This study aimed to identify health behaviours that determine adolescent’s adherence to the Mediterranean diet (MD) through a decision tree statistical approach.

Cross-sectional study, with data collected through a self-fulfilment questionnaire with five sections: (1) eating habits; (2) adherence to the MD (KIDMED index); (3) physical activity; (4) health habits and (5) socio-demographic characteristics. Anthropometric and blood pressure data were collected by a trained research team. The Automatic Chi-square Interaction Detection (CHAID) method was used to identify health behaviours that contribute to a better adherence to the MD.

Eight public secondary schools, in Algarve, Portugal.

Adolescents with ages between 15 and 19 years (n 325).

According to the KIDMED index, we found a low adherence to MD in 9·0 % of the participants, an intermediate adherence in 45·5 % and a high adherence in 45·5 %. Participants that regularly have breakfast, eat vegetable soup, have a second piece of fruit/d, eat fresh or cooked vegetables 1 or more times a day, eat oleaginous fruits at least 2 to 3 times a week, and practice sports and leisure physical activities outside school show higher adherence to the MD (P < 0·001).

The daily intake of two pieces of fruit and vegetables proved to be a determinant health behaviour for high adherence to MD. Strategies to promote the intake of these foods among adolescents must be developed and implemented.

Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA.

The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017.

The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15–49 years and children under 5 years).

Logistic regression analyses were used to determine household correlates of household burden of malnutrition.

Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition.

The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.

The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence.

A secondary data analysis that uses baseline data from a pilot intervention/feasibility study.

Detroit, Michigan, USA.

Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry’s Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure.

After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity.

Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment.

To determine the level of adherence and to assess the association between higher adherence to the South African food based dietary guidelines (SAFBDG) and breast cancer risk.

Population-based, case–control study (the South African Breast Cancer study) matched on age and demographic settings. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to the SAFBDG, a nine-point adherence score (out of eleven guidelines) was developed, using suggested adherence cut-points for scoring each recommendation (0 and 1). When the association between higher adherence to the SAFBDG and breast cancer risk was assessed, data-driven tertiles among controls were used as cut-points for scoring each recommendation (0, 0·5 and 1). OR and 95 % CI were estimated using multivariate logistic regression models.

Soweto, South Africa.

Black urban women, 396 breast cancer cases and 396 controls.

After adjusting for potential confounders, higher adherence (>5·0) to the SAFBDG v. lower adherence (<3·5) was statistically significantly inversely associated with breast cancer risk overall (OR = 0·56, 95 % CI 0·38, 0·85), among postmenopausal women (OR = 0·64, 95 % CI 0·40, 0·97) as well as for oestrogen-positive breast cancers (OR = 0·51, 95 % CI 0·32, 0·89). Only 32·3 % of cases and 39·1 % of controls adhered to at least half (a score >4·5) of the SAFBDG.

Higher adherence to the SAFBDG may reduce breast cancer risk in this population. The concerning low levels of adherence to the SAFBDG emphasise the need for education campaigns and to create healthy food environments in South Africa to increase adherence to the SAFBDG.

The current study aimed to explore the interplay between food insecurity, fast-food outlet exposure and dietary quality in disadvantaged neighbourhoods.

In this cross-sectional study, main associations between fast-food outlet density and proximity, food insecurity status and dietary quality were assessed using Generalized Estimating Equation analyses. We assessed potential moderation by fast-food outlet exposure in the association between food insecurity status and dietary quality by testing for effect modification between food insecurity status and fast-food outlet density and proximity.

A deprived urban area in the Netherlands.

We included 226 adult participants with at least one child below the age of 18 years living at home.

Fast-food outlet exposure was not associated with experiencing food insecurity (fast-food outlet density: b = −0·026, 95 % CI = −0·076; 0·024; fast-food outlet proximity: b = −0·003, 95 % CI = −0·033; 0·026). Experiencing food insecurity was associated with lower dietary quality (b = −0·48 per unit increase, 95 % CI = −0·94; −0·012). This association was moderated by fast-food outlet proximity (Pinteraction = 0·008), and stratified results revealed that the adverse effect of food insecurity on dietary quality was more pronounced for those with the nearest fast-food outlet located closer to the home.

Food insecurity but not fast-food outlet density is associated with dietary quality. However, the association between food insecurity and dietary quality may be modified by the food environment. These findings could inform policymakers to promote a healthier food environment including less fast-food outlets, with particular emphasis on areas with high percentages of food insecure households.

To simulate the impact – effectiveness and safety – of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program.

This is a secondary analysis of national or sub-national dietary intake databases.

Uganda, Lao People’s Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy.

We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19–31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy.

We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake.

To investigate the association between ultra-processed food (UPF) consumption and internalising symptoms (IS) among adolescents.

It is a cross-sectional study. Paper-pencil survey was completed in classroom with information on UPF consumption, IS and selected covariates. IS were assessed with the Internalizing Symptoms sub-scale from the Social Behaviour Questionnaire (IS-SBQ). UPF was evaluated with a FFQ extracted from the Brazilian National School Health Survey. Crude and adjusted association between UPF and IS was investigated with structural equation models.

São Paulo, SP, Brazil.

A total of 2680 students, Mage = 14·85; (95 % CI 14·81, 14·88).

UPF consumption was associated with higher scores in IS in the crude (β = 0·14; P < 0·001) and adjusted (β = 0·12; P < 0·001) models. The higher the consumption of UPF, the higher is the IS score. The following variables were associated with a lower risk of UPF consumption: male sex, public school and having more meals with parents. The change in the magnitude of the standardised score was almost negligible, but the model was significantly improved with the inclusion of covariates.

Our results provide evidence about the positive association between UPF consumption and IS among adolescents. The association, despite its low magnitude, remained significant after adjusting for potential confounders. These results are relevant considering the increase in UPF consumption worldwide and in low- and middle-income countries. Also, our study emphasises the importance of a healthy diet with a reduction in UPF consumption among adolescents.

To measure the associations of sociodemographic and behavioural factors with fruit and vegetable consumption among adults in China.

A cross-sectional study.

A 2015 wave of the China Health and Nutrition Survey.

Totally, 11 910 adults aged 18 to 64 years.

Adjusted log binomial regression analyses showed that adults with higher income levels had higher fruit intake than those with low income levels (medium income group, risk ratio (RR): 1·28; 95 % CI: 1·16, 1·41; high income group, RR: 1·58; 95 % CI: 1·43, 1·74). Current smokers had lower fruit intake than non-smokers (RR: 0·86; 95 % CI: 0·77, 0·96). Adults living in southern China had higher vegetable intake (RR: 1·88; 95 % CI: 1·76, 2·01) but lower fruit intake (RR: 0·85; 95 % CI: 0·79, 0·91) than adults in northern China. With increasing age, adults had higher fruit intake (50–64 years, RR: 1·20; 95 % CI: 1·09, 1·33; reference category 18–34 years) and higher vegetable intake (35–49 years, RR: 1·13; 95 % CI: 1·05, 1·22; 50–64 years, RR: 1·22; 95 % CI: 1·13, 1·31).

Our findings identify a range of sociodemographic and behavioural factors associated with fruit and vegetable consumption among Chinese adults. They also point to the need for public health nutrition interventions for socially disadvantaged populations in China.

To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women.

Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study.

General community setting in four Canadian provinces.

In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012.

Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months.

Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally.

To identify determinants of egg consumption in infants and young children aged 6–23·9 months in Ethiopia.

Data used were from the cross-sectional baseline survey of an egg campaign in Ethiopia implemented by the Global Alliance for Improved Nutrition.

Children aged 6–23·9 months (n 453) were sampled. Data on socio-demographic characteristics, economic resources, caregiver’s behaviour, child health and feeding practices, and egg consumption in the last 7 d were collected using interviewer-administered questionnaires. Multivariable ordinal logistic regression was used to examine the association between explanatory variables and egg consumption in the last 7 d.

About half of children (53·4 %) did not consume eggs in the last 7 d. The odds of children consuming eggs were 4·33 (P < 0·002) times higher when their caregivers had some college education compared with no education. Wealth was positively (OR, 1·13, P = 0·029) and household food insecurity was negatively (OR, 0·96, P = 0·117) associated with child egg consumption. Purchasing eggs (OR, 9·73, P < 0·001) and caregiver’s positive behavioural determinants (OR, 1·37, P = 0·005) were associated with child egg consumption. The associations of socio-demographic characteristics and economic resources with egg consumption provide evidence of partial mediation through caregiver behaviour and child health.

About half of children aged 6–23·9 months consumed eggs. Availability of eggs in households, mainly through purchase, was strongly associated with egg consumption. Education of caregivers and household heads and economic resources were associated with egg consumption and may operate through caregiver behaviour.

To examine the association between the amount of time spent at childcare and diet quality in 668 Japanese children aged 1·5–6 years.

A cross-sectional design was used. Dietary information was collected using dietary records (1 d for children aged 1·5–2 years and 2 d for children aged 3–6 years). Diet quality was assessed by counting the number of nutrients not meeting the Japanese Dietary Reference Intakes (DRI). Each child’s guardian reported the average amount of time spent at childcare per d for the previous 1 month.

In total, 315 childcare centres located in twenty-four areas in Japan.

In total, 753 children aged 1·5–6 years who attend childcare facilities.

After adjustment for potential confounders, OR for the low diet quality (≥ 5 of twenty nutrients not meeting DRI) in long (≥10 h/d) v. medium (8–10 h/d) childcare hours was 4·81 (95 % CI 1·96, 11·8) among children aged 5–6 years. There was no significant association in children aged 1·5–2 and 3–4 years.

This study showed that long time spent at childcare was strongly associated with low diet quality among children aged 5–6 years, but not those aged 1·5–2 and 3–4 years. More research is needed to clarify different associations in each age group.

To investigate the influence of parental physical activity on offspring’s nutritional status in the 1993 Pelotas (Brazil) birth cohort.

Birth cohort study.

The main outcomes were overweight and obesity status of children. The main exposure was parental physical activity over time, measured during the 11, 15 and 18 years of age follow-ups. The exposure was operationalised as cumulative, and the most recent measure before the birth of child. We adjusted Poisson regression models with robust variance to evaluate crude and adjusted associations between parental physical activity and offspring’s nutritional status. All analyses were stratified according to the sex of the parent.

A total of 874 members from the 1993 Pelotas (Brazil) birth cohort followed-up at 22 years of age with their first-born child were analysed.

Children were, on average, 3·1 years old. Crude analyses showed that the mother’s cumulative physical activity measure had an indirect association with the prevalence of children’s obesity. The most recent maternal physical activity measure before the birth of the child was associated with 41 % lower prevalence of obesity in children, even after adjustment for confounders.

The most recent maternal physical activity measure was indirectly associated with the prevalence of obesity in children. No associations were found for fathers, reinforcing the hypothesis of a biological effect of maternal physical activity on offspring’s nutritional status.

The aim of this study was to examine the trade-offs related to the production and consumption of palm oil in Myanmar from a sustainable diets perspective.

We used an enhanced value chain analysis approach that included semi-structured interviews with key stakeholders; market analyses to assess edible oils in markets and focus groups as well as surveys with consumers to ascertain their perceptions and practices related to edible oils.

Four settings in Myanmar (upper income urban; lower income urban; middle-income urban; lower income rural).

Key stakeholders (n 12) from government, trade bodies and civil society organisations were included in the interviews. Women from each of the regions participated in four focus groups (n 32), and a convenience sample of male and female consumers participated in the surveys (n 362).

We found mistrust of the oil sector overall. Poor production practices, leading to low yields, limit the economic viability of oil palm production in Myanmar and contribute to negative environmental (e.g. deforestation) and social outcomes (e.g. land conflicts). Consumers demonstrated low preferences for palm oil as compared with traditional oils from a taste, health and transparency perspective; however, they indicated that its relative low cost led to its purchase over other oils.

The Burmese example suggests that there may be limited benefits, and significant costs, of investing in palm oil production in regions where there are coordinating disincentives from a sustainable diets perspective. However, if oil palm cultivation is to continue, there are opportunities to improve its economic viability and environmental sustainability.

To provide a comprehensive seasonal analysis of pregnant mothers’ eating behaviour and maternal/newborn nutritional status in an undernourished population from lowland rural Nepal, where weather patterns, agricultural labour, food availability and disease prevalence vary seasonally.

Secondary analysis of cluster-randomised Low Birth Weight South Asia Trial data, applying cosinor analysis to predict seasonal patterns.

Maternal mid-upper arm circumference (MUAC), BMI, dietary diversity, meals per day, eating down and food aversion in pregnancy (≥31 weeks’ gestation) and neonatal z-scores of length-for-age (LAZ), weight-for-age (WAZ) and head circumference-for-age (HCAZ) and weight-for-length (WLZ).

Rural areas of Dhanusha and Mahottari districts in plains of Nepal.

2831 mothers aged 13–50 and 3330 neonates.

We found seasonal patterns in newborn anthropometry and pregnant mothers’ anthropometry, meal frequency, dietary diversity, food aversion and eating down. Seasonality in intake varied by food group. Offspring anthropometry broadly tracked mothers’. Annual amplitudes in mothers’ MUAC and BMI were 0·27 kg/m2 and 0·22 cm, with peaks post-harvest and nadirs in October when food insecurity peaked. Annual LAZ, WAZ and WLZ amplitudes were 0·125, 0·159 and 0·411 z-scores, respectively. Neonates were the shortest but least thin (higher WLZ) in winter (December/January). In the hot season, WLZ was the lowest (May/June) while LAZ was the highest (March and August). HCAZ did not vary significantly. Food aversion and eating down peaked pre-monsoon (April/May).

Our analyses revealed complex seasonal patterns in maternal nutrition and neonatal size. Seasonality should be accounted for when designing and evaluating public heath nutrition interventions.

To investigate acquisition and mobility experiences of food-insecure individuals across urbanicity levels (i.e., urban, suburban, rural) in the early months of the COVID-19 pandemic.

Cross-sectional study using a nationally representative online panel to measure where food-insecure individuals acquired food, food acquisition barriers and mobility to food sources, which were evaluated across urbanicity levels using chi-squared tests and 95 % CI.

USA.

2011 adults (18 years or older).

Food insecurity impacted 62·3 % of adults in urban areas, 40·5 % in rural areas and 36·7 % in suburban areas (P < 0·001). Food acquisition barriers that were significantly more prevalent among food-insecure adults in urban areas were a change in employment status (34·2 %; 95 % CI 27·2 %, 41·1 %; P < 0·0001) and limited availability of food in retailers (38·8 %; 95 % CI 31·7 %, 45·9 %; P < 0·001). In rural areas, food-insecure adults primarily acquired food for the household from supercentres (61·5 %; 95 % CI 50·4 %, 72·5 %; P < 0·05), while locally sourced foods were less common among food-insecure adults in rural areas (6·9 %; 95 % CI 0·01 %, 13·0 %) compared to urban areas (19·8 %; 95 % CI 14·3 %, 25·4 %; P < 0·01). Transportation as a barrier did not vary significantly by urbanicity, but food-insecure adults across urbanicity levels reported utilising a range of transportation modes to acquire food.

A planning approach that links urban and rural areas could address food insecurity by enhancing the integration of food production, transportation and food distribution, building towards a more resilient and equitable food system for all Americans.

To evaluate the association of Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII) with the prevalence of high-grade cervical intraepithelial neoplasia (CIN).

A cross-sectional study was conducted on women with abnormal Papanicolaou test, who underwent high-risk human papillomavirus (HPV) screening and histological test through colposcopy. Dietary data were collected using a FFQ and used to assess both CDAI and DII.

Women were recruited from 2012 to 2015 at the Cervical Cancer Screening Unit of the ‘Azienda Sanitaria Provinciale’ of Catania (Italy).

The study included 539 women with a mean age of 40·2 years, who were classified as cases (n 127 with CIN2 or more severe lesions) and controls (n 412 with normal cervical epithelium or CIN1).

Although we observed a lower proportion of HPV-positive women among those with higher CDAI (P < 0·001), the index was not associated with the diagnosis of CIN2 or more severe lesions. By contrast, women with medium or high DII showed higher odds to be diagnosed with CIN2 or more severe lesions than those with low DII (OR = 2·15; 95 % CI 1·11, 4·17; P = 0·024 and OR = 3·14; 95 % CI 1·50, 6·56; P = 0·002, respectively), after adjusting for age, HPV status, educational level, BMI, smoking status, parity, use of oral contraceptives and supplements.

Our findings suggested that a pro-inflammatory diet might be associated with an increased risk of CIN2 and more severe lesions. However, further prospective studies should be encouraged to support this evidence.

To prospectively evaluate the association of three dietary patterns: the MIND (Mediterranean-DASH diet intervention for Neurodegenerative Delay) diet; a Mediterranean-type diet and a traditional diet, with all-cause mortality over a 12-year period in an older sample.

A longitudinal birth cohort study. We ascertained dietary patterns using FFQ data at baseline (2004–2007) and mortality using linkage data. Cox regression was used to estimate mortality hazard ratios (HR) with adjustment for confounders.

The Lothian Birth Cohort 1936 (LBC1936) study in Edinburgh, Scotland.

Dietary patterns were ascertained in 882 participants, mean age 69·5 (±0·8) years, at baseline. During the 12-year follow-up (to October 2019), 206 deaths occurred.

In the basic-adjusted model, all three dietary patterns were significantly associated with mortality, the MIND diet and Mediterranean-type diet with a lower risk and the traditional diet with a higher risk. In fully adjusted models, MIND diet score was inversely related to all-cause mortality (HR 0·88; 95 % CI 0·79, 0·97) such that the risk of death was reduced by 12 % per unit increase in MIND diet score. Participants in the top compared with the bottom third of MIND diet score had a 37 % lower risk of death (HR 0·63; 95 % CI 0·41, 0·96). No significant associations with the Mediterranean-type or traditional dietary patterns were observed in the final multivariate model.

Our findings suggest that closer adherence to the MIND diet is associated with a significantly lower risk of all-cause mortality, over 12 years of follow-up, and may constitute a valid public health recommendation for prolonged survival.

To investigate the association between serum vitamin D (25-hydroxy-cholecalciferol) (25(OH)D) concentrations and cognitive impairment in older adults living in Southern Brazil.

Cross-sectional analysis using data from the second follow-up wave of the populational-based EpiFloripa Aging Cohort Study was collected in 2013–2014.

Cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE). Blood samples were collected to measure serum vitamin D concentrations using a chemiluminescent microparticle immunoassay. Vitamin D concentrations were distributed in quartiles (Q1: 4·0–20·7 ng/ml; Q2: 20·8–26·6 ng/ml; Q3: 26·7–32·0 ng/ml and Q4: 32·1–60·1 ng/ml), and its association with cognitive impairment was tested by crude and adjusted logistic regression (sociodemographic, behavioural and health aspects) using Q4 as a reference group.

200 men and 371 women aged 60 years or older participated in this study.

The prevalence of probable cognitive impairment was 21·7 %. Those without cognitive impairment had a higher mean of vitamin D serum concentrations (26·8 v. 24·6, P = 0·014). In the crude analysis, only individuals in Q2 of vitamin D presented an increased risk for probable cognitive impairment compared with Q4 (highest quartile) (OR 2·65, 95 % CI 1·46, 4·81), remaining significant in the adjusted analysis (OR 6·04, 95 % CI 2·78, 13·13). While Q1 (lowest quartile) was not associated in the crude analysis, but when adjusted, an increased risk of cognitive impairment was observed.

The lowest quartile of vitamin D was directly associated with probable cognitive impairment in older adults in Southern Brazil. More studies are needed to investigate whether maintaining adequate serum levels may represent a significant factor in preventing age-related neurological disorders as well as to verify the need for new cutoff points for this age group.

The current study aimed to identify features to include in online grocery stores to support healthful food purchasing by those striving to lose weight.

A Value Proposition Design approach was used to gain shopper insights, devise potential online grocery store features and obtain feedback on these features.

Telephone interviews were conducted to gain insight into shoppers’ needs and perceptions. Results were used by the research team to identify potential online grocery shopping features that may support healthful purchase decisions, and interviews were conducted with a different sample of shoppers to gather feedback on features.

Insight (n 25) and feedback (n 25) interviews were conducted with convenience samples of adults trying to lose weight.

Participants were primarily female, white, college educated and with obesity or overweight. Online grocery features devised by the research team based on findings from the insight interviews included (1) shopping cart nutrition rating tool; (2) healthy meal planning tool; (3) interactive healthy eating inspiration aisle and (4) healthy shopping preference settings option. Findings from the feedback interviews indicated that the healthy meal planning tool, healthy shopping preference settings option and shopping cart nutrition rating tool features were positively rated by most participants.

There are multiple features grocers should consider including in their online stores to attract and support customers striving to eat healthy for weight loss.

To identify eating occasion-level and individual-level factors associated with the consumption of larger portions in young children and estimate their relative importance.

Cross-sectional.

Data from parent-reported 4-d food diaries in the UK National Diet and Nutrition Survey (2008–2017) were analysed. Multilevel models explored variation in eating occasion size (kJ) within (n 48 419 occasions) and between children (n 1962) for all eating occasions. Eating contexts: location, eating companion, watching TV, and sitting at a table and individual characteristics: age, gender, ethnicity and parental socio-economic status were explored as potential correlates of eating occasion size.

Children aged 1·5–5 years.

Median eating occasion size was 657 kJ (IQR 356, 1117). Eating occasion size variation was primarily attributed (90 %) to differences between eating occasions. Most (73 %) eating occasions were consumed at home. In adjusted models, eating occasions in eateries were 377 kJ larger than at home. Eating occasions sitting at a table, v. not, were 197 kJ larger. Eating in childcare, with additional family members and friends, and whilst watching TV were other eating contexts associated with slightly larger eating occasion sizes.

Eating contexts that vary from one eating occasion to another are more important than demographic characteristics that vary between children in explaining variation in consumed portion sizes in young children. Strategies to promote consumption of age-appropriate portion sizes in young children should be developed, especially in the home environment, in eating contexts such as sitting at the table, eating with others and watching TV.