To review regulations and to perform a media audit of promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes (‘the Code’) in South-East Asia.

We reviewed national regulations relating to the Code and 800 clips of editorial content, 387 advertisements and 217 Facebook posts from January 2015 to January 2016. We explored the ecological association between regulations and market size, and between the number of advertisements and market size and growth of milk formula.

Cambodia, Indonesia, Myanmar, Thailand and Vietnam.

Regulations on the child’s age for inappropriate marketing of products are all below the Code’s updated recommendation of 36 months (i.e. 12 months in Thailand and Indonesia; 24 months in the other three countries) and are voluntary in Thailand. Although the advertisements complied with the national regulations on the age limit, they had content (e.g. stages of milk formula; messages about the benefit; pictures of a child) that confused audiences. Market size and growth of milk formula were positively associated with the number of newborns and the number of advertisements, and were not affected by the current level of implementation of breast-milk substitute laws and regulations.

The present media audit reveals inappropriate promotion and insufficient national regulation of products under the scope of the Code in South-East Asia. Strengthened implementation of regulations aligned with the Code’s updated recommendation should be part of comprehensive strategies to minimize the harmful effects of advertisements of breast-milk substitutes on maternal and child nutrition and health.

BMI is a proxy for fat accumulation in the body. Increased diabetes and CVD risks have been observed for Asian populations at lower BMI than the WHO-recommended BMI cut-off points for overweight (≥25·0 kg/m2) and obesity (≥30·0 kg/m2). The current study aimed to quantify the increased hypertension (HTN) and type 2 diabetes mellitus (T2DM) prevalence in Bangladeshi adults with moderately increased BMI (23·0–24·9 kg/m2).

Data from the most recent Bangladesh Demographic and Health Survey (2011) were analysed. Modified Poisson regression models with robust error variance were used to calculate prevalence ratios (PR) for HTN or T2DM by BMI category, considering BMI=18·5–22·9 kg/m2 as the reference. All analyses incorporated the complex sampling design of the survey.

BMI, blood pressure, blood sugar and related information were collected from a nationally representative sample.

Adults (n 7433) aged≥35 years.

About 12 % of Bangladeshi adults, both male and female, were within the BMI range 23·0–24·9 kg/m2 or moderately overweight. Compared with the reference BMI group (18·5–22·9 kg/m2), they had an increased PR for HTN (1·55–1·77) and T2DM (1·54–1·93). These increased PR are similar to those for the WHO-defined overweight group (BMI=25·0–29·9 kg/m2).

Our findings support the recommendation that calls for setting the optimum BMI for Asian populations to 18·5–23·0 kg/m2 for health promotion and for public health interventions like leisure-time physical activity. WHO cut-off points for overweight (≥25 kg/m2) should be used to facilitate international comparisons.

Food composition databases are essential for estimating nutrient intakes in food consumption surveys. The present study aimed to evaluate the Mali food composition database (TACAM) for assessing intakes of energy and selected nutrients at population level.

Weighed food records and duplicate portions of all foods consumed during one day were collected. Intakes of energy, protein, fat, available carbohydrates, dietary fibre, Ca, Fe, Zn and vitamin A were assessed by: (i) estimating the nutrient intake from weighed food records based on an adjusted TACAM (a-TACAM); and (ii) chemical analysis of the duplicate portions. Agreement between the two methods was determined using the Wilcoxon signed-rank test and Bland–Altman plots.

Bamako, Mali.

Apparently healthy non-pregnant, non-lactating women (n 36) aged 15–36 years.

Correlation coefficients between estimated and analysed values ranged from 0·38 to 0·61. At population level, mean estimated and analysed nutrient intakes differed significantly for carbohydrates (203·0 v. 243·5 g/d), Fe (9·9 v. 22·8 mg/d) and vitamin A (356 v. 246 µg retinol activity equivalents). At individual level, all estimated and analysed nutrient intakes differed significantly; the differences tended to increase with higher intakes.

The a-TACAM is sufficiently acceptable for measuring average intakes of macronutrients, Ca and Zn at population level in low-intake populations, but not for carbohydrate, vitamin A and Fe intakes, and nutrient densities.

When planning severe acute malnutrition (SAM) treatment services, estimates of the number of children requiring treatment are needed. Prevalence surveys, used with population estimates, can directly estimate the number of prevalent cases but not the number of subsequent incident cases. Health managers often use a prevalence-to-incidence conversion factor (J) derived from two African cohort studies to estimate incidence and add the expected number of incident cases to prevalent cases to estimate expected SAM caseload for a given period. The present study aimed to estimate J empirically in different contexts.

Observational study, with J estimated by correlating expected numbers of children to be treated, based on prevalence surveys, population estimates and assumed coverage, with the observed numbers of SAM patients treated.

Survey and programme data from six African and Asian countries.

Twenty-four data sets including prevalence surveys and programme admissions data for 5 months following the survey.

A statistically significant relationship between the number of SAM cases admitted to SAM treatment services and the estimated burden of SAM from prevalence surveys was found. Estimate for the slope (intercept forced to be zero) was 2·17 (95 % CI 1·33, 3·79). Estimates for the prevalence-to-incidence conversion factor J varied from 2·81 to 11·21, assuming programme coverage of 100 % and 38 %, respectively.

Estimation of expected caseload from prevalence may require revision of the currently used prevalence-to-incidence conversion factor J of 1·6. Appropriate values for J may vary between different locations.

To facilitate the introduction of food insecurity screening into clinical settings, we examined the test performance of two-item screening questions for food insecurity against the US Department of Agriculture’s Core Food Security Module.

We examined sensitivity, specificity and accuracy of various two-item combinations of questions assessing food insecurity in the general population and high-risk population subgroups.

2013 Current Population Survey December Supplement, a population-based US survey.

All survey participants from the general population and high-risk subgroups.

The test characteristics of multiple two-item combinations of questions assessing food insecurity had adequate sensitivity (>97 %) and specificity (>70 %) for widespread adoption as clinical screening measures.

We recommend two specific items for clinical screening programmes based on their widespread current use and high sensitivity for detecting food insecurity. These items query how often the household ‘worried whether food would run out before we got money to buy more’ and how often ‘the food that we bought just didn’t last and we didn’t have money to get more’. The recommended items have sensitivity across high-risk population subgroups of ≥97 % and a specificity of ≥74 % for food insecurity.

Eating less frequently is associated with increased obesity risk in older children but data are potentially confounded by reverse causation, where bigger children eat less often in an effort to control their weight. Longitudinal data, particularly in younger children, are scarce. We aimed to determine whether eating frequency (meals and snacks) at 2 years of age is associated with past, current or subsequent BMI.

Cohort analysis of a randomised controlled trial. Eating frequency at 2 years of age was estimated using 48 h diaries that recorded when each child ate meals and snacks (parent-defined) in five-minute blocks. Body length/height and weight were measured at 1, 2 and 3·5 years of age. Linear regression assessed associations between the number of eating occasions and BMI Z-score, before and after adjustment for potential confounding variables.

Prevention of Overweight in Infancy (POI) study, Dunedin, New Zealand.

Children (n 371) aged 1–3·5 years.

On average, children ate 5·5 (sd 1·2) times/d at 2 years of age, with most children (88–89 %) eating 4–7 times/d. Eating frequency at 2 years was not associated with current (difference in BMI Z-score per additional eating occasion; 95 % CI: −0·02; −0·10, 0·05) or subsequent change (0·02; −0·03, 0·06) in BMI. Similarly, BMI at age 1 year did not predict eating frequency at 2 years of age (difference in eating frequency per additional BMI Z-score unit; 95 % CI: −0·03; −0·19, 0·13).

Number of eating occasions per day was not associated with BMI in young children in the present study.

To determine if the association between soda consumption and obesity is uniform among Asian-American population subgroups.

We conducted multivariate logistic regression analyses on odds of being obese among seven Asian subgroups and by place of birth using data from the 2009 California Health Interview Survey.

An omnibus population-based health survey.

Non-institutionalized adults, aged 18 years or over, residing in California (n 36 271).

Despite low levels of soda consumption in several Asian-American ethnic groups, soda consumption increased the odds of being obese among Chinese, Koreans and Other Asians but not for Whites. Obesity risk varied across Asian subgroups and by place of birth within these subgroups.

More public health efforts addressing soda consumption in Asian-American communities are needed as a strategy for not only preventing chronic diseases but also disparities, considering the varying levels of soda intake across subgroups. Results support the growing body of literature critiquing acculturation theory in immigrant health research by documenting inconsistent findings by place of birth. Future research should take into account the heterogeneity among Asian Americans to advance our understanding of health outcomes and disparities.

To examine the feasibility of implementing nine behavioural economics-informed strategies, or ‘nudges’, that aimed to encourage home dinner vegetable intake among low-income children.

Caregivers were assigned six of nine strategies and implemented one new strategy per week (i.e. 6 weeks) during three dinner meals. Caregivers recorded child dinner vegetable intake on the nights of strategy implementation and rated the level of difficulty for assigned strategies. Baseline data on home vegetable availability and child vegetable liking were collected to assess overall strategy feasibility.

Participants’ homes in a large Midwestern metropolitan area, USA.

Low-income caregiver/child (aged 9–12 years) dyads (n 39).

Pairwise comparisons showed that child dinner vegetable intake for the strategy ‘Serve at least two vegetables with dinner meals’ was greater than intake for each of two other strategies: ‘Pair vegetables with other foods the child likes’ and ‘Eat dinner together with an adult(s) modelling vegetable consumption’. Overall, caregivers’ mean rating of difficulty for implementing strategies was 2·6 (1=‘not difficult’, 10=‘very difficult’). Households had a mean of ten different types of vegetables available. Children reported a rating ≥5 for seventeen types of vegetable on a labelled hedonic scale (1=‘hate it’, 5–6=‘it’s okay’, 10=‘like it a lot’).

Behavioural economics-informed strategies are feasible to implement during dinner meals, with some strategies differing by how much they influence vegetable intake among low-income children in the home.

The present study aimed to examine the association between different breakfast consumption patterns and vitamin intakes and blood vitamin concentrations in European adolescents.

Breakfast consumption was assessed by a questionnaire. Vitamin intake was calculated from two 24 h recalls. Blood vitamin and total homocysteine (tHcy) concentrations were analysed from fasting blood samples.

The European Commission-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

Participants were 1058 (52·8 % females) European adolescents (aged 12·5–17·5 years) from ten cities.

Lower vitamin D and vitamin C concentrations were observed in male and female breakfast skippers than in consumers (P<0·05). Female breakfast consumers presented higher holo-transcobalamin and lower tHcy (P<0·05), while males had higher cobalamin concentrations, compared with skippers (P<0·05). Higher vitamin D and total folate intakes were observed in adolescents who consumed breakfast compared with skippers (P<0·05). Likewise, female consumers had higher intakes of vitamin B6 and vitamin E than occasional consumers (P<0·05).

Regular breakfast consumption is associated with higher blood vitamin D and cobalamin concentrations in males and with higher vitamin D and holo-transcobalamin and lower tHcy concentrations in females. Moreover, breakfast consumption is associated with high intakes of vitamin D and total folate in both sexes, and with high intakes of vitamin B6 and vitamin E in females.

To determine the associations between haemoconcentration at the end of pregnancy (third trimester and delivery) and neonatal behaviour in healthy pregnant women supplemented with moderate doses of Fe.

A prospective longitudinal study in which obstetric and clinical history, maternal toxic habits, maternal anxiety and Hb levels were recorded at the third trimester and delivery. Neonatal behaviour was assessed at 48–72 h of age using the Neonatal Behavioral Assessment Scale.

Unit of Obstetrics and Gynaecology of the Sant Joan University Hospital in Reus, Tarragona (Spain).

A total of 210 healthy and well-nourished pregnant women and their full-term, normal-weight newborns.

The results showed that, after adjusting for confounders, in the third trimester the risk of haemoconcentration (6·2 % of pregnant women) was related to decreased neonatal state regulation (B=−1·273, P=0·006) and alertness (B=−1·848, P=0·006) scores. In addition, the risk of haemoconcentration at delivery (12·0 % of pregnant women) was also related to decreased neonatal state regulation (B=−0·796, P=0·021) and poor robustness and endurance (B=−0·921, P=0·005) scores.

Our results show that the risk of haemoconcentration at the end of pregnancy is related to the neonate’s neurodevelopment (and self-regulation capabilities), suggesting that Fe supplementation patterns and maternal Fe status during pregnancy are important factors for neurodevelopment which may be carefully controlled.

Food insecurity has been rising across Europe following the Great Recession, but to varying degrees across countries and over time. The reasons for this increase are not well understood, nor are what factors might protect people’s access to food. Here we test the hypothesis that an emerging gap between food prices and wages can explain increases in reported inability to afford protein-rich foods and whether welfare regimes can mitigate its impact.

We collected data in twenty-one countries from 2004 to 2012 using two databases: (i) on food prices and deprivation related to food (denoted by reported inability to afford to eat meat, chicken, fish or a vegetarian equivalent every second day) from EuroStat 2015 edition; and (ii) on wages from the Organisation for Economic Co-operation and Development 2015 edition.

After adjusting for macroeconomic factors, we found that each 1 % rise in the price of food over and above wages was associated with greater self-reported food deprivation (β=0·060, 95 % CI 0·030, 0·090), particularly among impoverished groups. However, this association also varied across welfare regimes. In Eastern European welfare regimes, a 1 % rise in the price of food over wages was associated with a 0·076 percentage point rise in food deprivation (95 % CI 0·047, 0·105) while in Social Democratic welfare regimes we found no clear association (P=0·864).

Rising prices of food coupled with stagnating wages are a major factor driving food deprivation, especially in deprived groups; however, our evidence indicates that more generous welfare systems can mitigate this impact.

To determine whether a cardioprotective dietary intervention based on UK dietary guidelines was more expensive than a conventional UK diet.

Cost analysis of food records collected at baseline and after a 12-week dietary intervention of a cardioprotective diet v. conventional UK diet.

A randomized controlled dietary intervention study (CRESSIDA; ISRCTN 92382106) investigating the impact of following a diet consistent with UK dietary guidelines on CVD risk.

Participants were healthy UK residents aged 40–70 years. A sub-sample of participants was randomly selected from those who completed the cardioprotective dietary intervention (n 20) or the conventional UK dietary intervention (n 20).

Baseline diet costs did not differ between groups; mean daily food cost for all participants was £6·12 (sd £1·83). The intervention diets were not more expensive: at end point the mean daily cost of the cardioprotective diet was £6·43 (sd £2·05) v. the control diet which was £6·53 (sd £1·53; P=0·86).

There was no evidence that consumption of a cardioprotective diet was more expensive than a conventional dietary pattern. Despite the perception that healthier foods are less affordable, these results suggest that cost may not be a barrier when modifying habitual intake and under tightly controlled trial conditions. The identification of specific food groups that may be a cost concern for individuals may be useful for tailoring interventions for CVD prevention for individuals and populations.

To consider the plausible nutritional impacts of fluctuations in money availability within an income cycle for remote Indigenous Australians.

Community-level dietary intake (energy, micro/macronutrients) and expenditure on foods and beverages (F&B) were estimated over one year for three remote Indigenous Australian communities (Northern Territory, Australia) using monthly F&B transaction data. F&B that were likely to be consumed during a period within an income cycle when money was relatively limited (low money period (LMP) foods) were identified by panel consensus and scenario modelling was conducted to simulate the nutritional outcomes of a range of F&B selection responses to having an LMP.

All scenarios resulted in reduced diet quality during the LMP relative to overall average diet values. Protein and fat energy percentages were reduced and carbohydrate energy percentage increased. Despite reduced expenditure, declines in energy intake were typically buffered due to the reduced energy cost ($AU/MJ) of the LMP diet. The micronutrient profile of the LMP diet was substantially poorer, such that additional key micronutrients dropped below population-weighted Estimated Average Requirements/Adequate Intakes.

The modelling undertaken herein suggests that even a short period of low money within an income cycle may noticeably contribute to the reduced diet quality of remote Indigenous Australians and exacerbate lifestyle disease risk. Dietary strategies that are designed to respond to diets and expenditure during different income cycle periods, rather than the overall average diet and expenditure, should be considered for improving diet quality and reducing cardiometabolic disease risk in remote Indigenous Australians.

To examine whether breast-feeding duration and socio-economic status (SES) interact to predict junk food consumption among offspring and whether the interaction differs across racial/ethnic groups.

Survey research using a longitudinal panel design. Hierarchical linear regression was used to analyse the data.

In-home interviews with the child’s parents over a 5-year period across the USA.

Approximately 10 000 American children from the Early Childhood Longitudinal Study: Birth Cohort (ECLS-B).

The findings revealed that longer breast-feeding durations correspond to lower levels of junk food consumption, but that this relationship emerges consistently only among low-SES blacks.

Efforts to promote breast-feeding among low-SES black women may have the added benefit of reducing their children’s junk food intake, and may thereby promote their general health and well-being. Future research should seek to explore the mechanisms by which breast-feeding might benefit the dietary habits of low-SES black children.

To better understand low-income adults’ attitudes towards participating in farmers’ markets, community-supported agriculture (CSA) and nutrition education programming.

Focus groups were held with a diverse sample of adults. Interviews were transcribed verbatim and analysed using thematic analysis.

Three affordable housing communities in Washington, DC, USA.

Participants included twenty-eight residents of the three affordable housing communities.

Four major themes emerged across groups, along with several sub-themes within each theme. These included: (i) perceptions of farmers’ markets (benefits, barriers, current participation and knowledge); (ii) perceptions of CSA (benefits, barriers and questions/concerns); (iii) need/interest in additional programming (nutrition education, non-nutrition education, qualities of programming and perceived barriers); and (iv) current health knowledge and behaviours (dietary behaviours, health recommendations and health concerns).

Adults living in urban, affordable housing communities desire access to healthy foods, but are limited by cost. Programmes could have a higher likelihood of success if they accept benefits like SNAP (the Supplemental Nutrition Assistance Program), are heavily marketed and incorporate culturally relevant nutrition education components.

To evaluate the effectiveness of a community-based participatory nutrition promotion (CPNP) programme involving a 2-week group nutrition session in improving child feeding and hygiene practices among caregivers.

Cluster randomized trial. In the intervention area (six clusters), the CPNP programme was added to the context of government nutrition programmes; the control area (six clusters) received the government programme only. Child feeding practices were assessed every 3 months using a 24 h dietary recall questionnaire, and hand washing with soap was assessed every 6 months, over a period of 12 months. Feeding and hygiene measures at each visit were scored and the scores summed up for the entire follow-up period.

Habro and Melka Bello districts, Ethiopia.

Randomly selected mothers with a child aged 6–12 months (n 1790).

A total of 1199 mothers, 629 in the control and 570 in the intervention areas, were assessed at all visits and included in the analysis. Mothers in the intervention area showed higher scores than those in the control area regarding meal frequency (difference: 1·04, 95 % CI 0·35, 1·73), composite feeding score_1 (difference: 1·25, 95 % CI 0·37, 2·13; a summing score of currently breast-feeding, meal frequency and dietary diversity) and composite feeding score_2 (difference: 1·40, 95 % CI 0·49, 2·32; a summing score of meal frequency and dietary diversity). However, there were no differences in the scores of breast-feeding, dietary diversity and hand washing between the two areas (all P>0·05).

The CPNP programme was effective in improving some child feeding behaviours in rural Eastern Ethiopia.

To differentiate the effects of food vouchers and training in health and nutrition on consumption and dietary diversity in Ecuador by using an experimental design.

Interventions involved enrolling three groups of approximately 200 randomly selected households per group in three provinces in Ecuador. Power estimates and sample size were computed using the Optimal Design software, with a power of 80 %, at 5 % of significance and with a minimum detectable effect of 0·25 (sd). The first group was assigned to receive a monthly food voucher of $US 40. The second group was assigned to receive the same $US 40 voucher, plus training on health and nutrition issues. The third group served as the control. Weekly household values of food consumption were converted into energy intake per person per day. A simple proxy indicator was constructed for dietary diversity, based on the Food Consumption Score. Finally, an econometric model with three specifications was used for analysing the differential effect of the interventions.

Three provinces in Ecuador, two from the Sierra region (Carchi and Chimborazo) and one from the Coastal region (Santa Elena).

Members of 773 households randomly selected (n 4343).

No significant impact on consumption for any of the interventions was found. However, there was evidence that voucher systems had a positive impact on dietary diversity. No differentiated effects were found for the training intervention.

The most cost-effective intervention to improve dietary diversity in Ecuador is the use of vouchers to support family choice in food options.

Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women.

The Information–Motivation–Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial.

Pietermaritzburg, South Africa, at two comparable rural public health service clinics.

Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum.

While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm.

Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour.

The Crunch&Sip programme is a school-based nutrition initiative designed to increase the fruit, vegetable and water intakes of primary-school children. In recognition of the notable deficits in children’s vegetable consumption, the present study explored the receptivity of school staff to a realignment of the Crunch&Sip programme to feature a primary focus on vegetable consumption. This involved investigating school staff members’ perceptions of relevant barriers, motivators and facilitators.

A multi-method approach was adopted that involved four focus groups and a survey (administered in paper and online formats) containing a mixture of open- and closed-ended items.

Western Australia.

Staff from Western Australian schools participated in the focus groups (n 37) and survey (n 620).

School staff were strongly supportive of modifying the Crunch&Sip programme to focus primarily on children’s vegetable consumption and this was generally considered to be a feasible change to implement. Possible barriers identified included children’s taste preferences and a perceived lack of parental support. Suggested strategies to overcome these barriers were education sessions for parents and children, teachers modelling vegetable consumption for their students and integrating vegetable-related topics into the school curriculum.

School staff are likely to support the introduction of school-based nutrition programmes that specifically encourage the consumption of vegetables. Potential barriers may be overcome through strategies to engage parents and children.

To study the salt and sugars content of breakfast cereals sold in the UK between 1992 and 2015.

Cross-sectional surveys on salt and sugars content collected from the nutrition information panel of breakfast cereals in 1992, 2004, 2006, 2009, 2012 and 2015.

All major UK retailers operating at that moment in time (approximately ten).

The salt and sugars content was collected from product packaging and the nutrition information panels.

Cereals consistently surveyed across all five years (n22) showed a significant reduction in salt content of 47 % (P<0·001). Sugars content of breakfast cereals (n 15), however, did not show a significant change; 25·65 g/100 g in 1992 and 22·45 g/100 g in 2015 (P=0·170). There was a large variation in salt and sugars content between different categories and within the same type of category.

The study shows the progressive reduction in salt content of breakfast cereals in the UK since 2004 as a result of the successful salt reduction programme, particularly the setting of incremental salt targets. Further reductions in salt content need to be made as cereals remain a major contributor to salt intake. Sugars content, however, has been consistently high due to the lack of a sugar reduction strategy. The research demonstrates that the sugars content of breakfast cereals in the UK is of concern, particularly in children’s breakfast cereals, with a typical serving (30 g) containing a third of a 4–6-year-old’s maximum daily recommendation (19 g/d) for free sugars intake in the UK. More can and should be done to reformulate, with an urgent need to set incremental sugar reduction targets.