To evaluate the relationship between neighbourhood food environment perceptions and obesity among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) or Expanded Food and Nutrition Education Program (EFNEP) participants.

A cross-sectional study conducted during SNAP-Ed or EFNEP programme participation in six states in the Midwest US between May 2016 and November 2017.

Community centres, food pantries and other SNAP-Ed or EFNEP recruitment locations.

Convenience sample of 1743 low-income, adult nutrition education programme participants.

Controlling for participant location and other demographic variables, those who perceived that a large selection of fruits and vegetables were available to them were 22 % less likely to be obese (adjusted odds ratio 0·78, 95 % CI 0·63, 0·97). In addition, participants who perceived the distance to the grocery store where they purchased most of their groceries to be greater than 5 miles were 1·36 times more likely to be overweight or obese than those who travelled shorter distances for their groceries.

SNAP-Ed or EFNEP participants’ weight status may be associated with their perceptions of their neighbourhood food environments. Programmes incorporating nutrition education and food access initiatives should attempt to better understand participant perceptions in order to address barriers in their efforts and to ensure that healthy food is accessible to low-income residents.

We performed the cohort study to evaluate the association between BMI, high-sensitivity C-reactive protein (hs-CRP) and the conversion from metabolically healthy to unhealthy phenotype in Chinese adults.

Metabolically healthy was defined as participants without history of metabolic diseases and with normal fasting blood glucose level, glycated Hb A1c level, blood pressure, lipid profile, serum uric acid level and liver ultrasonographic findings at baseline. Participants were either classified into normal weight (18·5 ≤ BMI < 24·0 kg/m2) and overweight (BMI ≥ 24·0 kg/m2) based on baseline BMI, or low (<1 mg/l) and high (≥1 mg/l) groups based on baseline hs-CRP. The conversion from metabolically healthy to unhealthy phenotype was deemed if any of the metabolic abnormalities had been confirmed twice or more during 5 years of follow-up.

Included were 4855 (1942 men and 2913 women, aged 36·0 ± 8·9 years) metabolically healthy Chinese adults. We identified 1692 participants who converted to metabolically unhealthy phenotype during the follow-up. Compared with their counterparts, the adjusted hazards ratio of the conversion was 1·19 (95 % CI 1·07, 1·33) for participants with overweight, while it was 1·15 (95 % CI 1·03, 1·29) for those with high hs-CRP level (≥1 mg/l). Further adjustment of hs-CRP did not materially change the association between BMI and the conversion. However, the association between hs-CRP and the conversion was not significant after further adjustment of BMI. The sensitivity analysis generated similar results to main analysis.

BMI was associated with the risk of the conversion from metabolically healthy to unhealthy status in Chinese adults.

To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels.

We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child.

Nationally representative surveys from ninety-three LMIC.

A total of 825 633 children were studied.

DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt.

The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.

The current study evaluated the associations between different forms and sources of Fe and breast cancer risk in Southern Chinese women.

Case–control study. We collected data on the consumption of Fe from different forms and food sources by using a validated FFQ. Multivariable logistic regression and restricted cubic spline (RCS) analysis was used to reveal potential associations between Fe intake and breast cancer risk.

A case-control study of women at three major hospitals in Guangzhou, China.

From June 2007 to March 2019, 1591 breast cancer cases and 1622 age-matched controls were recruited.

In quartile analyses, Fe from plants and Fe from white meat intake were inversely associated with breast cancer risk, with OR of 0·65 (95 % CI 0·47, 0·89, Ptrend = 0·006) and 0·76 (95 % CI 0·61, 0·96, Ptrend = 0·014), respectively, comparing the highest with the lowest quartile. No associations were observed between total dietary Fe, heme or non-heme Fe, Fe from meat or red meat and breast cancer risk. RCS analysis demonstrated J-shaped associations between total dietary Fe, non-heme Fe and breast cancer, and reverse L-shaped associations between heme Fe, Fe from meat and Fe from red meat and breast cancer.

Fe from plants and white meat were inversely associated with breast cancer risk. Significant non-linear J-shaped associations were found between total dietary Fe, non-heme Fe and breast cancer risk, and reverse L-shaped associations were found between heme Fe, Fe from meat or red meat and breast cancer risk.

To explore the effect of maternal BMI class pre-pregnancy (overweight/obese v. healthy weight/underweight) on childhood diet quality and on childhood overweight/obesity risk.

Dietary data were collected using 3-d parental-completed food records for their children at ages 18 and 43 months. An index of diet quality was derived by classification of food items into core and non-core foods. Adjusted multiple linear regression analyses were used to explore the effect of maternal BMI class on diet quality in their children.

Avon, UK.

A 10% subsample of the Avon Longitudinal Study of Parents and Children. Nine-hundred and eighty children provided complete dietary data at 18 months and 769 at 43 months.

Children with overweight/obese mothers consumed greater amounts of energy from non-core foods than children with healthy weight/underweight mothers (0·20 MJ (48 kcal)/d more at 18 months (P < 0·001); 0·19 MJ (45 kcal)/d more at 43 months (P = 0·008)) in adjusted models. Diet quality deteriorated between 18 and 43 months (children reduced their dietary energy intake from core foods (P < 0·001) and increased intake from non-core foods (P < 0·001)). However, this change was not associated with maternal BMI class in adjusted models. Having an overweight/obese mother was associated with an increased odds of the child being overweight/obese at 43 months (OR 1·74 (1·17, 2·58)).

Children aged 18 and 43 months with overweight/obese mothers are likely to have a poorer quality diet than those with healthy/underweight mothers. Parents should be supported in discouraging the consumption of non-core foods in children at these ages.

Food delivery apps represent an important and emerging dimension of the digital food environment. This study aimed to examine food availability and the use of marketing strategies by two food delivery apps in a Brazilian metropolis.

An exploratory study was conducted in the city of Belo Horizonte, Minas Gerais. Food groups were identified and the use of price discounts and photos by the apps was observed.

Eighteen neighbourhoods and the ten best rated restaurants in each app.

Three hundred sixty-two commercial food establishments.

The proportion of ultra-processed beverages on offer in the apps (78·45 %) was much higher in comparison with water (48·89 %), natural juices or smoothies (27·07 %). Ultra-processed ready-to-eat meals represented almost 70 % of the food offered in the establishments’ menus, while traditional meals and vegetables represented just over 30 % of the offering. Ice cream, candies and salty packaged snacks were nine times more frequently presented than fruits. The use of photos and price discounts prevailed predominantly among ultra-processed beverages, sandwiches and ice cream, candies and salty packaged snacks. These marketing strategies were least used for promoting fruits and vegetables.

Restaurants registered on food delivery apps offered a significant amount of ultra-processed foods with price discounts and photos in comparison with unprocessed and minimally processed foods.

Existing research suggests walnut intake may be associated with better cognitive function in older adults, yet few studies utilise longitudinal data from observational studies of ageing populations. Our objective was to estimate the association between whole walnut intake and cognitive change in a representative sample of older Americans.

Secondary analysis of the Health and Retirement Study and Health Care and Nutrition Study. Walnut consumption was defined as a categorical measure (none, low intake (0·01–0·08 1 oz. servings per day) and moderate intake (>0·08 1 oz. servings per day)) and cognitive function was measured using the Telephone Interview for Cognitive Status. Latent growth modelling estimated the association between walnut consumption and trajectories of cognitive status over a 4-year observational period. Sensitivity analyses assessing non-random dropout and Monte Carlo power analyses were conducted to contextualise results.

The USA.

A sample of 3632 US adults aged 65 years and older.

Those reporting any walnut consumption had greater cognitive scores at baseline than those not consuming walnuts (low walnut consumption, b = 1·53, se = 0·21, P < 0·001; moderate walnut consumption, b = 2·22, se = 0·27, P < 0·001), but walnut consumption was not associated with cognitive change. Walnut consumption was positively associated with socioeconomic status and health behaviours as well as intake of nutrients identified to have neuroprotective benefits.

We identified an association between walnut consumption and cognitive function in older adults, although we did not find that walnut consumption was protective against age-related cognitive decline.

Family meals promote healthful dietary intake and well-being among children. Despite these benefits, family meal participation typically declines as children age. This study utilises life course theory to explore parents’ perceptions of family meals in order to understand how parents’ past experiences with family meals (in childhood and earlier in adulthood) influence their current beliefs and practices regarding mealtimes with their own children.

Semi-structured qualitative interviews.

In-person interviews were conducted in participants’ homes.

Twenty families (twenty-one mothers and fifteen fathers) with a child aged between 18 months and 5 years.

Thematic analysis revealed that families seemed to primarily approach mealtimes from one of three overarching orientations: meals for (1) Togetherness, (2) Nutrition Messaging or (3) Necessity. These orientations were informed by parents’ own mealtime experiences and significant life transitions (e.g. parenthood). The current family meal context, including the messages parents shared with their children during mealtimes and the challenges experienced with mealtimes, characterised the orientations and families’ approaches to mealtimes.

Parents’ own early life experiences and significant life transitions influence why families eat meals together and have important implications for the intergenerational transmission of mealtime practices. Results may help to inform the content and timing of intervention strategies to support the continuation of frequent family meals beyond the preschool years.

We examined associations of urine iodide excretion, proxy for iodine intake, with child development and growth.

This is a secondary analysis of a 1:1 cluster-randomised trial with a 6-month nutrition/stimulation/hygiene education intervention among mothers of children aged 6–8 months to improve child development and growth. Development was assessed using Bayley Scales of Infant and Toddler Development–III (BSID-III) and Ages and Stages Questionnaire (ASQ), whereas anthropometry was used to assess growth. Urine iodide concentration (UIC) and urine iodide/creatinine ratio (ICR) were measured.

The current study was conducted in southern Uganda.

We randomly selected 155 children from the 511 enrolled into the original trial and analysed data when they were aged 20–24 and 36 months.

Median UIC for both study groups at 20–24 and 36 months were similar (P > 0·05) and within the normal range of 100–199 µg/l (0·79–1·60 µmol/l), whereas the intervention group had significantly higher ICR at 20–24 months. The BSID-III cognitive score was positively associated (P = 0·028) with ICR at 20–24 months in the intervention group. The ASQ gross motor score was negatively associated (P = 0·020) with ICR at 20–24 months among the controls. ICR was not significantly associated with anthropometry in the two study groups at either time-point.

Following the intervention, a positive association was noted between ICR and child’s cognitive score at 20–24 months, whereas no positive association with ICR and growth was detected. Iodine sufficiency may be important for child’s cognitive development in this setting.

Osteoarthritis (OA) is associated with functional limitations that can impair mobility and reduce quality of life in affected individuals. Excess body weight in OA can exacerbate impaired physical function, highlighting the importance of weight management in this population. The aim of this systematic review was to compare the effects of different dietary interventions for weight loss on physical function in overweight and obese individuals with OA.

A comprehensive search of five databases was conducted to identify relevant articles for inclusion. Studies were included that examined the effect of dietary weight loss interventions, with or without exercise, on physical function in adults with OA who were overweight or obese. Quality and risk of bias were assessed using the Quality Criteria Checklist for primary research. Primary and secondary outcomes were extracted, including change in weight and physical function which included performance-based and self-report measures.

Nineteen relevant studies were included, which incorporated lifestyle interventions (n 8), diet in combination with meal replacements (DMR; n 5) and very low-energy diets (VLED; n 6) using meal replacements only. Pooled data for eight RCT indicated a mean difference in Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical function of 12·4 and 12·5 % following DMR or VLED interventions, respectively; however, no statistically significant change was detected for lifestyle interventions.

Our findings suggest that partial use of meal replacements is as effective as their sole use in the more restrictive VLED. Both dietary interventions are more effective than lifestyle programmes to induce significant weight loss and improvements in physical function.

To elucidate mechanisms across family function, home environment and eating behaviours within sociocultural context among Hispanic youth.

Two models tested via path analysis (youth fruit and vegetable (FV) consumption; empty energy consumption) using data from the Study of Latino Youth (2011–2013).

Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.

Youth (8–16-year-olds), n 1466.

Youth ate 2·4 servings of FV per d and received 27 % of total energy from empty energies. Perceiving higher acculturative stress was indirectly associated with lower FV consumption via a pathway of low family function and family support for FV (β = −0·013, P < 0·001) and via lower family closeness and family support (β = −0·004, P = 0·004). Being >12-year-olds was indirectly associated with lower FV consumption via lower family closeness and family support (β = −0·006, P < 0·001). Household food security was indirectly associated with greater FV consumption via family closeness and family support (β = 0·005, P = 0·003). In contrast, perceiving higher acculturative stress was indirectly associated with higher empty energy consumption (via family closeness and family support: β = 0·003, P = 0·028 and via low family function and low family support: β = 0·008, P = 0·05). Being older was associated with higher consumption of empty energies via family closeness (related to family support: β = 0·04, P = 0·016; parenting strategies for eating: β = 0·002, P = 0·049).

Findings suggest pathways of influence across demographic and sociocultural context, family dynamics and home environment. The directionality of these associations needs confirmation using longitudinal data.

To understand how healthy menu labelling information is used by parents/caregivers and where it fits within predictors of healthy meal choices when eating out.

Parents were recruited to complete a 15-min observational, online survey regarding their experiences and hypothetical choices when eating out with their child/ren.

Australia.

Eligible participants had one or more child/ren aged between 2 and 12 years and attended cafes, restaurants, hotels and clubs (CRHC) for lunch or dinner at least four times a year. Of initial respondents (n 1802), 92·5 % provided complete and valid data. Participants were 84·7 % female, ranging from 18 to 68 years old.

98·3 % believed that healthier alternatives should be available for children in CRHC. For general food choices, health was a strong motivator (45·7 %); however, parents reported eating at CRHC mainly for pleasure or a treat (61·2 %) and being driven by children’s taste preferences (85·9 %) when selecting menu items. 59·0 % of orders included a combination of healthy and traditional items. 42·0 % of the sample were influenced by the healthy choice (HC) labelling. Multiple regression revealed that, in addition to some demographic variables, the percent of HC ordered was positively associated with self-reported parent vegetable consumption, making food choices for the children for health reasons, familiarity with HC items and making order choices due to dietary needs and good nutrition.

Despite a preference for availability of healthier children’s menu choices in CRHC, menu labelling highlighting healthy options may have limited impact relative to child preferences.

To investigate the relationship between ultra-processed food consumption and early childhood caries.

Cross-sectional analysis of baseline data from a cluster randomised controlled study. Outcomes included the prevalence of children with non-cavitated and cavitated caries. The main exposure was the total daily consumption of ultra-processed foods (up to three times and four times or more), assessed through a FFQ. Potential confounders were socio-demographic characteristics of the child and caregiver/family, child breast-feeding, oral hygiene and use of dental services. Poisson regression using robust variance adjustment was used to estimate prevalence ratios (PR) and their respective 95 % CI.

Primary Healthcare Centers in an urban area of Pelotas, Southern Brazil.

Children aged 0–3 years (n 309).

Consumption of ultra-processed foods four times or more a day was found in 67·6 % of children; 24·4 and 12·0 % presented non-cavitated and cavitated caries, respectively. After adjustment, children who consumed ultra-processed foods four times or more a day were more likely to present both non-cavitated caries (PR 2·25, 95 % CI 1·19, 4·27, P = 0·013) and cavitated caries (PR 3·48, 95 % CI 1·18, 10·30, P = 0·024) compared with those who have consumed them up to three times a day.

Consumption of ultra-processed foods is associated with early childhood caries. Interventions aiming at reducing ultra-processed food consumption should be implemented to improve children’s oral health.

The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women’s knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children.

Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews.

Poor rural communities in Mexico; 48 intervention and 29 control.

Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention).

The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers’ knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose–response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant.

Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.

To update the estimation of the prevalence of anaemia in Brazilian children according to four different epidemiological scenarios.

A new systematic review was conducted with a meta-analysis of the results published between 2007 and May 2019. Literature search was carried out in the PubMed and LILACS databases using keywords anaemia, child and Brazil. A total of thirty-seven articles (17 741 children) were selected and categorised according to the origin of their respective samples: childcare centres (Childcare; n 13 studies/2697 individuals), health services (Services; n 4/755), populations with social inequities (Inequities, n 7/6798) and population-based studies (Populations; n 13/7491). Assuming a prevalence of 20·9 % as reference (Health National Survey; n 3455), the combined prevalence ratios (PR) were calculated. A random-effects model was used.

Brazilian children 6–60 months of age.

The prevalence of anaemia, by scenario, was: Childcare 24·8 % (PR 1·06; 95 % CI 0·81, 1·40); Services 39·9 % (PR 1·76, 95 % CI 1·33, 2·35); Inequities 51·6 % (PR 2·02, 95 % CI 1·87, 2·18); and Populations 35·8 % (PR 1·42, 95 % CI 1·23, 1·64). Therefore, the values were all higher than the national prevalence; the Inequities had the highest prevalence, and only Childcare did not reach statistical significance. Concerning the previous meta-analysis, there was a reduction in anaemia prevalence in all scenarios: –52·3, –33·7, –22·4 and –10·7 %, respectively.

Compared to the situation revealed in the previous meta-analysis, anaemia, although observed to a lesser extent, remains an important public health problem in the different scenarios analysed, especially for children living in Inequities. Access to Childcare mitigates the risk for this condition.

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

Cross-sectional study.

All Lebanese governorates.

A total of 811 participants randomly selected participated in this 5-month study (January–May 2018).

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach’s α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

To examine the associations between vitamins of the methionine-homocysteine (Hcys) cycle (B6, B12 and folate) and Hcys with metabolic syndrome (MetS) among Mesoamerican children and their adult parents.

We conducted a cross-sectional study. Exposures were plasma vitamins B6 and B12 concentrations, erythrocyte folate and plasma Hcys. In children, the outcome was a continuous metabolic risk score calculated through sex- and age standardisation of waist circumference, the homoeostatic model assessment for insulin resistance, mean arterial pressure (MAP), serum HDL-cholesterol and serum TAG. In parents, the outcome was the prevalence of MetS according to the Adult Treatment Panel III Criteria. We estimated mean differences in the metabolic risk score and prevalence ratios of MetS between quartiles of the exposures using multivariable-adjusted linear and Poisson regression models, respectively.

Capital cities of Belize, Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica and Chiapas State in Mexico.

In total, 237 school-aged children and 524 parents.

Among children, vitamin B12 was inversely associated with the metabolic risk score (quartiles 4–1 adjusted difference = –0·13; 95 % CI: –0·21, –0·04; Ptrend = 0·008) through MAP, HDL-cholesterol and TAG. In contrast, folate was positively associated with the metabolic risk score (quartiles 4–1 adjusted difference = 0·11; 95 % CI: 0·01, 0·20; Ptrend = 0·02). In adults, vitamin B6 was inversely associated with MetS prevalence, whereas vitamin B12 and folate were positively related to this outcome.

Vitamins of the methionine-Hcys cycle are associated with MetS in different directions. The associations differ between children and adults.

To examine the feasibility of taste testing and point-of-purchase prompting to promote healthier food choices at a food truck event.

A pre-/post-study was conducted where food trucks provided samples of healthy food items to patrons and implemented point-of-purchase prompting (promotional signage; verbal cues). Implementation fidelity, acceptability and initial effectiveness were assessed via observation, patron surveys and sales data. A linear mixed model with a random effect for subject (food truck) and fixed effect for time point (baseline, intervention and post-intervention) was used to assess changes in relative sales of promoted healthy items as a percentage of food items sold.

Weekly food truck event in Buffalo, New York.

Seven food trucks; 179 patrons.

Implementation fidelity data illustrated that all food trucks complied with manualised procedures. Approximately one-third of surveyed patrons accepted a healthy sample, with the majority rating the sample positively. There was no main effect of time when examining changes in relative sales of promoted healthy items across all periods (P = 0·32); however, effect sizes representing changes between individual time points are consistent with an increase from baseline to intervention (d = 0·51), which was maintained through post-intervention (d = 0·03). The change from baseline to post-intervention corresponded to a medium effect size (d = 0·55).

Findings generally support the feasibility of implementing taste testing and point-of-purchase prompting to increase the selection of healthy food items from food trucks; implications for future research in this novel setting are discussed.

High-quality diets, characterised by nutrient-rich foods, are one of the foundations for health and well-being. Indicators of diet quality, antioxidants, are associated with protection against cardiometabolic diseases. The current study explores relationships between plasma antioxidants and cardiometabolic risk among Aboriginal people in Australia.

As part of a community-driven health promotion programme, we conducted a cross-sectional study including a health-behaviour questionnaire, plasma antioxidants and cardiometabolic risk markers (anthropometric, blood pressure measurements, fasting glucose, glycated Hb (HbA1c), lipids, C-reactive protein and albumin-creatinine-ratio) continuous and categorised into population-specific cut-offs. Antioxidants (β-carotene, β-cryptoxanthin, lycopene, lutein-zeaxanthin, retinol and α-tocopherol measured using HPLC) were applied to a principal component analysis, which aggregated these into a single component. Linear regression models were applied to investigate associations between the antioxidant component and cardiometabolic risk markers.

Community in a remote area in Northern Territory, Australia.

A total of 324 Aboriginal people, mean age 35·5 (range 15–75) years.

Antioxidant component levels were higher among individuals with higher self-reported vegetable intake (P < 0·01), higher among individuals with higher self-reported fruit intake (P = 0·05) and lower among current smokers (P = 0·06). Linear regression revealed an inverse association between the antioxidant component and C-reactive protein (β = –0·01, P < 0·01) after adjusting for confounders.

Higher plasma antioxidant levels, indicators of diet quality, were associated with lower levels of high-sensitivity C-reactive protein in this Aboriginal population in remote Australia. This association suggests plasma antioxidants may be protective against inflammation; however, longitudinal studies are needed to examine this potentially protective relationship.

To describe existing online, 24-h dietary recall (24-h DR) tools in terms of functionalities and ability to tackle challenges encountered during national dietary surveys, such as maximising response rates and collecting high-quality data from a representative sample of the population, while minimising the cost and response burden.

A search (from 2000 to 2019) was conducted in peer-reviewed and grey literature. For each tool, information on functionalities, validation and user usability studies, and potential adaptability for integration into a new context was collected.

Not country-specific

General population

Eighteen online 24-h DR tools were identified. Most were developed in Europe, for children ≥10 years old and/or for adults. Eight followed the five multiple-pass steps but used various methodologies and features. Almost all tools (except three) validated their nutrient intake estimates, but with high heterogeneity in methodologies. User usability was not always assessed, and rarely by applying real-time methods. For researchers, eight tools developed a web platform to manage the survey and five appeared to be easily adaptable to a new context.

Among the eighteen online 24-h DR tools identified, the best candidates to be used in national dietary surveys should be those that were validated for their intake estimates, had confirmed user and researcher usability, and seemed sufficiently flexible to be adapted to new contexts. Regardless of the tool, adaptation to another context will still require time and funding, and this is probably the most challenging step.