The availability of iodized salt in households remains low in Bangladesh, which calls for improving the salt iodization quality and its coverage. The present study assessed the socio-economic disparity in Bangladesh to characterize the availability of iodized salt at household level.

Associations between different socio-economic factors and availability of iodized salt at household level were explored using Bayesian mixed-effects logistic models after adjusting the district- and cluster-level random effects.

Bangladesh Multiple Indicator Cluster Survey (MICS), 2012–13.

Households (sample size, n 50981).

Results showed that 73·15 % of household salt samples were iodized to some extent although iodization level varied. According to the regression model, houses with young (adjusted odds ratio of posterior mean (OR) = 1·31; 95 % credible interval (CI) 1·09, 1·64) and educated (OR = 3·66; 95 % CI 3·25, 4·23) household heads had significantly higher likelihood of availability of iodized salt. In addition, iodized salt was less likely be found in poor and rural households, as urban households were 2·88 times (95 % CI 2·41, 3·34) more likely have iodized salt. Moreover, the regional locations of the households were an important component that contributed to the local iodized salt coverage. As per the district-wise distribution, the north-west part of Bangladesh and Cox’s Bazar in the far south seemed to lack household-level iodized salt.

Our findings suggest that iodized salt intervention should be promoted considering the area variations, which could potentially help policy makers to design interventions in the context of Bangladesh.

Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand.

Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence.

Emerging hypertension and changing diets in Thailand.

TCS participants who were normotensive at baseline in 2005.

Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: ‘Modern’ and ‘Prudent’. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI.

Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.

The present study explored chronic disease management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, PA, USA.

In-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP households.

Interviews and surveys were conducted in a clinical setting at Children’s Hospital of Philadelphia, at participants’ homes, and in food procurement settings including grocery stores, food pantries and soup kitchens.

Eighteen adults who received SNAP; five with a diet-related chronic condition, five managing the chronic condition of a family member and thirteen with overweight or obesity.

All households had at least one member with a chronic disease or condition. Households reported that the dietary demands of managing chronic illnesses were expensive and mentally taxing. Food and financial shortfalls at the end of the benefit cycle, as well as reliance on charitable food assistance programmes, often had negative impacts on chronic disease self-management.

Drawing from nearly 50 h of in-depth qualitative interviews with SNAP participants, the study highlights the dual cognitive burden of poverty and chronic disease and elucidates the particular challenges of food procurement and maintenance of diet quality throughout the benefit month faced by SNAP households with diet-related chronic diseases. Interventions targeted at reducing the cost of medically appropriate, healthy foods may help to improve chronic disease self-management within SNAP populations.

The aim of the present study was to compare selected obesity indicators with comprehensive health status.

The study employed a pooled cross-sectional design.

BMI, waist circumference, waist-to-height ratio (WHtR) and body fat percentage were considered as indirect obesity indicators. The Edmonton Obesity Staging System (EOSS) was used as a composite indicator to comprehensively reflect obesity-related co-morbidities. Cohen’s κ coefficient was used to evaluate inter-measurement agreement for obesity. Conformity of indirect obesity indicators to the EOSS was assessed based on percentage agreement (proportion classified as obese and severely unhealthy as a result of obesity among the total sample), sensitivity (proportion classified as obese among individuals severely unhealthy as a result of obesity) and specificity (proportion classified as non-obese among fairly healthy individuals). Logistic regression analysis was used to identify the sociodemographic factors most strongly associated with conformity.

The study included 17338 adults from the Korea National Health and Nutrition Examination survey conducted between July 2008 and May 2011.

Level of conformity to the EOSS was highest for WHtR (60·77 %) and lowest for BMI (35·96 %). WHtR and BMI had the highest sensitivity (53·7 %) and specificity (98·4 %), respectively. Predictability of conformity was lower among men for all indirect obesity indicators.

WHtR has the greatest potential to identify individuals at risk of health problems due to obesity. Individual demographic factors must be considered in selecting the most appropriate obesity measurement.

To identify demographic risk factors associated with high stress and examine the relationships between levels of stress, demographics and dietary fat, fruit and vegetable intakes in low-income pregnant women with overweight or obesity.

A cross-sectional study.

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, USA.

Participants (n 353) were non-Hispanic Black (black) or White (white).

Women aged 35 years or older (OR=4·09; 95% CI 1·45, 11·51) and who had high school or less education (OR=1·88; 95% CI 1·22, 2·89) or were unemployed (OR=1·89; 95% CI 1·15, 3·12) were significantly more likely to report high stress than women who were younger, had at least some college education or were employed/homemakers. However, race and smoking status were not associated with level of stress. Women with high stress reported significantly lower fruit and vegetable intakes but not fat intake than women with low stress. Women aged 35 years or older reported significantly higher vegetable but not fat or fruit intake than women who were 18–24 years old. Black women reported significantly higher fat but not fruit or vegetable intake than white women. Education, employment and smoking status were not significantly associated with dietary intake of fat, fruits and vegetables.

Nutrition counselling on reducing fat and increasing fruit and vegetable intakes may consider targeting women who are black or younger or who report high stress, respectively.

We analysed the impact of the national general truck drivers’ strike on the availability, variety and price of foods sold by a food supply centre.

Descriptive study using secondary data to examine the percentage change in the mean price of fruits, vegetables and eggs before, during and after the strike. The strike in Brazil lasted 10 d from 21 to 30 May 2018. The drivers were on strike in order to make diesel oil tax-free and to obtain better working conditions.

The food supply centre, named CEASA-Minas Grande BH, was located in the metropolitan area of a Brazilian city.

We examined twenty types of foods.

After 10 d, there was a ~30 % reduction in the availability of all types of foods and prices increased. Foods with the highest price increases included cabbage (233·3 %), potatoes (220·0 %), papaya (160·0 %) and oranges (78·6 %). At the end of the strike, we observed reductions in the price of eggs, fruits, vegetables, roots and tubers; however, some foods remained more expensive than before the strike, including chayote (203·2 % higher), cucumber (66·7 % higher) and potatoes (60·0 % higher).

The general truck drivers’ strike was correlated with a reduction in the availability of food and, consequently, increases in price and possibly restrictions on access. The strike demonstrated the dependence of metropolises on road transportation and the conventional market. We speculate that initiatives aiming to shorten the food supply chain and promote food sovereignty and resilience of the supply circuits could be important.

The present study’s aim was to assess the impact of a nutrition-sensitive intervention on dietary diversity and home gardening among non-participants residing within intervention communities.

The study was a cross-sectional risk factor analysis using linear and logistic multivariate models.

In Tanzania, women and children often consume monotonous diets of poor nutritional value primarily because of physical or financial inaccessibility or low awareness of healthy foods.

Participants were women of reproductive age (18–49 years) in rural Tanzania.

Mean dietary diversity was low with women consuming three out of ten possible food groups. Only 23·4 % of respondents achieved the recommended minimum dietary diversity of five or more food groups out of ten per day. Compared with those who did not, respondents who had a neighbour who grew crops in their home garden were 2·71 times more likely to achieve minimum dietary diversity (95 % CI 1·60, 4·59; P=0·0004) and 1·91 times more likely to grow a home garden themselves (95 % CI 1·10, 3·33; P=0·02). Other significant predictors of higher dietary diversity were respondent age, education and wealth, and number of crops grown.

These results suggest that there are substantial positive externalities of home garden interventions beyond those attained by the people who own and grow the vegetables. Cost-effectiveness assessments of nutrition-sensitive agriculture, including home garden interventions, should factor in the effects on the community, and not just on the individual households receiving the intervention.

To characterize the food environment in schools that participated in the Study of Cardiovascular Risks in Adolescents (ERICA) and to identify individual and contextual factors associated with hypertension and obesity.

National school-based survey.

Blood pressure, weight and height were measured, and characteristics of the schools were obtained in interviews with the principals. For each outcome, multilevel models of mixed effects were applied by logistic regression.

School-going adolescents aged 12–17 years.

A total of 73 399 adolescents were evaluated. The prevalence of hypertension was 9·6 (95 % CI 9·0, 10·3) % and that of obesity was 8·4 (95 % CI 7·9, 8·9) %. Approximately 50 % of the adolescents were able to purchase food at school and in its immediate vicinity and 82 % had access to no-charge meals through Brazil’s National School Feeding Program. In the adjusted analysis, hypertension was associated (OR; 95 % CI) with the consumption of meals prepared on the school premises (0·79; 0·69, 0·92), the sale of food in the school’s immediate vicinity (0·67; 0·48, 0·95) and the purchase of food in the school cafeteria (1·29; 1·11, 1·49). It was observed that there were lower odds of obesity among students who were offered meals prepared on the school premises (0·68; 0·54, 0·87).

High frequency of sales of ultra-processed foods in schools was identified. Contextual and individual characteristics in the school food environment were associated with hypertension and obesity, pointing to the need for regulation and supervision of these spaces.

The aim of the present study was to clarify the global relationship between Mediterranean diet score (MDS) and the incidence of IHD by country using international statistics.

The incidence of IHD by country was derived from the Global Burden of Disease (GBD) database. Average supplies of food (g/d per capita) and energy (kcal/d per capita) by country, excluding loss between production and household, were obtained from the FAOSTAT database. MDS was evaluated based on the total score of nine food items that characterize the Mediterranean diet. The association between MDS and the incidence of IHD was examined in countries with a population of 1 million or greater using a general linear model controlled for socio-economic and lifestyle variables.

Population data from global international databases.

One hundred and thirty-two countries with a population of over 1 million.

MDS was inversely correlated with obesity rate, ageing rate, years of education and IHD incidence; however, no associations were found with gross domestic product, life expectancy, smoking rate, energy supply or health expenditure. In the general linear model of IHD incidence by MDS controlled for socio-economic and lifestyle variables, the β of the MDS was –26·4 (se 8·6; P<0·01).

The results of this global international comparative study confirmed that the Mediterranean diet is inversely associated with the incidence of IHD.

To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure.

Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles.

Non-probability sample of low-income and food-insecure households in South Carolina, USA.

Parent–child dyads (n 171). Parents were ≥18 years old and children were 9–15 years old.

We found a significant interaction between authoritative and authoritarian parenting style scores. For those with a mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 3·36, P < 0.05). For those with an authoritarian score that was 1 sd above the mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 8.42, P < 0.01). For those with an authoritarian score that was −1 sd below the mean authoritarian score, each unit increase in authoritative score was associated with a lower HEI-2005 score; however, this was not significant (b = −1·69, P > 0·05). Permissive parenting style scores were negatively associated with child dietary quality (b = −2·79, P < 0·05).

Parenting styles should be considered an important variable that is associated with overall dietary quality in children living within low-income and food-insecure households.

To verify differences in the availability, variety, quality and price of unprocessed and ultra-processed foods in supermarkets and similar establishments in neighbourhoods with different social deprivation levels at Juiz de Fora, Minas Gerais, Brazil.

Cross-sectional study.

The Obesogenic Environment Study in São Paulo’s Food Store Observation Tool (ESAO-S) was applied in thirty-three supermarket chains, wholesale and retail supermarkets.

Fruits, vegetables and ultra-processed foods were available in almost all establishments, without differences according to Health Vulnerability Index (HVI; which varies from 0 to 1 point and the higher the worse; P > 0·05). Most establishments were concentrated in low vulnerability areas and offered healthy foods with greater variety and quality, despite higher prices. The Healthy Food Store Index (HFSI; which varies from 0 to 16 points and the higher the best) was calculated from the ESAO-S and the mean score was 8·91 (sd 1·51). The presence and variety of unprocessed foods count as positive points, as do the absence of ultra-processed products. When HFSI was stratified by HVI, low HVI neighbourhoods presented higher HFSI scores, compared with medium, high and very high HVI neighbourhoods (P = 0·001).

Supermarkets and similar establishments are less dense in areas of greater social deprivation and have lower prices of healthy foods, but the variety and quality of those foods are worse, compared with areas of low vulnerability. We found worse HFSI for supermarkets located in areas with greater vulnerability. Those findings can guide specific public policies improving the urban food environment.

Processed foods and fatty, sugary snacking products, such as fizzy drinks and desserts, have become more popular, causing a desire to replace meals with snacks worldwide. High-sugar and fat-rich food components have been reported to be associated with increased level of dental caries as well as underweight and overweight. The aim of the present cross-sectional population-based study was to analyse the eating behaviours of young, healthy Finnish males in association with oral health and BMI, considering self-reported and residential background factors.

Cross-sectional study.

Finnish Defence Forces, Finland.

The used clinical data were gathered from 13 564 Finnish conscripts born in the beginning of the 1990s through clinical check-ups. In addition, about 8700 of the conscripts answered a computer-assisted questionnaire (‘Oral Health of the Conscripts 2011’ data) about their background information and health habits.

There was distinct variation in dietary patterns. Eating breakfast, regular physical exercise and daily tooth brushing all decreased the odds for restorative dental treatment need (decayed teeth), whereas smoking and drinking fizzy drinks for quenching thirst increased it. Eating breakfast and dinner were each associated with lower BMI, but smoking increased the odds for higher BMI (≥25 kg/m2).

Regular, proper meals and especially eating breakfast decreased the odds for both dental caries and high BMI (≥25 kg/m2).

Consumption of fruits and vegetables has been shown to contribute to mental and cognitive health in older adults from Western industrialized countries. However, it is unclear whether this effect replicates in older adults from non-Western developing countries. Thus, the present study examined the contribution of fruit and vegetable consumption to mental and cognitive health in older persons from China, India, Mexico, Russia, South Africa and Ghana.

Representative cross-sectional and cross-national study.

We used data from the WHO Study on Global Ageing and Adult Health (SAGE), sampled in 2007 to 2010. Our final sample size included 28 078 participants.

Fruit and vegetable consumption predicted an increased cognitive performance in older adults including improved verbal recall, improved delayed verbal recall, improved digit span test performance and improved verbal fluency; the effect of fruit consumption was much stronger than the effect of vegetable consumption. Regarding mental health, fruit consumption was significantly associated with better subjective quality of life and less depressive symptoms; vegetable consumption, however, did not significantly relate to mental health.

Consumption of fruits is associated with both improved cognitive and mental health in older adults from non-Western developing countries, and consumption of vegetables is associated with improved cognitive health only. Increasing fruit and vegetable consumption might be one easy and cost-effective way to improve the overall health and quality of life of older adults in non-Western developing countries.

To study infant and young child feeding (IYCF) practices and their association with nutritional status among young children.

A community-based, cross-sectional study was carried out in ten states of India, using a multistage random sampling method. Anthropometric measurements such as length/height and weight were conducted and nutritional assessment was done using the WHO child growth standards.

National Nutrition Monitoring Bureau survey, 2011–2012.

Children aged <3 years and their mothers.

Only 36 % of infants received breast-feeding within an hour of birth and 50 % were exclusively breast-fed up to 6 months. Prevalence of underweight, stunting and wasting was 38, 41 and 22 %, respectively. The chance of undernutrition among <3-year-old children was significantly higher among those from scheduled caste/scheduled tribe communities, the lowest-income group, with illiterate mothers and lack of sanitary latrine. Among infants, the chance of undernutrition was significantly higher among low-birth-weight babies, and among children whose mother had not consumed iron–folic acid tablets during pregnancy. Immunization practices and minimum dietary diversity were observed to be associated with undernutrition among 12–23-month-old children.

Undernutrition is still an important public health problem in India and observed to be associated with low socio-economic status, illiteracy of mother, low birth weight and dietary diversity. Improving socio-economic and literacy status of mothers can help in improving maternal nutrition during pregnancy and thus low birth weight. Also, improving knowledge of mothers about IYCF practices will help in improving children’s nutritional status.

Epidemiological studies have indicated that dietary patterns during pregnancy are associated with adverse pregnancy and birth outcomes such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth (PTB) and low birth weight (LBW). However, the results of these studies are varied and inconsistent. The present study aimed to assess the association between dietary patterns and the risk of adverse pregnancy and birth outcomes.

Systematic review and meta-analysis. Seven databases were searched for articles. Two reviewers performed the study selection and data extraction. A random-effects model was used to estimate pooled effect sizes of eligible studies.

Studies conducted all over the world were incorporated.

The review focused on pregnant women.

A total of twenty-one studies were identified. Adherence to a healthy dietary pattern (intake of vegetables, fruits, legumes, whole grains) was significantly associated with lower odds (OR; 95 % CI) of pre-eclampsia (0·78; 0·70, 0·86; I2=39·0 %, P=0·178), GDM (0·78; 0·56, 0·99; I2=68·6 %, P=0·013) and PTB (0·75; 0·57, 0·93; I2=89·6 %, P=0·0001).

Our review suggests that dietary patterns with a higher intake of fruits, vegetables, legumes, whole grains and fish are associated with a decreased likelihood of adverse pregnancy and birth outcomes. Further research should be conducted in low-income countries to understand the impact of limited resources on dietary intake and adverse pregnancy and birth outcomes.

To examine whether an intervention consisting of a WIC-based farmers’ market, nutrition education, recipe demonstrations and tastings, and handouts could be implemented as intended and the acceptability of the programme to recipients. The availability, variety and prices of fruits and vegetables (F&V) and the Farmers’ Market Nutrition Program voucher redemption rate at the site with market (relative to the rate among fourteen other WIC agency sites) also were examined.

Site-level data were used to evaluate programme implementation. Acceptability was assessed with participant data.

A large, New Jersey-based, urban WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) agency.

Fifty-four women who purchased F&V at the market.

Gaps in stakeholder communication and coordination, F&V selling out by midday and staffing levels affected implementation fidelity. On average, 12 (sd 3) F&V were available daily at the market (twenty-five unique F&V in total). For thirteen of nineteen items, prices were lower at the WIC-based market than area farmers’ markets. The voucher redemption rate at the site with the market (46 %) was higher than the rate among the fourteen other sites (39 %; P < 0·01). The mean rating of satisfaction with the programme was 6·9 (sd 0·6) on a 7-point scale. All participants reported intending to purchase F&V again at the market, owing to the convenient location, quality of the F&V and helpfulness of the staff. Improving F&V availability and variety were recommended.

The intervention is feasible with improved stakeholder communication and coordination, F&V availability and variety, and staffing.

To examine the impact of a community culinary coaching programme (CCCP) on cafeteria food alignment with a freshly prepared Mediterranean-style diet, and diners’ consumption habits and satisfaction.

A non-randomized, controlled, community-based participatory research programme. CCCP included eight 90 min coaching sessions with a community steering committee, 22 h of kitchen staff training, 12 h of pre-school staff training and 30 h of education for diners; control communities received no intervention. Outcomes, measured before and 12 months after programme initiation, included cafeteria food alignment with a freshly prepared Mediterranean-style diet through a food items list derived from the cafeteria food purchasing software, and adult diners’ consumption habits and satisfaction through questionnaires.

Communal cafeterias of rural kibbutzim.

Intervention: kibbutz with 493 adults and 214 children. Control: Two kibbutzim with a total of 487 adults and 206 children.

Intervention cafeteria food improved significantly in all Mediterranean index categories except nuts (legumes, wholegrain products, fish, MUFA/SFA P < 0·0001; fruits, vegetables P < 0·001; processed meats P = 0·004), and in the proportion of ultra-processed and unprocessed or minimally processed foods categories of the NOVA classification (−22 %, P < 0·001 and +7 %, P < 0·001, respectively), compared with the control community. The intervention group’s satisfaction was significantly improved in twenty-five (83 %) out of the thirty satisfaction items, compared with twelve (40 %) in the control group. No changes were identified in diners’ consumption habits in either intervention or control communities.

CCCP might be useful in improving alignment of cafeteria food with a freshly prepared Mediterranean-style diet.

To develop a new predictive equation for fat mass percentage (%FM) based on anthropometric measurements and to assess its ability to discriminate between obese and non-obese individuals.

Cross-sectional study.

Mexican adults.

Adults (n 275; 181 women) aged 20–63 years with BMI between 17·4 and 42·4 kg/m2.

Thirty-seven per cent of our sample was obese using %FM measured by air-displacement plethysmography (BOD POD®; Life Measurement Instruments). The fat mass was computed from the difference between weight and fat-free mass (FFM). FFM was estimated using an equation obtained previously in the study from weight, height and sex of the individuals. The %FM estimated from the obtained FFM showed a sensitivity of 90·3 (95 % CI 86·8, 93·8) % and a specificity of 58·0 (95 % CI 52·1, 63·8) % in the diagnosis of obesity. Ninety-three per cent of participants with obesity and 65 % of participants without obesity were correctly classified.

The anthropometry-based equation obtained in the present study could be used as a screening tool in clinical and epidemiological studies not only to estimate the %FM, but also to discriminate the obese condition in populations with similar characteristics to the participant sample.

There is a large literature linking current BMI to levels of cardiovascular risk biomarkers, but it is unknown whether measures of BMI earlier in the life course and maximum BMI are predictive of current levels of biomarkers. The objective of the current study was to determine how current, maximum and age-25 BMI among individuals over the age of 60 years are associated with their current levels of cardiovascular risk biomarkers.

Cross-sectional study with retrospective recall.

Costa Rica (n 821) and the USA (n 4110).

Nationally representative samples of adults aged 60 years or over.

We used regression models to examine the relationship between multiple meaures of BMI with four established cardiovascular risk biomarkers. The most consistent predictor of current levels of systolic blood pressure, TAG and HDL-cholesterol was current BMI. However, maximum BMI was the strongest predictor of glycosylated Hb (HbA1c) and was also related to HDL-cholesterol and TAG. HbA1c was independent of current BMI. We found that these relationships are consistent between Costa Rica and the USA for HbA1c and for HDL-cholesterol.

Current levels of cardiovascular risk biomarkers are not only the product of current levels of BMI, but also of maximum lifetime BMI, particularly for levels of HbA1c and for HDL-cholesterol. Managing maximum obtained BMI over the life course may be most critical for maintaining the healthiest levels of cardiovascular risk.