In Ethiopia, information is limited about energy and micronutrient intakes from complementary foods consumed by children in Productive Safety Net Program districts. Therefore, we assessed feeding practices and intakes of energy and selected micronutrients from complementary foods of children aged 6–23 months in a food insecure rural area of Ethiopia. Energy and micronutrient intakes were estimated from multiple-pass 24 h recall. Data were collected using a structured questionnaire. Only 1⋅9 % of children in the age range 6–8 months met recommended minimum dietary diversity of ≥5 food groups; this value slightly increased to 4 and 10⋅1 % in the older age groups (9–11 months and 12–23 months, respectively). Overwhelmingly, none of the children (9–11 months) did get the minimum acceptable diet (Children receiving minimum acceptable diet were 4 and 2⋅6 % in 6–8 months and 12–23 months, respectively). The overall prevalence of stunting was 34 % in younger children (6–8 months) and 51 % in older children aged 12–23 months. Median energy and selected micronutrient intakes from complementary foods were below corresponding WHO recommendations assuming average breast-milk amount and composition. The worst shortfalls were for vitamins A and C and for Ca. In contrast, median iron, protein and niacin intakes and densities were above the WHO recommendation. Caretakers and community leaders in the study setting need nutrition education on IYCF-related practices and on the importance of men's involvement in IYCF. Ensuring the accessibility and affordability of animal source foods (ASFs), fruits and vegetables, and feasible complementary foods is critical to address the quality of complementary feedings. This can be achieved through promoting nutrition-sensitive agriculture such as poultry and home gardening in this setting.

Alternative plant-based meats have grown in popularity with consumers recently and researchers are examining the potential health effects, or risks, from consuming these products. Because there have been no studies to date that have specifically assessed the health effects of plant-based meats on biomarkers of inflammation, the purpose of this work was to conduct a secondary analysis of the Study With Appetizing Plantfood – Meat Eating Alternatives Trial (SWAP-MEAT). SWAP-MEAT was a randomised crossover trial that involved generally healthy adults eating 2 or more servings of plant-based meats per day for 8 weeks (i.e. Plant phase) followed by 2 or more servings of animal meats per day for 8 weeks (i.e. Animal phase). Results of linear mixed-effects models indicated only 4 out of 92 biomarkers reached statistical significance. The results were contrary to our hypothesis, since we expected relative improvements in biomarkers of inflammation from the plant-based meats.

A global target of increasing exclusive breast-feeding (EBF) to at least 50 % by the year 2025 was set by the WHO for infants under 6 months. The lowest prevalence in the world was found in the Eastern Mediterranean region in 2010–18 and little is known about the status of mothers’ feeding practices in Saudi Arabia. The present study aimed to assess mothers’ actual feeding and weaning practices used with their infants by the mothers’ different age groups. The present study was conducted among 247 mothers of infants aged 4–12 months who were attending public well-baby clinics. Quantitative data were obtained by nutritionists using an electronic semi-structured questionnaire about mothers’ feeding practices. Only 5·3 % of mothers engaged in EBF, 44·9 % breast-fed their infants after an hour of birth, while 92·7 % of infants had ever been breast-fed. The average intent/plan to continue breast-feeding was 4·9(±3·1) months. Younger mothers introduced weaning food around 4 weeks earlier than older mothers (mean differences were −0·4, 95 % CI −0·71, −0·13; P = 0·031). A total of 64·3 % of infants received complementary feeding before completing 17 weeks. Maternal age group and delivery mode were the only factors associated with the early introduction of complementary feeding. A total of 69·2 % of the mothers believed that ‘it is a good time’ and 61·1 % felt that ‘infants are hungry and need other sources of food’. Online sources and family advice were the top sources of information on mothers’ feeding practices. Provision of professional advice about EBF and optimal weaning practices are significant areas for improvement in terms of compliance with recommended infant feeding practices.

The ongoing nutrition transition in lower- and middle-income countries (LMIC) in South East Asia may have a positive impact on protein nutrition. This study assessed the diversity of plant and animal protein food sources in relation to essential amino acid (EAA) adequacy in a population-based sample (N 1665) in Indonesia. Dietary intakes from in-person 24 h recalls provided data on energy and protein intakes (in g/d) from plants (grains, legumes), meat, poultry and fish, and eggs and dairy. Protein diversity scores were based on the number of protein food sources over 24 h. EAA scores were the ratio of amino acid intakes to recommended values. Protein diversity and EAA scores were then compared across multiple socio-demographic indices. Analysis of variance and χ2 tests were used to test for differences among groups. Energy intakes were 1678 kcal/d for men and 1435 kcal/d for women. Average protein intakes (and prevalence of inadequacy) were 59⋅4 g/d (41⋅7 %) for men and 51⋅5 g/d (51⋅1 %) for women. In regression analyses, higher protein diversity scores were associated with higher protein intakes, more animal protein and less plant protein and with higher EAA scores. Lower protein diversity scores were associated with lower intakes of lysine, leucine and valine relative to requirements, as well as with lower EAA, rural settings, less wealth and less modernisation. Greater diversity of animal protein food sources, observed among groups of higher socio-economic status, was linked to better amino acid adequacy and protein nutrition.

Traditional methods of dietary assessment are prone to measurement error, with energy intake often under-reported. The 24-h recall is widely used in dietary assessment, however, its reliance on self-report without verification of consumption can result in inaccuracies in true nutrient intake. Wearable cameras may provide a complementary approach to improve self-report accuracy by providing an objective and passive measure of food consumption. The purpose of the present study was to determine whether a wearable camera improves the accuracy of a 24-h recall compared with a 24-h recall alone in twenty adults aged 18–65 years. The study also explored limitations associated with wearable cameras. Participants wore the camera for 1 d and a 24-h recall was then conducted the following day, before and after viewing the camera images. Dietary data were analysed using Nutritics dietary analysis software, while eating habits were assessed by a self-report questionnaire. Energy and nutrient intakes were compared between the recall alone and the camera-assisted recall. Results showed a significant increase in mean energy intake with the camera-assisted recall compared with the recall alone (9677⋅8 ± 2708⋅0 kJ/d v. 9304⋅6 ± 2588⋅5 kJ/d, respectively, P = 0⋅003). Intakes of carbohydrates, total sugars and saturated fats were also significantly higher with the camera-assisted recall. In terms of challenges, there were occasionally technological issues such as proper positioning of the camera by the participants. In conclusion, reporting of energy and nutrient intake may be enhanced when a traditional method of dietary assessment, the 24-h recall, is assisted by a wearable camera.

The objective of the present study was to assess the association between the observed and perceived food environment and food insecurity among households with children <18 years in Lima, Peru. This was a cross-sectional study including an income-stratified random sample of households (n 329) in Villa el Salvador, a low-income district in Lima, Peru. Data were collected with a household questionnaire – including the Household Food Insecurity Access Scale (HFIAS) and the University of Pennsylvania's Perceived Nutrition Environment Survey (NEMS-P) – and a neighbourhood food outlet census, including recording of food outlets’ GPS coordinates. Three-quarters of the households interviewed were food insecure. Compared with food secure households and adjusting for socio-demographic covariates, food insecure households were more likely to disagree to having easy access (OR 5⋅4; 95 % CI 2⋅1, 13⋅4), high quality (OR 3⋅1; 95 % CI 1⋅7, 5⋅5) and variety (OR 2⋅5; 95 % CI 1⋅4, 4⋅6) of fresh fruits and vegetables in their neighbourhood. About 60 % (513 out of 861) of the food outlets identified in participants’ neighbourhoods were classified as fresh, including markets, bodegas, and fruit and vegetable vendors. There was no difference in distance to fresh food outlets by household food insecurity; all households were on average within 52–62 m from a fresh food outlet (~2-min walk). Despite negative perceptions of their neighbourhood food environment, food insecure households had similar physical access to fresh food sources than their food secure counterparts. Thus, changes to the food environment may not alleviate food insecurity in urban poor areas of Peru.

The Home-grown School Feeding Program (HG-SFP) is a model designed to provide school meals to students using foods sourced from local markets. HG-SFP recently has been incorporated as one of the strategies of educational development in Ethiopia aiming to address hunger and food insecurity problems of school children. Yet, evaluation of the successes and challenges of the program has been limited evaluated. The purpose of the present study was to explore the successes and challenges of the SFP in Sidama Region, Southern Ethiopia. This exploratory qualitative study collected data from eight schools targeted for HG-SFP through key informant interviews and focus group discussions (FGDs). A total of sixteen FGDs and twenty-one in-depth interviews were conducted. Purposive sampling was used to include study participants based on their potential relevance in delivering in-depth information. The findings of the present study showed that HG-SFP was successful in improving class attendance and academic performance of school children. In addition, the program had a contribution in saving the parents’ money and time as a result of the food provided. With regard to SFP challenges, lack of permanent clean water provision, delay in ration delivery, poor-quality food provision, inadequate amount of food allocated for the academic year, lack of necessary infrastructure for the program, and lack of training in sanitation and hygiene for cooks were among the major challenges identified. Therefore, program challenges need high-level attention in order to make the school feeding program more successful in Sidama Region, Ethiopia.

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6–23 months in Ethiopia. We included 2960 children aged 6–23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6–23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6–23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9–11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12–17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18–23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

The classical deficiency diseases have nearly disappeared from the industrialised world and are thought to be found largely in sub-Saharan Africa and South Asia. More than 80 collected medical articles, mostly from Europe and North America, describe more than 9000 people with low concentrations of copper in organs or tissues or impaired metabolic pathways dependent on copper. More than a dozen articles reveal improved anatomy, chemistry or physiology in more than 1000 patients from supplements containing copper. These criteria are diagnostic of deficiency according to The Oxford Textbook of Medicine. Alzheimer's disease, ischaemic heart disease and osteoporosis receive major emphasis here. However, impaired vision, myelodysplastic syndrome and peripheral neuropathy are mentioned. Copper deficiency probably causes some common, contemporaneous diseases. Advice is provided about opportunities for research. Seemingly authoritative statements concerning the rarity of nutritional deficiency in developed countries are wrong.

Little is known about the relation between the women empowerment in agriculture index, and health and nutrition outcomes among under-five children in Ethiopia. The study's objective was to examine women's empowerment in agriculture and its association with the nutritional status of children (6–59 months) in rural, cash crop producing, and resource-limited settings of Ethiopia. A community-based cross-sectional study was conducted employing 422 households; having women of reproductive age group and children under-five. Stratified simple random sampling was used to identify households; a simple random sampling was used to select villages and households. Women empowerment in agriculture was measured by the abbreviated women empowerment in agriculture index. Even if the overall multi-dimensional five domains of empowerment index (5DE) was not a significant predictor of nutritional status in children (P > 0⋅05), sub-indicators had a pivotal role in child nutritional status. Disempowerment in decisions about input into production [AOR = 8⋅85], empowerment on control of income [AOR = 0⋅35] and availability of livestock [AOR = 0⋅38] were predictors of child stunting, whereas women's disempowerment in production decisions seems beneficiary for wasting, disempowered women have 84 % less likely to have wasted child than empowered women [AOR = 0⋅16]. Dietary and agricultural diversity [particularly livestock farming], and women's empowerment in production decisions were predictors of better nutritional outcomes in children. Therefore, a concentrated effort is needed towards strengthening the multi-dimensional empowerment of women in agriculture emphasising women's input into production decisions, dietary and agricultural diversification, mainly livestock farming.

Contemporary diets in Western countries are largely acid-inducing and deficient in potassium alkali salts, resulting in low-grade metabolic acidosis. The chronic consumption of acidogenic diets abundant in animal-based foods (meats, dairy, cheese and eggs) poses a substantial challenge to the human body's buffering capacities and chronic retention of acid wherein the progressive loss of bicarbonate stores can cause cellular and tissue damage. An elevated dietary acid load (DAL) has been associated with systemic inflammation and other adverse metabolic conditions. In this narrative review, we examine DAL quantification methods and index observational and clinical evidence on the role of plant-based diets, chiefly vegetarian and vegan, in reducing DAL. Quantitation of protein and amino acid composition and of intake of alkalising organic potassium salts and magnesium show that plant-based diets are most effective at reducing DAL. Results from clinical studies and recommendations in the form of expert committee opinions suggest that for a number of common illnesses, wherein metabolic acidosis is a contributing factor, the regular inclusion of plant-based foods offers measurable benefits for disease prevention and management. Based on available evidence, dietary shifts toward plant-based nutrition effectively reduces dietary-induced, low-grade metabolic acidosis.

Access to and utilisation of antenatal care (ANC) is important for optimising health and nutrition during pregnancy. This study aimed to assess adherence to and factors associated with ANC and antenatal supplement use among Laotian women, and consider culturally appropriate strategies to increase micronutrient intakes. Mother–child (aged 21 d to <18 months) dyads (n 699) enrolled in a hospital-based prospective cohort study with the community comparison group in Luang Prabang province were interviewed about their antenatal history, supplement use, household sociodemographic and dietary practices, including postpartum food avoidances. Ninety percent of women (mean age 24⋅7 ± 6⋅3 years) reported receiving ANC during their pregnancy, with the majority reporting four to seven contacts, while 84⋅6 and 17⋅3 % reported supplement use during pregnancy and lactation, respectively. Adequate ANC contacts (≥8) and supplement use was more likely among women with complete primary education and from higher socioeconomic status households, and less likely among women belonging to ethnic minority populations and those who delivered their child at home. All women continued to consume salt while adhering to postpartum food avoidances; however, 58⋅5 and 38⋅7 % of habitual consumers restricted fish and soy sauces, respectively. Eighty-six percent of women reported they would be willing to take supplements when adhering to postpartum dietary restrictions. Overall, women's reported ANC attendance and antenatal supplement use was suboptimal. Understanding predictors of and barriers to ANC and supplement use may help implement effective public health strategies to improve adherence. Alongside targeted supplementation, salt fortification with micronutrients may be a viable population-wide intervention that needs further evaluation.

Anaemia remains among the most prevalent nutritional problems among children in developing countries. In Ethiopia, more than half of children <5 years of age are anaemic. In the early stages of life, it leads to poor cognitive performance, delay psychomotor development and decreases working capacity in later life. The present study aimed to assess the prevalence and associated factors of anaemia among children aged 6–23 months in the Bale zone. A community-based cross-sectional study was conducted from 1 to 30 June 2021. Multistage stratified sampling and simple random sampling techniques were employed to select 770 samples. An interviewer-administered questionnaire was used to collect data on socio-demographic, child health and feeding practices. Haemoglobin levels were estimated using a portable Hemosmart machine. Children with haemoglobin values below 11 g/dl were considered anaemic. Binary logistic regression analysis was performed to identify factors associated with anaemia. Statistical significance was set at P < 0⋅05. The prevalence of anaemia was 47⋅9 % (95 % CI (44⋅4, 51⋅5)). The multivariate analysis showed that child age (6–11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), household food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhoea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were significantly associated with anaemia. Anaemia in children aged 6–23 months was a severe public health problem in the study area. Integrated nutritional interventions combined with iron fortification and supplementation is recommended.

A mother's nutritional status and participation in household decision-making, a proxy for empowerment, are known determinants of improved nutrition and health outcomes for infants and young children; however, little is known about the association among adolescents. We examined the association between maternal nutritional status, decision-making autonomy and adolescent girls’ nutritional status. We analysed data of 711 mother–adolescent girl pairs aged 10–17 years from the Mion District, Ghana. Maternal nutritional status and decision-making autonomy were the independent variables while the outcomes were adolescent girls’ nutritional status as defined by anaemia, stunting and body mass index-for-age Z-score categories. Girl-level (age, menarche status and the frequency of animal-source food consumption), mother-level (age, education level, and monthly earnings) and household-level (wealth index, food security status and family size) covariates were adjusted for in the analysis. All associations were examined with hierarchical survey logistic regression. There was no association between maternal height and adolescent girls being anaemic, underweight or overweight/obese. Increasing maternal height reduced the odds of being stunted [adjusted odds ratio (OR) 0⋅92, 95 % CI (0⋅89, 0⋅95)] for the adolescent girl. Maternal overweight/obesity was positively associated with the girl being anaemic [OR 1⋅35, 95 % CI (1⋅06, 1⋅72)]. The adolescent girl was more than five times likely to be thin [OR 5⋅28, 95 % CI (1⋅64–17⋅04)] when the mother was underweight. Maternal decision-making autonomy was inversely associated with stunting [OR 0⋅88, 95 % CI (0⋅79, 0⋅99)] among the girls. Our findings suggest that intergenerational linkages of a mother's nutritional status are not limited to childhood but also during adolescence.

All dietary assessment methods inevitably introduce measurement errors, which should ideally be considered during data analysis and interpretation. Methodological studies should be conducted to address how well a given assessment method captures dietary intake and to highlight the extent and direction of the measurement error. Within a subgroup of the Hordaland Health Study (HUSK3), we examined the relative validity of a web-based food frequency questionnaire (WebFFQ) by comparing its estimates of mean daily intake of nutrients and foods with estimated mean daily intakes from repeated administrations of 24-hour dietary recall interviews (24-HDRs). Men and women born between 1950 and 1951 were recruited from HUSK3. The participants (n = 67) completed a WebFFQ and three non-consecutive 24-HDRs over the course of a year. Relative validity was assessed using Spearman's rank correlation, crosstab analysis and Bland–Altman plots. Linear regression models were used to compute the calibration coefficients. The estimated correlation coefficients were acceptable or strong for all nutrients and foods except iodine (rs = 0⋅19). The highest correlation coefficient was found for juice (rs = 0⋅71), whereas the lowest correlation coefficient was found for iodine (rs = 0⋅19). Cross-classification by quartiles categorised more than 72 % of the participants into the same or adjacent quartiles using the two methods. Few data points fell outside the limits of agreement in the Bland–Altman plots. Calibration coefficients ranged from 0⋅10 (wholegrain) to 0⋅81 (alcohol). Our findings suggest that the WebFFQ has reasonable ranking abilities for all the included nutrients and foods, except for iodine.

Since conducting a long-term randomised clinical trial is not logical and feasible to find the optimum dosage of salt intake in patients with cirrhosis, cohort studies are the best design to assess the long-term effects of dietary salt on the survival of cirrhotic patients. This cohort study aimed to evaluate the association between dietary intake of salt and mortality risk in cirrhotic patients. The present study was designed as a cohort in three referral hospitals in Iran in 2018. One hundred and twenty-one patients aged between 20 and 70 years with established cirrhosis were recruited. Dietary intakes, demographic data and disease severity were evaluated at the baseline. Participants were followed up annually. Crude survival was greater in patients with low-to-moderate salt consumption rather than in those with high consumption, and in non-consumers [34⋅26 (95 % CI 33⋅04, 35⋅49) v. 30⋅41 (95 % CI 27⋅13, 33⋅69) v. 32⋅72 (95 % CI 30⋅63, 34⋅80), P = 0⋅028; log-rank test]. Using the Cox proportional hazard model, it was shown that the risk of mortality in the high-salt consumption category was approximately 126 % higher than that of the reference category (non-consumers) [HR value 2⋅26, (95 % CI 0⋅91, 5⋅63)], while this risk for the low-to-moderate consumption group was about 28 % lower than the reference category [HR value 0⋅72, (95 % CI 0⋅26, 1⋅99), P-trend = 0⋅04]. In conclusion, a high daily dietary intake of salt might increase the rate of mortality and moderate salt restriction (instead of elimination of salt) decreases the risk of death.

Adequate dietary protein intake is important in human subjects for maintaining muscle turnover, determining the protein content of tissues and thus the preservation of muscle mass and function as we age. A screening tool to assess if an older individual is likely to have a lower dietary protein intake (predicted probability of protein intake ≤1⋅0 g/kg per d), has been developed for a Netherlands dietary profile, but this has not been validated in a UK population. This study aimed to adapt and then validate the protein screening tool for use in a UK population. Amendment of the tool was undertaken using data from UK BioBank and the UK National Diet and Nutrition Survey to reflect protein sources in the UK diet. Validation of the amended version of the protein screener screening tool was conducted using protein intake derived from a food frequency questionnaire (FFQ) in a sample of UK adults (n = 184) (age range 18–91 years) as the reference standard. Using the FFQ, 40 % of respondents (n = 74) reported a protein intake of ≤1⋅0 g per kg body mass. The discriminative accuracy of the amended screener was tested using receiver operating characteristic (ROC) curves. The area under the curve for the ROC was 0⋅731 (95 % CI 0⋅657, 0⋅805), indicating that the amended screener may be a valid tool to screen for individuals consuming ≤1⋅0 g/kg adjusted BM/d in an adult UK population. This protein screener tool is a potential method to screen individuals with a likelihood of habitually consuming protein intakes of ≤1⋅0 g/kg per d. Further validation is needed using a more robust dietary intake methodology and for specific groups, such as older adults. The screener may be applicable across healthcare, clinical and research applications.