To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases by household income, education and race/ethnicity and if they changed over time.

We used Nielsen Homescan, a nationally representative household panel, from 2008 to 2018 (n = 672 821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat and Na) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods).

Household panel survey.

Approximately 60 000 households each year from the USA.

Disparities were found by income and education for most outcomes and widened for purchases of fruits, vegetables and the percentage of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percentage of calories from sugar, while no disparities were found between White and Hispanic households. Disparities have been largely persistent, as any significant changes over time have been substantively small.

Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes, and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.

To examine patterns of taxed and untaxed food and beverage shopping across store types after Mexico’s sugary drink and non-essential food taxes, the nutritional quality of these patterns and the socio-economic characteristics associated with them.

We performed k-means cluster analyses using households’ percentage of food and beverage purchases from each store type (i.e. convenience stores, traditional shops (e.g. bodegas, tiendas, mom-and-pop shops), supermarkets, wholesalers and others). We calculated adjusted mean proportions of taxed and untaxed products (ml or g/capita per d) purchased in each pattern. We studied the associations between households’ SES and shopping patterns using multinomial logistic regressions. Within shopping patterns, we obtained mean volumes and proportions of taxed and untaxed food and beverage subgroups and calculated the proportion of products purchased at each store type.

Mexico.

Urban Mexican households (n 5493) from the Nielsen Mexico Consumer Panel Survey 2015.

We found four beverage shopping patterns and three food shopping patterns, driven by the store type where most purchases were made. For beverages, 48 % of households were clustered in the Traditional pattern and purchased the highest proportion of taxed beverages. Low-SES households had the highest probability of clustering in the Traditional beverage shopping pattern. For foods, 35 % of households were clustered into the Supermarket pattern. High-SES households had the highest probability of clustering in the Supermarket food shopping pattern.

The combination of store types where Mexican households purchase packaged foods and beverages varies. However, households in all shopping patterns and SES purchase taxed beverages mainly at traditional stores. Store-level strategies should be developed to intervene on traditional stores to improve the healthfulness of purchases.

Understanding the association between diet quality and cardiometabolic risk by education level is important for preventing increased cardiometabolic risk in the Mexican population, especially considering pre-existing disparities in diet quality. The present study examined the cross-sectional association of overall diet quality with cardiometabolic risk, overall and by education level, among Mexican men and women.

Cardiometabolic risk was defined by using biomarkers and diet quality by the Mexican Diet Quality Index. We computed sex-specific multivariable logistic regression models.

Mexico.

Mexican men (n 634) and women (n 875) participating in the Mexican National Health and Nutrition Survey 2012.

We did not find associations of diet quality with cardiometabolic risk factors in the total sample or in men by education level. However, we observed that for each 10-unit increase in the dietary quality score, the odds of diabetes risk in women with no reading/writing skills was 0·47 (95 % CI 0·26, 0·85) relative to the odds in women with ≥10 years of school (referent). Similarly, for each 10-unit increase of the dietary quality score, the odds of having three v. no lipid biomarker level beyond the risk threshold in lower-educated women was 0·27 (95 % CI 0·12, 0·63) relative to the odds in higher-educated women.

Diet quality has a stronger protective association with some cardiometabolic disease risk factors for lower- than higher-educated Mexican women, but no association with cardiometabolic disease risk factors among men. Future research will be needed to understand what diet factors could be influencing the cardiometabolic disease risk disparities in this population.

The present study evaluated the association of two measures of diet quality with BMI and waist circumference (WC), overall and by education level, among Mexican men and women.

We constructed two a priori indices of diet quality, the Mexican Diet Quality Index (MxDQI) and the Mexican Alternate Healthy Eating Index (MxAHEI), which we examined relative to BMI and WC. We computed sex-specific multivariable linear regression models for the total sample and by education level.

Mexico.

Mexican men (n 954) and women (n 1356) participating in the Mexican National Health and Nutrition Survey 2012.

Total dietary scores were not associated with BMI in men and women, but total MxDQI was inversely associated with WC in men (−0·10, 95 % CI −0·20, −0·004 cm). We also found that some results differed by education level in men. For men with the lowest education level, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean reduction in BMI of 0·11 (95 % CI −0·18, 0·04) and 0·18 (95 % CI −0·25, −0·10) kg/m2, respectively. Likewise, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean change in WC of −0·30 (95 % CI −0·49, −0·11) and −0·53 (95 % CI −0·75, −0·30) cm, respectively, in men with the lowest level of education. In women, the association of diet quality scores with BMI and WC was not different by education level.

Our findings suggest that a higher diet quality in men with low but not high education is associated with lower BMI and WC.

To examine snacking patterns, food sources and nutrient profiles of snacks in low- and middle-income Chilean children and adolescents.

Cross-sectional. Dietary data were collected via 24 h food recalls. We determined the proportion of snackers, snacks per day and energy from top food and beverage groups consumed. We compared the nutrient profile (energy, sodium, total sugars and saturated fat) of snacks v. meals.

South-east region of Chile.

Children and adolescents from two cohorts: the Food Environment Chilean Cohort (n 958, 4–6 years old) and the Growth and Obesity Cohort Study (n 752, 12–14 years old).

With a mean of 2·30 (se 0·03) snacks consumed daily, 95·2 % of children and 89·9 % of adolescents reported at least one snacking event. Snacks contributed on average 1506 kJ/d (360 kcal/d) in snacking children and 2218 kJ/d (530 kcal/d) in snacking adolescents (29·0 and 27·4 % daily energy contribution, respectively). Grain-based desserts, salty snacks, other sweets and desserts, dairy foods and cereal-based foods contributed the most energy from snacks in the overall sample. For meals, cereal-based foods, dairy beverages, meat and meat substitutes, oils and fats, and fruits and vegetables were the top energy contributors.

Widespread snacking among Chilean youth provides over a quarter of their daily energy and includes foods generally considered high in energy, saturated fat, sodium and/or total sugars. Future research should explore whether snacking behaviours change as the result of Chile’s national regulations on food marketing, labelling and school environments.

To estimate changes in taxed and untaxed beverages by volume of beverage purchased after a sugar-sweetened beverage (SSB) tax was introduced in 2014 in Mexico.

We used household purchase data from January 2012 to December 2015. We first classified the sample into four groups based on pre-tax purchases of beverages: (i) higher purchases of taxed beverages and lower purchases of untaxed beverages (HTLU-unhealthier); (ii) higher purchases of both types of beverages (HTHU); (iii) lower purchases of taxed and untaxed beverages (LTLU); and (iv) lower purchases of taxed beverages and higher purchases of untaxed beverages (LTHU-healthier). Next, we estimated differences in purchases after the tax was implemented for each group compared with a counterfactual based on pre-tax trends using a fixed-effects model.

Areas with more than 50 000 residents in Mexico.

Households (n 6089).

The HTLU-unhealthier and HTHU groups had the largest absolute and relative reductions in taxed beverages and increased their purchases of untaxed beverages. Households with lower purchases of untaxed beverages (HTLU-unhealthier and LTLU) had the largest absolute and relative increases in untaxed beverages. We also found that among households with higher purchases of taxed beverages, the group with lowest socio-economic status had the greatest reduction in purchases of taxed beverages.

Evidence associating the SSB tax with larger reductions among high purchasers of taxed beverages prior to the tax is relevant, as higher SSB purchasers have a greater risk of obesity, diabetes and other cardiometabolic outcomes.

To describe trends across the intake distribution of total, manufactured and homemade sugar-sweetened beverages (SSB) from 1999 to 2012, focusing on high SSB consumers and on changes by socio-economic status (SES) subgroup.

We analysed data from one 24 h dietary recall from two nationally representative surveys. Quantile regression models at the 50th, 75th and 90th percentiles of energy intake distribution of SSB were used.

1999 Mexican National Nutrition Survey and 2012 Mexican National Health and Nutrition Survey.

School-aged children (5–11 years) and women (20–49 years) for trend analyses (n 7718). Population aged >1 year for 2012 (n 10 096).

Over the 1999–2012 period, there were significant increases in the proportion of total and manufactured SSB consumers (5·7 and 10·7 percentage points), along with an increase in per-consumer SSB energy intake, resulting in significant increases in per-capita total SSB energy intake (142, 247 and 397 kJ/d (34, 59 and 95 kcal/d) in school-aged children and 155, 331 and 456 kJ/d (37, 79 and 109 kcal/d) in women at the 50th, 75th and 90th percentile, respectively). Total and manufactured SSB intakes increased sharply among low-SES children but remained similar among high-SES children during this time span.

Large increases in SSB consumption were seen between 1999 and 2012 during this pre-tax SSB period, particularly for the highest consumers. Trends observed in school-aged children are a clear example of the nutrition transition experienced in Mexico. Policies to discourage high intake of manufactured SSB should continue, joined with strategies to encourage water and low-calorie beverage consumption.

Eating away from home is associated with poor diet quality, in part due to less healthy food choices and larger portions. However, few studies account for the potential additional contribution of differences in food composition between restaurant- and home-prepared dishes. The present study aimed to investigate differences in nutrients of dishes prepared in restaurants v. at home.

Eight commonly consumed dishes were collected in twenty of each of the following types of locations: small and large restaurants, and urban and rural households. In addition, two fast-food items were collected from ten KFC, McDonald’s and food stalls. Five samples per dish were randomly pooled from every location. Nutrients were analysed and energy was calculated in composite samples. Differences in nutrients of dishes by preparation location were determined.

Hunan Province, China.

Na, K, protein, total fat, fatty acids, carbohydrate and energy in dishes.

On average, both the absolute and relative fat contents, SFA and Na:K ratio were higher in dishes prepared in restaurants than households (P < 0·05). Protein was 15 % higher in animal food-based dishes prepared in households than restaurants (P<0·05). Quantile regression models found that, at the 90th quantile, restaurant preparation was consistently negatively associated with protein and positively associated with the percentage of energy from fat in all dishes. Moreover, restaurant preparation also positively influenced the SFA content in dishes, except at the highest quantiles.

These findings suggest that compared with home preparation, dishes prepared in restaurants in China may differ in concentrations of total fat, SFA, protein and Na:K ratio, which may further contribute, beyond food choices, to less healthy nutrient intakes linked to eating away from home.

Away-from-home foods have been shown to have lower nutritional quality and larger portion sizes than many foods prepared at home. We aimed to describe energy and nutrient intakes among 2–13-year-old Mexican children by eating location (at home and away from home), overall, by socio-economic status (SES) and by urbanicity.

Dietary intake was collected via one 24 h recall in the 2012 Mexican National Health and Nutrition Survey (ENSANUT). Location was reported for each food consumed. Results were adjusted for sex, day of recall, region, weight status, SES and urbanicity.

Mexico (nationally representative).

Children aged 2–5 years (n 1905) and 6–13 years (n 2868).

Children consumed the majority of daily energy at home (89% of 2–5-year-olds; 82 % of 6–13-year-olds). The most common away-from-home eating location was school (22 % of 2–5-year-olds; 43 % of 6–13-year-olds), followed by the street (14 % of 2–5-year-olds; 13 % of 6–13-year-olds). The most common foods consumed away from home were wheat/rice and corn mixed dishes, sugar-sweetened beverages, pastries/candy/desserts, milk (2–5-year-olds only) and salty snacks (6–13-year-olds). Multivariate models showed that high-SES 2–5-year-olds consumed 14 % of daily energy away from home v. 8 % among low-SES 2–5-year-olds, and high-SES 6–13-year-olds consumed 21 % of daily energy away from home v. 14 % among low-SES 6–13 year-olds. There were no differences by urban residence.

Among Mexican children, most foods and beverages were consumed at home. However, the percentage of foods consumed or purchased away from home increased with age and with SES.

To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children.

In order to obtain usual nutrient intakes, the National Cancer Institute’s method was used to correct the first 24 h dietary recall collected in the entire sample (n 2045) with a second 24 h recall collected in a sub-sample (n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na.

2012 Mexican National Health and Nutrition Survey.

A total of 2045 children were included: 0–5·9 months old (n 182), 6–11·9 months old (n 228), 12–23·9 months old (n 537) and 24–47·9 months old (n 1098). From these, 178 provided an additional dietary recall.

Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v. usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake (P<0·05). Compared with usual intake, estimates from one day yielded overestimated prevalences of inadequate micronutrient intakes but underestimated prevalences of excessive intakes among children aged >6 months.

There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used.

To examine the acceptability and feasibility of using smartphone technology to assess beverage intake and evaluate whether the feasibility of smartphone use is greater among key sub-populations.

An acceptability and feasibility study of recording the video dietary record, the acceptability of the ecological momentary assessment (EMA), wearing smartphones and whether the videos helped participants recall intake after a cross-over validation study.

Rural and urban area in Shanghai, China.

Healthy adults (n 110) aged 20–40 years old.

Most participants reported that the phone was acceptable in most aspects, including that videos were easy to use (70 %), helped with recalls (77 %), EMA reminders helped them record intake (75 %) and apps were easy to understand (85 %). However, 49 % of the participants reported that they had trouble remembering to take videos of the beverages before consumption or 46 % felt embarrassed taking videos in front of others. Moreover, 72 % reported that the EMA reminders affected their consumption. When assessing overall acceptability of using smartphones, 72 % of the participants were favourable responders. There were no statistically significant differences in overall acceptability for overweight v. normal-weight participants or for rural v. urban residents. However, we did find that the overall acceptability was higher for males (81 %) than females (61 %, P=0·017).

Our study did not find smartphone technology helped with dietary assessments in a Chinese population. However, simpler approaches, such as using photographs instead of videos, may be more feasible for enhancing 24 h dietary recalls.

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

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

Nationwide cross-sectional survey, 2008–2009.

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

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

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

To evaluate patterns of water consumption from plain water, beverages and foods among Mexican children and adolescents and to compare actual patterns of total daily water intake with the Dietary Reference Intakes (DRI).

We analysed one 24 h dietary recall from Mexican children and adolescents. We calculated intakes of total daily water and water from foods and from beverages. Actual total water intake per capita was subtracted from the DRI for water to calculate the shortfall.

Mexican National Health and Nutrition Survey in 2012.

Mexican children and adolescents (n 6867) aged 1–18 years.

Approximately 73 % of children and adolescents aged 1–18 years reported drinking plain water. Beverages and plain water represented 65·5 % and 26·5 % of total daily water intake, respectively. Among 1–3-year-olds, the top three main sources of water were from foods, plain water and water from plain milk. Among 4–8- and 9–13-year-olds, the main sources were from foods, plain water and agua fresca (fruit water). Among 14–18-year-olds, the main sources of water were plain water, water from foods and soda. A higher proportion of 1–3-year-olds and 4–8-year-olds met the DRI for water (38 % and 29 %, respectively). Among 9–13-year-olds and 14–18-year-olds, 13–19 % of children met the DRI for water.

Total daily water intakes remain below DRI levels in all age groups. Although plain water still contributes the greatest proportion to daily water intake among fluids, caloric beverages are currently major sources of water especially among older children and adolescents.

To examine the patterns of consumption of foods high in solid fats and added sugars (SoFAS) in Brazil.

Cross-sectional study; individual dietary intake survey. Food intake was assessed by means of two non-consecutive food records. Foods providing >9·1 % of energy from saturated fat, or >1·3 % of energy from trans fat, or >13 % of energy from added sugars per 100 g were classified as high in SoFAS.

Brazilian nationwide survey, 2008–2009.

Individuals aged ≥10 years old.

Mean daily energy intake was 8037 kJ (1921 kcal), 52 % of energy came from SoFAS foods. Contribution of SoFAS foods to total energy intake was higher among women (52 %) and adolescents (54 %). Participants in rural areas (43 %) and in the lowest quartile of per capita family income (43 %) reported the smallest contribution of SoFAS foods to total energy intake. SoFAS foods were large contributors to total saturated fat (87 %), trans fat (89 %), added sugar (98 %) and total sugar (96 %) consumption. The SoFAS food groups that contributed most to total energy intake were meats and beverages. Top SoFAS foods contributing to saturated fat and trans fat intakes were meats and fats and oils. Most of the added and total sugar in the diet was supplied by SoFAS beverages and sweets and desserts.

SoFAS foods play an important role in the Brazilian diet. The study identifies options for improving the Brazilian diet and reducing nutrition-related non-communicable chronic diseases, but also points out some limitations of the nutrient-based criteria.

To examine the relative contribution for the prediction of hypertension by waist circumference (WC), waist:stature ratio (WSR) or waist:hip ratio (WHR) with that by BMI, to ascertain if WC, WSR or WHR enhances the prediction of hypertension by BMI.

Population-based, cross-sectional study. A change of ≥10 % in the prevalence ratio of BMI (PR) or the area under the receiver-operating characteristic curve (AUC) when WC, WSR or WHR was added to a model with BMI was used as the criterion for significant contribution to the prediction of hypertension by BMI. For greater contributions (≥10 %) these waist measures were considered as better predictors.

Nine provinces in China.

Chinese adults aged 18 to 65 years (n 7336) who participated in the 2004 China Health and Nutrition Survey.

The prevalence of hypertension (17 % and 23 % for women and men, respectively) was significantly related to increased BMI, WC, WSR and WHR (P for trend <0·001). Although there was a better model fit when WC, WSR or WHR was added to a model with BMI (P < 0·05; likelihood ratio test), the changes in PR and AUC were <10 % and <5 %, respectively. The sex-specific AUC for the prediction of hypertension by BMI (of 0·7–0·8) was similar to that by WC, WSR or WHR.

The waist indices do not perform better than BMI or markedly enhance the prediction of increased hypertension risk by BMI in Chinese adults.