To investigate caregiver type as a potential moderating effect in the relationship between feeding style and weight status among Chinese pre-school children.

Cross-sectional data collected with the Caregiver’s Feeding Style Questionnaire (CFSQ), anthropometric data, childcare and sociodemographic information.

Shenyang, China.

Caregiver–child dyads (n 857).

After controlling for confounders, authoritarian feeding style was associated with a 0·30 lower BMI Z-score. Fathers as primary caregivers were related to lower BMI Z-score (β=−0·66), while grandparents as main caregivers were associated with higher BMI Z-score (β=0·66) after adjusting for covariates. Mothers buffered the relationship between authoritarian (β=0·50, 95 % CI 0·04, 0·95) or indulgent (β=−0·60, 95 % CI −1·06, −0·14) feeding styles and BMI Z-score. Grandparents strengthened the trend that indulgent feeding style was related to higher BMI Z-score (β=0·54, 95 % CI 0·01, 1·08).

The results of independent and interactive effects of specific feeding styles and caregiver types had different influences on child BMI Z-scores. Longitudinal investigations are needed to evaluate the effect of fathers’ and grandparents’ feeding on their children’s nutrition and weight status.

Long-chain PUFA (LCPUFA) found in breast milk are derived from dietary sources and critical for optimal infant development. We examined associations between fish consumption and concentrations of LCPUFA and essential n-3 and n-6 fatty acids in breast milk among mothers living around Lake Victoria.

We used cross-sectional analyses of associations between recent fish consumption and breast-milk fatty acid concentrations.

The study was conducted around Lake Victoria on Mfangano Island, Kenya, where multiple fish species are key dietary components and also are widely exported.

Breast-feeding mothers (n 60) provided breast-milk samples, anthropometric measurements and questionnaire responses.

In the previous 3 d, 97 % of women consumed a mean of 178 (sd 111) g fish (~2 servings/3 d). Mean breast-milk concentrations included DHA (0·75 % of total fatty acids), EPA (0·16 %), α-linolenic acid (ALA; 0·54 %), arachidonic acid (AA; 0·44 %) and linoleic acid (LA; 12·7 %). Breast-milk DHA concentrations exceeded the global average of 0·32 % in fifty-nine of sixty samples. We found native cichlids (Cichlidae) and dagaa (Rastrineobola argentea) contributed high levels of DHA, EPA and AA to local diets. We also found evidence for associations between fish species consumed and breast-milk LCPUFA concentrations when controlling for intake of other fish species, maternal body mass, maternal age, child age and exclusive breast-feeding.

The fatty acid composition of breast milk was influenced by the fish species consumed. Ensuring access to diverse fish and particularly inexpensive, locally available species, may be important for diet quality as well as infant growth and development.

Introduction of biofortified cassava as school lunch can increase vitamin A intake, but may increase risk of other deficiencies due to poor nutrient profile of cassava. We assessed the potential effect of introducing a yellow cassava-based school lunch combined with additional food-based recommendations (FBR) on vitamin A and overall nutrient adequacy using Optifood (linear programming tool).

Cross-sectional study to assess dietary intakes (24 h recall) and derive model parameters (list of foods consumed, median serving sizes, food and food (sub)group frequency distributions, food cost). Three scenarios were modelled, namely daily diet including: (i) no school lunch; (ii) standard 5d school lunch with maize/beans; and (iii) 5d school lunch with yellow cassava. Each scenario and scenario 3 with additional FBR were assessed on overall nutrient adequacy using recommended nutrient intakes (RNI).

Eastern Kenya.

Primary-school children (n 150) aged 7–9 years.

Best food pattern of yellow cassava-based lunch scenario achieved 100 % RNI for six nutrients compared with no lunch (three nutrients) or standard lunch (five nutrients) scenario. FBR with yellow cassava and including small dried fish improved nutrient adequacy, but could not ensure adequate intake of fat (52 % of average requirement), riboflavin (50 % RNI), folate (59 % RNI) and vitamin A (49 % RNI).

Introduction of yellow cassava-based school lunch complemented with FBR potentially improved vitamin A adequacy, but alternative interventions are needed to ensure dietary adequacy. Optifood is useful to assess potential contribution of a biofortified crop to nutrient adequacy and to develop additional FBR to address remaining nutrient gaps.

To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India.

Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall.

High-altitude region of Nainital District, Uttarakhand State, North India.

Community-dwelling geriatric subjects (n 981) aged 60 years or above.

We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0–29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work.

There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.

To identify the corporate political activity (CPA) of major food industry actors in France.

We followed an approach based on information available in the public domain. Different sources of information, freely accessible to the public, were monitored.

Data were collected and analysed between March and August 2015. Five actors were selected: ANIA (Association Nationale des Industries Agroalimentaires/National Association of Agribusiness Industries); Coca-Cola; McDonald’s; Nestlé; and Carrefour.

Our analysis shows that the main practices used by Coca-Cola and McDonald’s were the framing of diet and public health issues in ways favourable to the company, and their involvement in the community. ANIA primarily used the ‘information and messaging’ strategy (e.g. by promoting deregulation and shaping the evidence base on diet- and public health-related issues), as well as the ‘policy substitution’ strategy. Nestlé framed diet and public health issues, and shaped the evidence base on diet- and public health-related issues. Carrefour particularly sought involvement in the community.

We found that, in 2015, the food industry in France was using CPA practices that were also used by other industries in the past, such as the tobacco and alcohol industries. Because most, if not all, of these practices proved detrimental to public health when used by the tobacco industry, we propose that the precautionary principle should guide decisions when engaging or interacting with the food industry.

To estimate current food intake in the population of northern Norway and to investigate the impact of self-perceived Sami ethnicity and region of residence on food intake.

The data are part of the second cross-sectional survey of the Population-based Study on Health and Living Conditions in Regions with Sami and Norwegian Populations (the SAMINOR 2 Clinical Survey, 2012–2014). Food intake was assessed by an FFQ. Ethnic and regional differences in food intake were studied by sex-specific, multivariable-adjusted quantile regression models.

Ten municipalities (rural northern Norway).

Males (n 2054) and females (n 2450) aged 40–69 years (2743 non-Sami, 622 multi-ethnic Sami, 1139 Sami).

The diet of Sami participants contained more reindeer meat, moose meat, food made with animal blood and freshwater fish; and contained less lean fish and vegetables. In the inland region, the consumption of reindeer meat was greatest in Sami participants, followed by multi-ethnic Sami participants and non-Sami participants, who had the lowest consumption (median 25, 12 and 8 g/d, respectively). Compared with the inland region, fish roe/liver intake was higher in the coastal region and lean fish intake was twice as high (41 and 32 g/d in males and females, respectively).

When compared with non-Sami participants, those with solely self-perceived Sami ethnicity reported a significantly different intake of several foods, especially reindeer meat in the inland region. Multi-ethnic Sami tended to have similar diets to non-Sami. Residence in the coastal region predicted higher fish and roe/liver intake.

Observational studies reported potential associations between different dietary patterns and the risk of metabolic syndrome (MetS); however, a consistent perspective has not been established to date. The current systematic review and meta-analysis aimed to evaluate the relationship between a posteriori dietary patterns and MetS by pooling available data.

MEDLINE and EMBASE databases were searched for relevant articles published up to July 2015 with no time restriction and with English language restriction. Two independent reviewers completed study selection and data extraction. Random-effects models (DerSimonian–Laird method) were used to pool effect sizes of eligible studies. The potential sources of heterogeneity were assessed using the I2 statistic.

Nineteen papers that identified dietary patterns using an a posteriori method were selected and included in the meta-analysis. The ‘Healthy/Prudent’ dietary pattern was inversely associated with risk of MetS (OR=0·89; 95 % CI 0·84, 0·94, P=0·002). In contrast, the ‘Unhealthy/Western’ dietary pattern had a significant positive association with risk of MetS (OR=1·16; 95 % CI 1·11, 1·22, P<0·001).

Our findings provide evidence that greater adherence to a healthy/prudent dietary pattern is associated with a lower risk of MetS, while an unhealthy/Western dietary pattern is associated with increased risk of MetS. These data suggest that a diet based on healthy food choices is also beneficial for prevention of MetS.

Experimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density (‘protein leverage’). According to the ‘protein leverage hypothesis’ (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy.

National representative cross-sectional study.

National Health and Nutrition Examination Survey 2009–2010.

Participants (n 9042) aged ≥2 years with at least one day of 24 h dietary recall data.

We found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant.

The protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.

To assess the influence of a mobile produce market (MPM) on fruit and vegetable access.

Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM.

Low-income neighbourhoods with limited access to fruits and vegetables.

Older (≥60 years) and younger (18–59·9 years) shoppers.

Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %).

MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.

To examine the associations between adolescents’ diet quality and their perceived relatives’ and peers’ diet engagement and encouragement.

Cross-sectional study performed in European countries. Diet quality was scored using the Diet Quality Index for Adolescents (DQI-A) based on four components: quality, diversity, balance and meal frequency. Perceived diet quality engagement and perceived encouragement of the relatives/peers were assessed using the questions ‘How healthy is each of the following persons’ diet?’ and ‘How often does each of the following persons encourage you to eat a healthy diet?’

Vienna, Ghent, Lille, Athens, Heraklion, Pecs, Rome, Dortmund, Zaragoza and Stockholm.

Healthy adolescents (n 2943).

The perceived engagement level of the mother, father and sister was each positively associated with the DQI-A (P<0·05). A positive association was found for the perceived engagement level of siblings, father and mother with all specific components (P<0·05). DQI-A was negatively associated with the perceived encouragement level from a best friend and positively associated with the encouragement level of the mother and father (P<0·05). Diversity, balance and quality components were positively associated with the perceived encouragement level from the mother and father (P<0·05), whereas the best friend’s perceived encouragement was negatively associated with the meal frequency component (P<0·01).

These findings highlight the role of social engagement and encouragement of relatives and peers in adolescents’ diet quality. Intervention or promotion programmes aimed at enhancing diet quality in adolescents should target both family and peers.

Food practices in the early years of life are important to form healthy eating habits; therefore, it is essential for the caregivers of infants to receive appropriate guidance. The present study aimed to investigate the effectiveness of different nutritional interventions on complementary feeding practices in municipal nurseries.

Non-randomized controlled intervention study with education professionals and parents of infants (<2 years). Participants were divided into: control group (CG), standard food and nutrition education in writing; and intervention group (IG), the same information as the CG and face-to-face meetings (professionals, 8 h; parents, 5 h). Changes in professionals’ knowledge on the subject and alterations in parents’ beliefs, attitudes and intentions were assessed using questionnaires before and after the educational activities.

Ten public nurseries in Nova Lima, Belo Horizonte, Minas Gerais, Brazil, 2015.

Ninety professionals (fifty in CG; forty in IG) and 169 parents (ninety-seven in CG; seventy-two in IG).

After the intervention, there was a significant increase in the mean number of correct responses given by professionals in the IG (12·2 v. 10·7; P=0·001). In addition, there were improvements among the parents of the IG in relation to beliefs (soups and broths do not nourish my child: P=0·012), attitudes (offer meat from the sixth month: P=0·032) and intentions (do not offer soups and broths: P=0·003; offer vegetables: P=0·018; offer meat: P<0·001).

Face-to-face nutritional intervention had a significantly greater effect on the parameters evaluated, indicating the importance of adequate guidance in childcare services to support the introduction of complementary feeding.

To examine the types of coping strategies practised by Indigenous women or Orang Asli (OA) in Peninsular Malaysia during times of food shortage and to determine the level of severity for food insecurity that will trigger each specific coping strategy.

A qualitative case study was conducted. Pertinent information about each type of coping strategy was gathered by in-depth interviews. To gauge the level of severity for each of the coping strategies, focus group discussions (FGD) were held. Thematic analysis was used for data analysis.

OA villages in the states of Kelantan, Pahang, Perak and Selangor, Malaysia.

Sixty-one OA women from three ethnic groups (Senoi, Proto-Malay and Negrito) for in-depth interviews and nineteen OA women from the Proto-Malay ethnic group for three FGD.

The findings identified twenty-nine different coping strategies and these were divided into two main themes: food consumption (sub-themes of food consumption included dietary changes, diversification of food sources, decreasing the number of people and rationing) and financial management (sub-themes of financial management included increasing household income, reducing expenses for schooling children and reducing expenses on daily necessities). Three levels of severity were derived: less severe, severe and very severe.

This information would enable local authorities or non-governmental organisations to more precisely target and plan interventions to better aid the OA communities needing assistance in the areas of food sources and financial management.

To analyse the content and extent of marketing of ultra-processed food products (UPP) and their brand pages on Facebook, which are highly accessed by Brazilians.

Descriptive.

Sixteen UPP brand pages on Facebook were selected from 250 pages that were the most liked by Brazilians in October 2015.

We analysed the frequency of ‘likes’ and members ‘talking about’ each one of the pages, in addition to fifteen marketing techniques used in the previous year (September 2014 to October 2015). The number of posts, likes, ‘shares’ and ‘commentaries’, and the mean number of likes, shares and commentaries per post, were collected for one month, from 23 September to 23 October 2015.

The two most liked pages were: Coke® (93 673 979 likes) and McDonald’s® (59 749 819 likes). Regarding the number of people talking about the pages, McDonald’s led with 555 891 commentaries, followed by Coke (287 274), Burger King® (246 148) and Kibon® (244 523). All pages used marketing techniques, which included photos, user conversations, presence of brand elements and links. Videos were observed on 93·8 % of the pages; promotions on 68·8 %; and celebrities on 62·5 %. In one month, Garoto®, Outback® and Coke were brands that published more than one post per day. Kibon achieved the highest ratio of likes per post (285 845·50) and Burger King had the highest mean shares per post (10 083·93), including commentaries per post (7958·13).

UPP marketing is extensively used on Facebook pages and is highly accessed by Brazilians, with UPP companies employing a diversity of marketing strategies.

Obesity and insulin resistance play important roles in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Mg intake is linked to a reduced risk of metabolic syndrome and insulin resistance; people with NAFLD or alcoholic liver disease are at high risk of Mg deficiency. The present study aimed to investigate whether Mg and Ca intakes were associated with risk of fatty liver disease and prediabetes by alcohol drinking status.

We analysed the association between Ca or Mg intake and fatty liver disease, prediabetes or both prediabetes and fatty liver disease in cross-sectional analyses.

Third National Health and Nutrition Examination Survey (NHANES III) follow-up cohort of US adults.

Nationally representative sample of US adults in NHANES (n 13 489).

After adjusting for potential confounders, Mg intake was associated with approximately 30 % reduced odds of fatty liver disease and prediabetes, comparing the highest intake quartile v. the lowest. Mg intake may only be related to reduced odds of fatty liver disease and prediabetes in those whose Ca intake is less than 1200 mg/d. Mg intake may also only be associated with reduced odds of fatty liver disease among alcohol drinkers.

The study suggests that high intake of Mg may be associated with reduced risks of fatty liver disease and prediabetes. Further large studies, particularly prospective cohort studies, are warranted to confirm the findings.

To assess the consumption of ultra-processed foods and analyse its association with the content of added sugars in the Chilean diet.

Cross-sectional study of national dietary data obtained through 24 h recalls and classified into food groups according to the extent and purpose of food processing (NOVA classification).

Chile.

A probabilistic sample of 4920 individuals (aged 2 years or above) studied in 2010 by a national dietary survey (Encuesta Nacional de Consumo Alimentario).

Ultra-processed foods represented 28·6 (se 0·5) % of total energy intake and 58·6 (se 0·9) % of added sugars intake. The mean percentage of energy from added sugars increased from 7·7 (se 0·3) to 19·7 (se 0·5) % across quintiles of the dietary share of ultra-processed foods. After adjusting for several potential sociodemographic confounders, a 5 percentage point increase in the dietary share of ultra-processed foods determined a 1 percentage point increase in the dietary content of added sugars. Individuals in the highest quintile were three times more likely (OR=2·9; 95 % CI 2·4, 3·4) to exceed the 10 % upper limit for added sugars recommended by the WHO compared with those in the lowest quintile, after adjusting for sociodemographic variables. This association was strongest among individuals aged 2–19 years (OR=3·9; 95 % CI 2·7, 5·9).

In Chile, ultra-processed foods are important contributors to total energy intake and to the consumption of added sugars. Actions aimed at limiting consumption of ultra-processed foods are being implemented as effective ways to achieve WHO dietary recommendations to limit added sugars and processed foods, especially for children and adolescents.

The present study aimed to describe breast-feeding, complementary feeding and determining factors for early complementary feeding from birth to 8 months of age in a typical Brazilian low-income urban community.

A birth cohort was conducted (n 233), with data collection twice weekly, allowing close observation of breast-feeding, complementary feeding introduction and description of the WHO core indicators on infant and young child feeding. Infant feeding practices were related to socio-economic status (SES), assessed by Water/sanitation, wealth measured by a set of eight Assets, Maternal education and monthly household Income (WAMI index). Two logistic regression models were constructed to evaluate risk factors associated with early complementary feeding.

Based on twice weekly follow-up, 65 % of the children received exclusive breast-feeding in the first month of life and 5 % in the sixth month. Complementary feeding was offered in the first month: 29 % of the children received water, 15 % infant formulas, 13 % other milks and 9·4 % grain-derived foods. At 6 months, dietary diversity and minimum acceptable diet were both 47 % and these increased to 69 % at 8 months. No breast-feeding within the first hour of birth was a risk factor for the early introduction of water (adjusted OR=4·68; 95 % CI 1·33, 16·47) and low WAMI index a risk factor for the early introduction of other milks (adjusted OR=0·00; 95 % CI 0·00, 0·02).

Data suggest local policies should promote: (i) early breast-feeding initiation; (ii) SES, considering maternal education, income and household conditions; (iii) timely introduction of complementary feeding; and (iv) dietary diversity.

The present study explored recipients’ perceptions of food charity and their suggested improvements in inner-city Perth, Western Australia.

In-depth interviews were conducted with charitable food service (CFS) recipients. Transcripts were thematically analysed using a phenomenological approach.

Interviews were conducted at two CFS in inner-city Perth.

Fourteen adults.

The recipients’ journeys to a reliance on CFS were varied and multifactorial, with poverty, medical issues and homelessness common. The length of time recipients had relied on food charity ranged from 8 months to over 40 years. Most were ‘grateful yet resigned’, appreciative of any food and resigned to the poor quality, monotony and their unmet individual preferences. They wanted healthier food, more variety and better quality. Accessing services was described as a ‘full-time job’ fraught with unreliable information and transport difficulties. They called for improved information and assistance with transport. ‘Eroded dignity’ resulted from being fed without any choice and queuing for food in public places, often in a volatile environment. ‘Food memories and inclusion’ reflected a desire for commensality. Recipients suggested services offer choice and promote independence, focusing on their needs both physical and social.

Although grateful, long-term CFS recipients described what constitutes a voluntary failure. Their service improvement recommendations can help meet their nutritional and social needs. A successful CFS provides a food service that prioritises nutritious, good-quality food and individual need, while promoting dignity and social inclusion, challenging in the current Australian context.

Vitamin D deficiency (serum 25-hydroxyvitamin D<25 nmol/l) is extremely common in Western-dwelling South Asians but evidence regarding vitamin D supplement usage in this group is very limited. This work identifies demographic, dietary and lifestyle predictors associated with vitamin D supplement use.

Cross-sectional analysis of baseline vitamin D supplement use data.

UK Biobank cohort.

In total, 8024 South Asians (Bangladeshi, Indian, Pakistani), aged 40–69 years.

Twenty-three per cent of men and 39 % of women (P<0·001) (22 % of Bangladeshis, 32 % of Indians, 25 % of Pakistanis (P<0·001)) took a vitamin-D-containing supplement. Median vitamin D intakes from diet were low at 1·0–3·0 µg/d, being highest in Bangladeshis and lowest in Indians (P<0·001). Logistic regression modelling showed that females had a higher odds of vitamin D supplement use than males (OR=2·02; 95 % CI 1·79, 2·28). A lower supplement usage was seen in younger persons (40–60 years v. >60 years: OR=0·75; 95 % CI 0·65, 0·86) and in those living outside Greater London (OR=0·53 to 0·77), with borderline trends for a lower BMI, higher oily fish intake and higher household income associated with increased odds of vitamin D supplement use.

Vitamin D supplements were not used by most South Asians and intakes from diet alone are likely to be insufficient to maintain adequate vitamin D status. Public health strategies are now urgently required to promote the use of vitamin D supplements in these specific UK South Asian subgroups.

To characterise parent presentations of fussy eating and mealtime interactions at a point of crisis, through analyses of real-time recordings of calls to a parenting helpline.

Qualitative analysis included an inductive thematic approach to examine clinical parent presentations of fussy eating and derive underlying themes relating to mealtime interactions.

Calls made to the Child Health Line regarding feeding concerns were recorded and transcribed verbatim.

From a corpus of 723 calls made during a 4-week period in 2009, twelve were from parents of children aged 6–48 months.

Parents of infants (≤12 months, n 6) presented feeding concerns as learning challenges in the process of transitioning from a milk-based to a solid-based diet, while parents of toddlers (13–48 months, n 6) presented emotional accounts of feeding as an intractable problem. Parents presented their child’s eating behaviour as a battle (conflict), in which their children’s agency over limited intake and variety of foods (child control) was constructed as ‘bad’ or ‘wrong’. Escalating parent anxiety (parent concern) had evoked parent non-responsive feeding practices or provision of foods the child preferred.

Real-time descriptions of young children’s fussy eating at a time of crisis that initiated parents’ call for help have captured the highly charged emotional underpinnings of mealtime interactions associated with fussy eating. Importantly, they show the child’s emerging assertion of food autonomy can escalate parents’ emotional distress that, in the short term, initiates non-responsive feeding practices. The current study identifies the importance of educational and emotional support for parents across the period of introducing solids.