To review and synthesize studies on household food security in South Africa.

Systematic mapping review of metrics (methodological review).

Electronic databases, including EBSCOHost, Scopus and Web of Science, were searched for studies and reports on household food security in South Africa, reporting household food security published between 1999 and 2021. Searching, selecting and reporting were performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement.

South African households

Forty-eight articles reporting on six national surveys (one repeated annually since 2002) and forty sub-national studies meeting the inclusion criteria were selected. Various metrics, with different recall periods and ways of categorizing food security levels, were identified. Surveys that used similar metrics showed that the percentage of South African households that have experienced food insecurity and hunger has decreased over the review period yet remains concerning. However, the multitude of metrics used to assess the different components and levels of food security limits the comparability of the results to evaluate the scope and scale of the problem.

There is growing support for developing multi-variable approaches for food security research in sub-Saharan Africa. Future research should focus on finding the most appropriate combination of complementary metrics that would allow comparable data while holistically capturing food security and providing insight into the causes and consequences.

To evaluate various diet quality indices and to estimate their associations with major non-communicable diseases (NCD) (i.e. diabetes mellitus (DM) and myocardial infarction (MI)) and risk for overweight (OW).

Four dietary diversity indices (namely, count index (Count), dietary diversity score index, berry index (BI) and entropy index (EI)) and three Chinese dietary guideline-based indices (namely, China healthy diet index, Chinese food pagoda score and diet quality divergence index) were employed to evaluate Chinese diet quality. DM, MI and OW were used as diet-related health indicators. Logit regressions were employed to unveil the associations between diet quality indices and NCD and risk for OW. The relationships between diet quality indices and daily energy intakes were checked with ordinary least squares linear regressions.

Four recent waves (2004, 2006, 2009, 2011) of longitudinal individual data from China Health and Nutrition Survey.

Chinese adults (aged 18–64 years) from twelve provinces were included in the analysis (n 30 350).

Count, BI, and EI were positively associated with higher OW risk and daily energy intakes. As dietary guideline-based indices got better, people were exposed to lower DM and OW risks and got lower daily energy intakes. Finally, dietary guideline-based indices properly revealed the expected relationships that high-quality diets would reduce NCD and risk for OW, while high diversity indices were usually correlated with over-nutrition and high risks.

Increasing diversity of the diet does not necessarily improve the nutrition and health. Dietary guideline-based indices are more robust than dietary diversity indices; thus, they should be highly recommended when evaluating diet quality.

This study aimed to identify the amount of discretionary foods and drinks consumed by Norwegian children and adolescents, describe how such products contribute to the intake of total energy and nutrients, and study the distribution in intake of discretionary foods and drinks across different meals. Secondly, the aim was to explore factors associated with those children and adolescents having the highest consumption of discretionary foods and drinks.

Secondary analysis of data from a national survey of dietary intake among Norwegian children and adolescents.

Schools in fifty randomly selected municipalities in Norway.

The study population included 636 pupils in 4th grade (9–11 years) and 687 pupils in 8th grade (12–14 years).

Discretionary foods and drinks contributed to about 20 % of the children and adolescents’ total energy intake. These products contributed to about two-thirds of the participants’ intake of added sugar, and limited amounts of dietary fibre, vitamins and minerals. The quartile which had the lowest proportion of their energy intake from discretionary foods and drinks seemed to have a higher intake of whole grains, and fish and seafood.

Almost all 4th and 8th graders in Norway consumed discretionary foods and drinks, and these products contributed to a substantial proportion of the total energy intake and limited amounts of nutrients. Those children and adolescents consuming the least discretionary foods and drinks had a higher intake of whole grains, fish and seafood, indicating healthier and more sustainable food habits.

To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore key factors, including COVID-19 concerns, that influenced VAS status in four sub-Saharan African countries.

Data from eight representative household surveys were used to assess VAS coverage. Multivariable logistic regression models examined the effect of rural/urban residence, child sex and age, caregiver education, COVID-19 concern and household wealth on VAS status.

Nine (2019) and 12 (2020) districts in Burkina Faso, Côte d’Ivoire, Guinea and Mali.

28 283 caregivers of children aged 6–59 months.

Between 2019 and 2020, VAS coverage increased in Burkina Faso (82·2–93·1 %), Côte d’Ivoire (90·3–93·3 %) and Mali (76·1–79·3 %) and decreased in Guinea (86·0 % to 81·7 %). Rural children had a higher likelihood of VAS uptake compared with urban children in Burkina Faso (adjusted OR (aOR) = 4·22; 95 % CI: 3·11, 5·72), Côte d’Ivoire (aOR = 5·19; 95 % CI: 3·10, 8·70) and Mali (aOR = 1·41; 95 % CI: 1·15, 1·74). Children aged 12–59 months had a higher likelihood of VAS uptake compared with children aged 6–11 months in Côte d’Ivoire (aOR = 1·67; 95 % CI: 1·12, 2·48) and Mali (aOR = 1·74; 95 % CI: 1·34, 2·26). Moderate-to-high COVID-19 concern was associated with a lower likelihood of VAS uptake in Côte d’Ivoire (aOR = 0·55; 95 % CI: 0·37, 0·80).

The increase in VAS coverage from 2019 to 2020 suggests that COVID-19 concerns may not have limited VAS uptake in some African countries, though geographic inequities should be considered.

To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression.

Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations of food insecurity and related coping strategies with anxiety and depression.

South Africa during COVID-19, October 2021.

Nationally representative sample of 3402 adults, weighted to 39,640,674 South African households.

About 20·4 % of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from ‘food secure’ to ‘at risk’ or from ‘at risk’ to ‘food insecure’ group was associated with 1·7 times greater odds of being in a higher category of anxiety or depression (P < 0·001). All coping strategies were used to some extent in South African households, with 46·0 % relying on less preferred and less expensive foods and 20·9 % sending a household member to beg for food. These coping strategies were mostly used by food-insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all P < 0·001), begging for food was associated with the highest odds (OR = 2·3).

Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.

To describe the time trends and socio-economic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI).

This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008–2019. Prais–Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated.

Primary health care services, Brazil.

Totally, 911 735 Brazilian children under 2 years old.

Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1: Δ 47·8–52·2 %, APC + 1·44, P = 0·006), minimum acceptable diet (Q1: Δ 34·5–40·5 %, APC + 5·17, P = 0·004) and consumption of meat and/or eggs (Q1: Δ 59·7–80·3 %, APC + 6·26, P < 0·001; and Q5: Δ 65·7–70·7 %, APC + 2·20, P = 0·041). Stable trends in exclusive breast-feeding and decreasing trends in the consumption of sweetened drinks and ultra-processed foods were also observed regardless the level of the deprivation.

Improvements in some complementary food indicators were observed over time. However, the improvements were not equally distributed among the BDI quintiles, with children from the municipalities with less deprivation benefiting the most.

This study employs a strengths-based approach to assess food access in remote Alaska during the COVID-19 pandemic, identifying both the negative consequences of the pandemic on store-bought and subsistence/traditional food access and compensatory strategies used.

As a part of a larger study on the impacts of COVID-19 on daily life remote Alaskan communities, study data presented here were collected through key informant interviews (KII) and state-wide online surveys from 21 September 2020 to 31 March 2021 among remote Alaska community members.

This study was conducted with residents of remote communities in Alaska, defined as those off the road system. Remote communities often have small or no grocery stores and rely on subsistence or traditional sources of food.

KII participants (n 36) were majority female (78 %) and Alaska Native (57 %). Survey participants (n 615) were also majority female, 25–54 years old and most had had some post-secondary education or training.

Survey and interview data revealed that the pandemic had significant negative impacts on store-bought food access in remote Alaskan communities. Individuals also shared that locally available and wild harvested foods acted as a buffer to some of the loss of access to these store-bought foods, with some people sharing that the harvesting of wild and traditional foods served as a coping strategy during times of pandemic-related stress.

The results from this study demonstrate that the remoteness of some Alaskan communities has been both a source of vulnerability and protection in terms of food access.

The shift towards plant-based diets with less meat and more legumes is a global target and requires an understanding of the consequences of dietary adequacy on the population level. Our aim was to model the impact of partial replacement of red and processed meat with legumes on nutrient intakes and population shares below dietary reference intakes.

Modelling study with three scenarios anchored in meat cut-offs: ≤ 70 g/d (Finnish dietary guideline); ≤ 50 g/d (Danish dietary guideline); ≤ 30 g/d (EAT-Lancet recommendation). In all subjects, the amount of meat in grams over the cut-off was replaced with the same amount of legumes. The SPADE method was used to model usual intake distributions. Meaningful differences in average intakes and in population shares below dietary reference intakes compared to the reference (FinDiet) were evaluated based on non-overlapping 95 % CI.

Finnish national food consumption survey (FinDiet 2017).

Finnish adults (n 1655) aged18–74 years (47 % men).

The scenarios introduced increases in the average intakes of fibre, folate, K, Mg, Cu and Fe, and decreases in intakes of saturated fat, niacin, vitamin B12, Se and Zn. Meaningful shifts of the usual intake distributions of fibre and folate towards improvement in intakes emerged already in ‘scenario 70 g’. Overall, distribution shifts towards a higher probability of inadequate intakes of the studied nutrients were not observed.

These results support the public health message to partly replace meat with legumes and may benefit nutrition policy actions towards sustainable diets in the Nordic countries and beyond.

To describe the promotion of food and beverage and marketing strategies used by online food delivery services (OFDS) in a social media platform before and during the pandemic in Brazil.

Publicly available data were extracted from OFDS Instagram accounts. Posts published 6 months immediately before and after the first case of COVID-19 in Brazil were randomly sampled. Two independent authors coded the posts’ content. Food and beverage items featured in posts were classified according to the NOVA food system classification. Marketing strategies were coded according to protocols from previous studies.

Top three OFDS Instagram accounts in Brazil.

Posts published in the period studied (n 304).

During the pandemic, the proportion of posts featuring at least one food item decreased from 71·6 % to 40·2 %, and the proportion of ultra-processed foods decreased from 57·6 % to 27·9 %. Before the pandemic, the most widely used marketing strategies were branding elements (80·7 %), product imagery (unbranded) (48·9 %) and partnerships/sponsorship (35·2 %). While during the pandemic, branding elements (62·2 %) continued to be the most applied, but were followed by the use of videos/graphics interchange format/boomerangs (34·1 %) and corporate social responsibility (31·7 %). The most frequent COVID-19 marketing strategies were ‘social responsibility in the pandemic’ (30·5 %), ‘combatting the pandemic’ (28·0 %) and ‘accelerating digitalisation’ (20·7 %).

OFDS advertisements on a social media platform placed less emphasis on food items, but improved the nutritional quality of foods and beverages featured in posts. A COVID-washing approach was highlighted, especially through the use of social responsibility marketing during the pandemic.

The COVID-19 pandemic increased food insufficiency: a severe form of food insecurity. Drawing on an ecological framework, we aimed to understand factors that contributed to changes in food insufficiency from April to December 2020, in a large urban population hard hit by the pandemic.

We conducted internet surveys every 2 weeks in April–December 2020, including a subset of items from the Food Insecurity Experience Scale. Longitudinal analysis identified predictors of food insufficiency, using fixed effects models.

Los Angeles County, which has a diverse population of 10 million residents.

A representative sample of 1535 adults in Los Angeles County who are participants in the Understanding Coronavirus in America tracking survey.

Rates of food insufficiency spiked in the first year of the pandemic, especially among participants living in poverty, in middle adulthood and with larger households. Government food assistance from the Supplemental Nutrition Assistance Program was significantly associated with reduced food insufficiency over time, while other forms of assistance such as help from family and friends or stimulus funds were not.

The findings highlight that during a crisis, there is value in rapidly monitoring food insufficiency and investing in government food benefits.

To assess the associations among several anthropometric measures, as well as BMI trajectories and colorectal cancer (CRC) risk in older women.

Prospective cohort study.

Forty clinical centres in the USA.

Totally, 79 034 postmenopausal women in the Women’s Health Initiative Observational Study.

During an average of 15·8 years of follow-up, 1514 CRC cases were ascertained. Five BMI trajectories over 18–50 years of age were identified using growth mixture model. Compared with women who had a normal BMI at age 18, women with obesity at age 18 had a higher risk of CRC (HR 1·58, 95 % CI 1·02, 2·44). Compared with women who kept relatively low normal body size during adulthood, women who progressed from normal to obesity (HR 1·29, 95 % CI 1·09, 1·53) and women who progressed from overweight to obesity (HR 1·37, 95 % CI 1·13, 1·68) had higher CRC risks. A weight gain > 15 kg from age 18 to 50 (HR 1·20, 95 % CI 1·04, 1·40) and baseline waist circumference > 88 cm (HR 1·33, 95 % CI 1·19, 1·49) were associated with higher CRC risks, compared with stable weight and waist circumference ≤ 88 cm, respectively.

Women who have a normal weight in early adult life and gain substantial weight later, as well as those who are persistently heavy over adulthood, demonstrated a higher risk of developing CRC. Our study highlights the importance of maintaining a healthy body weight over the life course for reducing the risk of developing CRC in women.

To evaluate messages about infant feeding on breastmilk substitute (BMS) manufacturer websites directed at US caregivers and compare information and portrayals of breast-feeding/breastmilk with that of infant formula (IF) feeding.

We conducted a content analysis of US BMS companies’ websites. A codebook was created through an iterative process to identify messages and images about breast-feeding/breastmilk and IF feeding, including benefits or issues associated with each, and direct-to-consumer marketing practices that could discourage breast-feeding.

Data were collected in 2019–2020 and analysed in 2020–2021 for US websites of five IF manufacturers.

The websites of Similac, Enfamil and Gerber, which collectively represent approximately 98 % of the US IF market, and two US organic brands, Earth’s Best and Happy Baby.

Websites contained more messages about breast-feeding/breastmilk than IF but were significantly more likely to mention benefits to baby of IF (44 %) than breast-feeding/breastmilk (<26 %), including significantly more statements that IF provides brain, neural and gastrointestinal benefits; 40 % of breast-feeding/breastmilk content was dedicated to breast-feeding problems (e.g. sore nipples). Twice as many screenshots compared IF brands favourably to breastmilk than as superior to other brands. Certain companies displayed images indicating ease of IF feeding and difficulty of breast-feeding.

Substantial messaging on BMS manufacturer websites encouraged IF feeding and discouraged breast-feeding. Health professionals should discourage their patients from visiting these websites and the US government should regulate misleading claims. Companies should refrain from providing breast-feeding advice and align their US marketing with the International Code of Marketing of Breast-milk Substitutes.

Children are frequently exposed to unhealthy food marketing on digital media. This marketing contains features that often appeal to children, such as cartoons or bold colours. Additional factors can also shape whether marketing appeals to children. In this study, in order to assess the most important predictors of child appeal in digital food marketing, we used machine learning to examine how marketing techniques and children’s socio-demographic characteristics, weight, height, BMI, frequency of screen use and dietary intake influence whether marketing instances appeal to children.

We conducted a pilot study with thirty-nine children. Children were divided into thirteen groups, in which they evaluated whether food marketing instances appealed to them. Children’s agreement was measured using Fleiss’ kappa and the S score. Text, labels, objects and logos extracted from the ads were combined with children’s variables to build four machine-learning models to identify the most important predictors of child appeal.

Households in Calgary, Alberta, Canada.

39 children aged 6–12 years.

Agreement between children was low. The models indicated that the most important predictors of child appeal were the text and logos embedded in the food marketing instances. Other important predictors included children’s consumption of vegetables and soda, sex and weekly hours of television.

Text and logos embedded in the food marketing instances were the most important predictors of child appeal. The low agreement among children shows that the extent to which different marketing strategies appeal to children varies.

The COVID-19 pandemic changed early care and education (ECE) mealtimes. Feeding practices that support children’s emerging autonomy may support children’s healthy eating, but it is unknown whether and how COVID-19 changed feeding practices. This paper describes caregiver feeding practices in ECE centres in Florida during COVID-19.

A mixed-methods design was used to understand mealtime feeding practices. Survey and interview questions were developed based on the Trust Model. More than 7000 surveys were sent to ECE centres. Analysis included descriptive statistics for survey data and thematic analysis for interview data.

This statewide study included teachers in all licensed and license-exempt ECE centres.

Four hundred and thirty-one teachers completed a survey, and twenty-nine participated in follow-up interviews.

Surveys showed most teachers engaged in autonomy-supportive behaviours, such as letting children eat until they were finished (90 %). The most common controlling behaviour was praising children for cleaning their plates (70 %). The most common responses about changes to mealtimes were keeping physical distance and serving healthy food. Interview themes were Autonomy Support, Controlling Feeding Practices, Interactions are the Same, Interactions are Different, Physical Distancing and Healthy Eating.

Mealtimes are a central part of the day for young children and teachers in ECE environments. COVID-19 continues to influence ECE routines as behaviour change remains the primary method of reducing the risk of COVID-19 in the absence of a vaccine for young children. Understanding teachers’ practices and perspectives is important for reducing the risk of COVID-19 and supporting children’s autonomy and healthy eating.

To nutritionally analyse lunches provided for 3–4-year-old children attending school nurseries. Energy and nutrient content are compared with nutrient frameworks underpinning voluntary guidelines for early years settings (EYS) and mandatory standards for infant schools (4–7-year-olds).

A cross-sectional study, recording all main meals, vegetarian meals, jacket potato options, sandwich options and all desserts and accompaniments provided over 5 consecutive days in each school. Two portions of each meal were collected each day and weighed. Recipe and portion weight data were entered into nutrient analysis software.

School nurseries where lunch was provided by the school.

Nine schools, providing a total of 161 meals.

Lunches contained more energy (1881 kJ/450 kcal), fat (15·5 g), free sugars (10·5 g) and Na (424 mg) than suggested by the nutrient framework for EYS. Carbohydrate (60·6 g), protein (16·8 g), fibre (6·7 g), Fe (2·4 mg), Zn (2·0 mg), Ca (202 mg), vitamin A (304 µg) and vitamin C (19 mg) also exceeded minimum recommendations. Compared with a revised nutrient framework for infant schools, energy was within range, whilst saturated fat, free sugars and Na were above maximum recommendations for this age group, and Zn was below. Sandwich meals were lower in vitamin C (P < 0·001–P = 0·05) and Fe (P = 0·012–P = 0·017) and higher in Na (P < 0·001–P = 0·003) and Ca (P < 0·001–P = 0·05).

Lunches provided for children attending school nurseries are more in line with the framework for 4–7-year-olds. Free sugars, saturated fat and Na are areas of concern consistent with previous studies. Protein is three times more than recommended. Large portions of cakes and biscuits contribute to excess energy provision.