredient), glucose syrup, maple syrup, maltodextrin and glucose/dextrose were the most common sugar ingredient types identified. Most Australian packaged food products had at least one added sugar ingredient, the most common being ‘sugar’.

The study provides insight into the most common types of added sugars and non-nutritive sweeteners used in the Australian food supply and is a useful baseline to monitor changes in how added sugars are used in Australian packaged foods over time.

To compare the nutritional quality of New Zealand breakfast cereals in 2013 and 2017.

Nutrition Information Panel data were collected from all cereals available from two large supermarket chains in 2017 and compared with earlier published data collected in 2013.

Urban New Zealand supermarkets.

The nutritional content of breakfast cereals (‘biscuits and bites’, ‘brans’, ‘bubbles, flakes and puffs’, ‘children’s cereals’, ‘muesli’ and ‘oats’) was analysed for total energy, protein, fat (total and saturated), carbohydrate, sugar, fibre and Na. The Nutrient Profile Scoring Criterion (NPSC) for each cereal was calculated to determine the proportion of ‘less healthy’ cereals (NPSC≥4) in each product category.

The energy and fat content of bubbles, flakes and puffs, muesli and oats were significantly higher in 2017 compared with 2013 (all P≤0·01). However, there was a small reduction in Na overall in 2017 (P<0·05). There was no change between 2013 and 2017 in the proportion of ‘healthy’ or ‘less healthy’ breakfast cereals available.

The nutrient profile of breakfast cereals has not improved since 2013, suggesting that industry self-regulation of the nutritional composition of cereals in New Zealand is not working and needs urgent reconsideration.

To document changes in consumption of food away from home (FAFH) and intakes of selected nutrients by working-age adults between 2005–06 and 2013–14, covering the most recent recessionary period and recovery.

Means were compared across survey rounds relative to 2005–06. Multivariate regression was used to account for changes in demographic characteristics over time.

National Health and Nutrition Examination Survey (NHANES), 2005–2014.

Working-age adults born in 1951–80 (n 12 129) and adolescents and young adults born in 1981–90 (n 5197) who reported day 1 dietary intake data.

Approximately 34 % of energy consumed by working-age adults came from FAFH (14 % from fast foods) in 2005–06. Levels of FAFH consumption were lowest in 2009–10, at 28 and 11 % of energy from FAFH and fast foods, respectively. Percentage of energy from fast foods was 1·9 percentage points higher in 2013–14. Percentage of energy from saturated fat and total mg of cholesterol consumed were lower in 2009–14, while intake of fibre was higher in 2011–14. At-home foods had less saturated fat and more fibre in 2009–14. The greater the percentage of energy from FAFH in the day, the greater the intakes of fat and cholesterol. Percentage of energy from FAFH was highest among those born in 1981–90 and lowest among those born in 1951–60.

FAFH is a significant source of energy, fat and cholesterol among working-age adults. Menu labelling may lower FAFH’s energy content and make it easier for consumers to choose more healthful items.

Although a high intake of fat, particularly SFA, is a well-known risk factor for CVD, fat intake in Japan has attracted relatively little attention from health professionals to date due to the low intake in the Japanese population. However, recent surveys have shown an increase in fat intake in younger Japanese populations. Here, we described the fat intake and dietary sources of SFA in Japanese schoolchildren. Also, we experimentally exchanged a high-SFA food with a low-SFA substitute in the data, and calculated the resulting changes in nutrient intakes.

The study was conducted nationwide under a cross-sectional design. A non-consecutive, three-day diet record was performed on two school days and a non-school day.

Fourteen elementary and thirteen junior high schools.

Elementary-school children (n 629) and junior high-school children (n 281).

Prevalence of excess fat intake was 35·4 % in boys and 45·0 % in girls. Excess SFA intake was suspected in 97·7 % of boys and 99·4 % of girls when the dietary reference intake values for adults were applied. Major dietary sources of SFA were meat (26·4 % of total SFA intake), dairy products (25·7 %) and confectioneries (11·3 %).

Since one-third to nearly one-half of our Japanese schoolchildren consumed excess fat, careful monitoring of fat intake in the Japanese population should be continued. Adoption of low-fat milk and/or lean meat in daily meals might be a suitable means of reducing fat, particularly SFA intake, in schoolchildren.

To describe dietary patterns by applying cluster analysis and to describe the cluster memberships of European children over time and their association with body composition changes.

The analyses included k-means clustering based on the similarities between the relative frequencies of consumption of forty-three food items and regression models were fitted to assess the association between dietary patterns and body composition changes.

Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.

Participants (n 8341) in the baseline (2–9 years old) and follow-up (4–11 years old) surveys of the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) study.

Three persistent clusters were obtained at baseline and follow-up. Children consistently allocated to the ‘processed’ cluster presented increased BMI (β=0·050; 95 % CI 0·006, 0·093), increased waist circumference (β=0·071; 95 % CI 0·001, 0·141) and increased fat mass gain (β=0·052; 95 % CI 0·014, 0·090) over time v. children allocated to the ‘healthy’ cluster. Being in the ‘processed’–‘sweet’ cluster combination was also linked to increased BMI (β=0·079; 95 % CI 0·015, 0·143), increased waist circumference (β=0·172; 95 % CI 0·069, 0·275) and increased fat mass gain (β=0·076; 95 % CI 0·019, 0·133) over time v. the ‘healthy’ cluster.

Children consistently showing a processed dietary pattern or changing from a processed pattern to a sweet pattern presented the most unfavourable changes in fat mass and abdominal fat. These findings support the need to promote overall healthy dietary habits in obesity prevention and health promotion programmes targeting children.

Meal skipping is a relatively common behaviour during adolescence. As peer influence increases during adolescence, friendship groups may play a role in determining eating patterns such as meal skipping. The current study examined cross-sectional and longitudinal associations between perceived friends’ support of healthy eating and breakfast and lunch skipping among adolescents.

Survey of intrapersonal, social and environmental factors that may influence eating patterns at baseline (2004/05) and follow-up (2006/07).

Thirty-seven secondary schools in Victoria, Australia.

Sample of 1785 students aged 12–15 years at baseline.

Adolescents who reported that their friends sometimes or often ate healthy foods with them were less likely (adjusted OR; 95 % CI) to skip breakfast (sometimes: 0·71; 0·57, 0·90; often: 0·54; 0·38, 0·76) or lunch (sometimes: 0·61; 0·41, 0·89; often: 0·59; 0·37, 0·94) at baseline than those who reported their friends never or rarely displayed this behaviour. Although this variable was associated with lunch skipping at follow-up, there was no evidence of an association with breakfast skipping at follow-up. There was no evidence of an association between perceived encouragement of healthy eating, and an inconsistent relationship between perceived discouragement of junk food consumption, and meal skipping.

Friends eating healthy foods together may serve to reduce meal skipping during early adolescence, possibly due to the influence of directly observable behaviour and shared beliefs held by those in the same friendship group. Verbal encouragement or discouragement from friends may be less impactful an influence on meal skipping (than directly observable behaviours) in adolescents.

Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children’s overall diet quality (HEI-2010) and BMI percentile.

Cross-sectional baseline data (2012–2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.

Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.

Parent–child (ages 2–5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.

Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children.

Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile.

Research indicates that children are at higher risk for obesity if their parents have been exposed to a larger number of stressors, yet little is known about effects of parents’ subjective, perceived experience of stress on children’s eating behaviours and adiposity and whether weight-related parenting practices (i.e. parent rules and positive family meal practices) mediate this relationship. The present study evaluated the direct and mediated relationship between parent perceived stress and child waist circumference and parent stress and child consumption of added sugars one year later.

Longitudinal panel data.

Eleven communities in Southern California, USA.

Data were collected over two waves from parent–child dyads (n 599). Most parents were female (81 %) and Hispanic (51 %); children were 11 years old on average (sd 1·53; range 7–15 years) and 31 % received free school lunch.

Perceived parent stress was not significantly associated with child waist circumference or consumption of added sugars one year later, and mediating pathways through parenting practices were not significant. However, parent rules were significantly associated with lower child consumption of added sugars (β=−0·14, P<0·001).

Results suggest that parent rules about the types of foods children can eat, clearly explained to children, may decrease child consumption of added sugars but not necessarily lead to changes in obesity risk. Parent- and family-based interventions that support development of healthy rules about child eating have the potential to improve child dietary nutrient intake.

To (i) identify the major temporal patterns of energy intake among adults; (ii) examine the association between employment status and the patterns; and (iii) examine the association between dietary quality and the patterns.

Secondary analysis based on the cross-sectional population-based nutrition survey in Taiwan, 2005–2008. Based on energy intake levels at six time intervals of a day derived from 24 h recall data, we applied cluster analysis to identify major temporal patterns of energy intake. Self-reported employment status was categorized into six groups: full-time, part-time, no job, student, homemaker and retired. Multinomial logistic regression models were fitted to test the association between temporal patterns of energy intake and employment groups.

Non-institutionalized community dwellers.

Non-pregnant adults (≥19 years old) with total energy intake between 2092 and 20920 kJ/d (500 and 5000 kcal/d; n 4508).

Five major patterns were identified, which can be seen as the traditional meal pattern and its variants. About 20 % of adults had the traditional pattern. The most prevalent pattern was the delayed morning meal pattern (33 %), which had lower Ca and P intakes than the traditional pattern. About 14 % of adults had the delayed lunchtime pattern, which had lower protein, PUFA, fibre, Ca, P, vitamin D and vitamin E intakes than the traditional. Adjusted prevalence of the delayed lunchtime pattern was highest among full-time students (34 %), followed by part-time workers (24 %), and was lower in retired (8 %), homemakers (11 %) and full-time employed adults (12 %).

Adults’ temporal patterns of energy intake, which varied with their employment status, affected their dietary quality.

To investigate dietary intake, BMI and supermarket access at varying geographic scales and transport modes across areas of socio-economic disadvantage, and to evaluate the implementation of an urban planning policy that provides guidance on spatial access to supermarkets.

Cross-sectional study used generalised estimating equations to investigate associations between supermarket density and proximity, vegetable and fruit intake and BMI at five geographic scales representing distances people travel to purchase food by varying transport modes. A stratified analysis by area-level disadvantage was conducted to detect optimal distances to supermarkets across socio-economic areas. Spatial distribution of supermarket and transport access was analysed using a geographic information system.

Melbourne, Australia.

Adults (n 3128) from twelve local government areas (LGA) across Melbourne.

Supermarket access was protective of BMI for participants in high disadvantaged areas within 800 m (P=0·040) and 1000 m (P=0·032) road network buffers around the household but not for participants in less disadvantaged areas. In urban growth area LGA, only 26 % of dwellings were within 1 km of a supermarket, far less than 80–90 % of dwellings suggested in the local urban planning policy. Low public transport access compounded disadvantage.

Rapid urbanisation is a global health challenge linked to increases in dietary risk factors and BMI. Our findings highlight the importance of identifying the most appropriate geographic scale to inform urban planning policy for optimal health outcomes across socio-economic strata. Urban planning policy implementation in disadvantaged areas within cities has potential for reducing health inequities.

To explore associations between dietary quality and access to different types of food outlets around both home and school in primary school-aged children.

Cross-sectional observational study.

Hampshire, UK.

Children (n 1173) in the Southampton Women’s Survey underwent dietary assessment at age 6 years by FFQ and a standardised diet quality score was calculated. An activity space around each child’s home and school was created using ArcGIS. Cross-sectional observational food outlet data were overlaid to derive four food environment measures: counts of supermarkets, healthy specialty stores (e.g. greengrocers), fast-food outlets and total number of outlets, and a relative measure representing healthy outlets (supermarkets and specialty stores) as a proportion of total retail and fast-food outlets.

In univariate multilevel linear regression analyses, better diet score was associated with exposure to greater number of healthy specialty stores (β=0·025 sd/store: 95 % CI 0·007, 0·044) and greater exposure to healthy outlets relative to all outlets in children’s activity spaces (β=0·068 sd/10 % increase in healthy outlets as a proportion of total outlets, 95 % CI 0·018, 0·117). After adjustment for mothers’ educational qualification and level of home neighbourhood deprivation, the relationship between diet and healthy specialty stores remained robust (P=0·002) while the relationship with the relative measure weakened (P=0·095). Greater exposure to supermarkets and fast-food outlets was associated with better diet only in the adjusted models (P=0·017 and P=0·014, respectively).

The results strengthen the argument for local authorities to increase the number of healthy food outlets to which young children are exposed.

To study the association between density of stores (food and beverage stores, stores selling only fruits and vegetables, and supermarkets) and the BMI of adults aged ≥20 years in Mexico.

A cross-sectional study was performed. Individual data came from the 2012 National Health and Nutrition Survey, while information on stores was taken from the National Institute of Geography and Statistics’ National Statistics Directory of Economic Units. A weighted least-squares model was estimated to test the association between density of stores and BMI of adults adjusting for sex, age, education, presence of hypertension, diabetes or both, household assets index and marginality index at the municipality level.

Mexico.

An additional 1 sd in the density of fruit and vegetable stores was associated with a reduction of 0·24 (95 % CI −0·37, −0·12) kg/m2 in BMI when the densities of the other stores were at their mean values. For food and beverage store density, a difference of 1 sd was associated with an increase of 0·50 (95 % CI 0·33, 0·67) kg/m2 in BMI, while for supermarkets the corresponding association was a reduction of 0·48 (95 % CI −1·52, 0·56) kg/m2 in BMI.

In places with a higher density of stores that offer unhealthy foods, the BMI of adults tends to be higher.

The present study examined food and beverage distributors’ sourcing, placement and promotion of obesogenic (energy-dense, nutrient-poor) product categories from the perspective of small food store owners/managers. The obesogenic product categories of interest were savoury snacks, sugary beverages, sweet snacks, confectionery and frozen treats. Specifically, we examined how frequently distributors sourced these products, and the types of agreements and expectations they had for their placement and promotion. Differences were explored by store size and ethnicity. Fresh produce was used as a comparison when examining differences in frequency of sourcing only, with implications for healthy food access.

Survey research involving in-person interviews.

Four urban areas in the USA: Baltimore, MD; Durham, NC; Minneapolis/St. Paul, MN; and San Diego, CA.

Seventy-two small food store owners/managers, 65 % consent rate.

Most distributors sourced obesogenic products weekly. Agreements to place products were predominantly informal (e.g. handshake) with sweet snack, confectionery and frozen treat distributors, and formal (e.g. contract) with savoury snack and sugary beverage distributors. Free-standing displays were the most common incentive provided by distributors and they expected some control over their placement and pricing. Free/discounted products and signage were also common incentives but slotting fees were not. Smaller stores and ethnic stores were less likely to receive various incentives, but among sweet snack distributors, they were more likely to control the price in ethnic v. non-ethnic stores.

Obesogenic products are ubiquitous. Influencing what is made available to consumers in the retail food environment needs to consider the distributor.

To assess relationships between mothers’ feeding practices (food as a reward, food for emotion regulation, modelling of healthy eating) and mothers’ willingness to purchase child-marketed foods and fruits/vegetables (F&V) requested by their children during grocery co-shopping.

Cross-sectional. Mothers completed an online survey that included questions about feeding practices and willingness (i.e. intentions) to purchase child-requested foods during grocery co-shopping. Feeding practices scores were dichotomized at the median. Foods were grouped as nutrient-poor or nutrient-dense (F&V) based on national nutrition guidelines. Regression models compared mothers with above-the-median v. at-or-below-the-median feeding practices scores on their willingness to purchase child-requested food groupings, adjusting for demographic covariates.

Participants completed an online survey generated at a public university in the USA.

Mothers (n 318) of 2- to 7-year-old children.

Mothers who scored above-the-median on using food as a reward were more willing to purchase nutrient-poor foods (β=0·60, P<0·0001), mothers who scored above-the-median on use of food for emotion regulation were more willing to purchase nutrient-poor foods (β=0·29, P<0·0031) and mothers who scored above-the-median on modelling of healthy eating were more willing to purchase nutrient-dense foods (β=0·22, P<0·001) than were mothers with at-or-below-the-median scores, adjusting for demographic covariates.

Mothers who reported using food to control children’s behaviour were more willing to purchase child-requested, nutrient-poor foods. Parental feeding practices may facilitate or limit children’s foods requested in grocery stores. Parent–child food consumer behaviours should be investigated as a route that may contribute to children’s eating patterns.

Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors.

Factorial design randomized controlled trial.

Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA.

Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10–30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators.

All interventions showed significantly increased stock of promoted foods v. control. There was a significant treatment effect for daily unit sales of healthy snacks (β=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (β=–0·49, 95 % CI –0·90, –0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors.

All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.

Warnings are a new directive front-of-pack (FOP) nutrition labelling scheme that highlights products with high content of key nutrients. The design of warnings influences their ability to catch consumers’ attention and to clearly communicate their intended meaning, which are key determinants of their effectiveness. The aim of the present work was to evaluate the influence of design features of warnings as a FOP nutrition labelling scheme on perceived healthfulness and attentional capture.

Five studies with a total of 496 people were carried out. In the first study, the association of colour and perceived healthfulness was evaluated in an online survey in which participants had to rate their perceived healthfulness of eight colours. In the second study, the influence of colour, shape and textual information on perceived healthfulness was evaluated using choice-conjoint analysis. The third study focused on implicit associations between two design features (shape and colour) on perceived healthfulness. The fourth and fifth studies used visual search to evaluate the influence of colour, size and position of the warnings on attentional capture.

Perceived healthfulness was significantly influenced by shape, colour and textual information. Colour was the variable with the largest contribution to perceived healthfulness. Colour, size and position of the warnings on the labels affected attentional capture.

Results from the experiments provide recommendations for the design of warnings to identify products with unfavourable nutrient profile.

Recent studies have identified parents and children as two target groups whom Big Food hopes to positively influence through its corporate social responsibility (CSR) strategies. The current preliminary study aimed to gain an in-depth understanding of parents and children’s awareness and interpretation of Big Food’s CSR strategies to understand how CSR shapes their beliefs about companies.

Community-based qualitative semi-structured interviews.

New South Wales, Australia.

Parents (n 15) and children aged 8–12 years (n 15).

Parents and children showed unprompted recognition of CSR activities when shown McDonald’s and Coca-Cola brand logos, indicating a strong level of association between the brands and activities that target the settings of children. When discussing CSR strategies some parents and most children saw value in the activities, viewing them as acts of merit or worth. For some parents and children, the companies’ CSR activities were seen as a reflection of the company’s moral attributes, which resonated with their own values of charity and health. For others, CSR strategies were in conflict with companies’ core business. Finally, some also viewed the activities as harmful, representing a deceit of the public and a smokescreen for the companies’ ultimately unethical behaviour.

A large proportion of participants valued the CSR activities, signalling that denormalising CSR to sever the strong ties between the community and Big Food will be a difficult process for the public health community. Efforts to gain public acceptance for action on CSR may need greater levels of persuasion to gain public support of a comprehensive and restrictive approach.

To explore associations between diet-related greenhouse gas emissions (GHGE), nutrient intakes and adherence to the Nordic Nutrition Recommendations among Swedish adults.

Diet was assessed by 4d food records in the Swedish National Dietary Survey. GHGE was estimated by linking all foods to carbon dioxide equivalents, using data from life cycle assessment studies. Participants were categorized into quartiles of energy-adjusted GHGE and differences between GHGE groups regarding nutrient intakes and adherence to nutrient recommendations were explored.

Sweden.

Women (n 840) and men (n 627) aged 18–80 years.

Differences in nutrient intakes and adherence to nutrient recommendations between GHGE groups were generally small. The dietary intake of participants with the lowest emissions was more in line with recommendations regarding protein, carbohydrates, dietary fibre and vitamin D, but further from recommendations regarding added sugar, compared with the highest GHGE group. The overall adherence to recommendations was found to be better among participants with lower emissions compared with higher emissions. Among women, 27 % in the lowest GHGE group adhered to at least twenty-three recommendations compared with only 12 % in the highest emission group. For men, the corresponding figures were 17 and 10 %, respectively.

The study compared nutrient intakes as well as adherence to dietary recommendations for diets with different levels of GHGE from a national dietary survey. We found that participants with low-emission diets, despite higher intake of added sugar, adhered to a larger number of dietary recommendations than those with high emissions.