The EAT–Lancet Commission promulgated a universal reference diet. Subsequently, researchers constructed an EAT–Lancet diet score (0–14 points), with minimum intake values for various dietary components set at 0 g/d, and reported inverse associations with risks of major health outcomes in a high-income population. We assessed associations between EAT–Lancet diet scores, without or with lower bound values, and the mean probability of micronutrient adequacy (MPA) among nutrition-insecure women of reproductive age (WRA) from low- and middle-income countries (LMIC). We analysed single 24-h diet recall data (n 1950) from studies in rural DRC, Ecuador, Kenya, Sri Lanka and Vietnam. Associations between EAT–Lancet diet scores and MPA were assessed by fitting linear mixed-effects models. Mean EAT–Lancet diet scores were 8·8 (SD 1·3) and 1·9 (SD 1·1) without or with minimum intake values, respectively. Pooled MPA was 0·58 (SD 0·22) and energy intake was 10·5 (SD 4·6) MJ/d. A one-point increase in the EAT–Lancet diet score, without minimum intake values, was associated with a 2·6 (SD 0·7) percentage points decrease in MPA (P < 0·001). In contrast, the EAT–Lancet diet score, with minimum intake values, was associated with a 2·4 (SD 1·3) percentage points increase in MPA (P = 0·07). Further analysis indicated positive associations between EAT–Lancet diet scores and MPA adjusted for energy intake (P < 0·05). Our findings indicate that the EAT–Lancet diet score requires minimum intake values for nutrient-dense dietary components to avoid positively scoring non-consumption of food groups and subsequently predicting lower MPA of diets, when applied to rural WRA in LMIC.

Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost–benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa.

Adolescents’ snack choices could be altered by increasing the reinforcing value (RV) of healthy snacks compared with unhealthy snacks. This study assessed whether the RV of fruit increased by linking it to a reward and if this increased RV was comparable with the RV of unhealthy snacks alone. Moderation effects of sex, hunger, BMI z-scores and sensitivity to reward were also explored. The RV of snacks was assessed in a sample of 165 adolescents (15·1 (sd 1·5) years, 39·4 % boys and 17·4 % overweight) using a computerised food reinforcement task. Adolescents obtained points for snacks through mouse clicks (responses) following progressive ratio schedules of increasing response requirements. Participants were (computer) randomised to three experimental groups (1:1:1): fruit (n 53), fruit+reward (n 60) or unhealthy snacks (n 69). The RV was evaluated as total number of responses and breakpoint (schedule of terminating food reinforcement task). Multilevel regression analyses (total number of responses) and Cox’s proportional hazard regression models (breakpoint) were used. The total number of responses made were not different between fruit+reward and fruit (b −473; 95 % CI −1152, 205, P=0·17) or unhealthy snacks (b410; 95 % CI −222, 1043, P=0·20). The breakpoint was slightly higher for fruit than fruit+reward (HR 1·34; 95 % CI 1·00, 1·79, P=0·050), whereas no difference between unhealthy snacks and fruit+reward (HR 0·86; 95 % CI 0·62, 1·18, P=0·34) was observed. No indication of moderation was found. Offering rewards slightly increases the RV of fruit and may be a promising strategy to increase healthy food choices. Future studies should however, explore if other rewards, could reach larger effect sizes.

Eating out has been linked to the current obesity epidemic, but the evaluation of the extent to which out of home (OH) dietary intakes are different from those at home (AH) is limited. Data collected among 8849 men and 14 277 women aged 35–64 years from the general population of eleven European countries through 24-h dietary recalls or food diaries were analysed to: (1) compare food consumption OH to those AH; (2) describe the characteristics of substantial OH eaters, defined as those who consumed 25 % or more of their total daily energy intake at OH locations. Logistic regression models were fit to identify personal characteristics associated with eating out. In both sexes, beverages, sugar, desserts, sweet and savoury bakery products were consumed more OH than AH. In some countries, men reported higher intakes of fish OH than AH. Overall, substantial OH eating was more common among men, the younger and the more educated participants, but was weakly associated with total energy intake. The substantial OH eaters reported similar dietary intakes OH and AH. Individuals who were not identified as substantial OH eaters reported consuming proportionally higher quantities of sweet and savoury bakery products, soft drinks, juices and other non-alcoholic beverages OH than AH. The OH intakes were different from the AH ones, only among individuals who reported a relatively small contribution of OH eating to their daily intakes and this may partly explain the inconsistent findings relating eating out to the current obesity epidemic.

The objective of the present study was to document the food, energy and macronutrient contribution of out-of-home prepared foods in school-going adolescents in Cotonou (Benin) and compare the food, energy and macronutrient intakes of low and high out-of-home consumers. We used a cross-sectional study with 24 h dietary recalls on two non-consecutive school days to collect food intake data. Low and high consumers were defined respectively as subjects whose percentage of daily energy intake from out-of-home foods was in the first and the third terciles of the sample distribution. The setting was twelve secondary schools in Cotonou with 656 adolescents aged 13–19 years. Out-of-home prepared foods contributed more than 40 % of the daily energy, fat, protein, carbohydrate and fibre intakes and of the daily weight of food in the adolescents. They were highly present at breakfast and as afternoon snacks in high consumers, providing respectively 94 and 82 % of the energy intake of high consumers at breakfast and as afternoon snacks. Low consumers ate more fruit and vegetables and cereal grain products than high consumers whereas high consumers consumed more sweet energy-dense foods. Both categories had a diet poor in fruit and vegetables (hardly one-fourth of the recommended 400 g) and high in fat. We concluded that out-of-home foods are important in the diet of urban school adolescents in Benin. Therefore, they should be investigated in depth and taken into account in the development of interventions to promote healthy diet and lifestyles in adolescents.

Canteens are known to be promising settings for activities to promote intake of fruits and vegetables, but it remains unclear to what extent distributing free fruits and vegetables can influence dietary patterns of customers. The present study evaluated the effect of providing fruits and vegetables for free in a university canteen on the daily diet of university canteen customers. Canteen customers (n 209) were randomly allocated to a fruit and vegetable group (FVG) and a control group (CG). FVG participants were given two portions of fruits and one portion of vegetables for free at lunchtime. Food and beverage intake was measured using a dietary record for 3 d and dietary quality was appraised using a comprehensive scoring system. The FVG participants ate 80 g more fruits (P < 0·01) and 108 g more vegetables (P < 0·001) on a daily basis compared with the CG participants. No differences were found for energy density, total energy, Na and energy from fat between the groups per day. A higher intake of fruits and vegetables was observed at lunch and of vegetables during the dinner and evening snacks. The FVG participants were more likely to comply with dietary recommendations for fruits and vegetables and had a better dietary profile on the study days and for the lunch consumed on those days. The results of the present study demonstrate how modifications of a canteen lunch can be instrumental to enhance the nutritional quality of lunch as well as the overall quality of the diet of the customers.

The aim of the study was to characterise substantial out-of-home (SOH) eaters, describe the nutritional quality of their diet, compare SOH eaters and non-SOH eaters for a set of nutritional indicators and evaluate the quality of meals consumed at home and at different places outside the home. Information on food intake was collected with two 24 h recalls. Habitual food intake was estimated by the Nusser method. Non-dietary variables were obtained using a face-to-face questionnaire. SOH eaters were defined as individuals who consume at least 25 % of their daily energy out of home. A representative sample (n 3245) of the Belgian population aged 15 years and older was randomly selected from the National Register using a multi-stage stratified procedure. Of the Belgian population, 35·2 % were defined as SOH eaters. Energy intake, energy density of the total diet and daily consumption of most food groups, except for fruits and vegetables, were substantially higher among SOH eaters compared with non-SOH eaters. Out-of-home eating was more common among men than women and decreased with increasing age. There were considerable differences in portion sizes, consumption frequency of different foods and diversity of meals according to different places of consumption. Out-of-home eating is a significant nutritional issue in Belgium and is associated with a more adverse dietary profile. Out-of-home eating, places of consumption, and specific population groups, eating substantially out of home, should consequently be taken into account when designing and evaluating nutrition policies.

In 2000, the Centers for Disease Control and Prevention (CDC) produced a revised growth reference. This has already been used in different settings outside the USA. Using data obtained during a nutritional survey in Madagascar, we compare results produced by using both the 2000 CDC and the 1978 National Center for Health Statistics (NCHS)/World Health Organization (WHO) growth references. We show that changing the reference has an important impact on nutritional diagnosis. In particular, the prevalence of wasting is greatly increased. This could generate substantial operational and clinical difficulties. We recommend continued use of the 1978 NCHS/WHO reference until release of the new WHO multi-country growth charts.

The Fe solubility test is a commonly used, easy and relatively cheap in vitro tool for predicting Fe bioavailability in food matrices. However, the outcome of a recent field trial comparing the effect on Fe status of Tanzanian infants of processed V. unprocessed complementary foods (CF), with otherwise the same composition, challenged the validity of this test for predicting Fe bioavailability. In the solubility test, significant more soluble Fe was observed in processed compared with unprocessed foods (mean 18·8 (sem 0·21) V. 4·8 (sem 0·23) %; V<0·001). However, in the field trial, no significant difference in Fe status was seen between processed and unprocessed CF groups after 6 months' follow-up. Therefore, twenty-four samples of these CF (twelve processed and twelve unprocessed batches) were analysed in triplicate for Fe availability using an in vitro digestion–Caco-2 cell culture method and results were compared with solubility results. Significantly more soluble Fe was presented to Caco-2 cells in the processed compared with unprocessed samples (mean 11·5 (sem 1·16) V. 8·5 (sem 2·54) % p=0·028), but proportionally less Fe was taken up by the cells (mean 3·0 (sem 0·40)p. 11·7 (sem 2·22) %; p=0·007). As a net result, absolute Fe uptake was lower (not significantly) in processed compared with unprocessed CF (mean 1·3 (sem 0·16) V. 3·4 (sem 0·83) nmol/mg cell protein; p=0·052). These data clearly demonstrate that the Fe solubility test was not a good indicator of Fe bioavailability in these particular food matrices. In contrast, the results of an in vitro Caco-2 model supported the effects observed in vitro.

The study objective was to estimate food and nutrient availability in Bolivian households using data from the nationally representative under the Programme for the household surveys undertaken yearly from 1999 to 2002 Improvement of Surveys and the Measurement of Living Conditions in Latin America and the Caribbean (MECOVI). In the present study, we analysed data from four repeated, cross-sectional surveys and applied European Data Food Networking (DAFNE) methodology for post-harmonising the data. Raw data of 19 483 households in Bolivia (3035 in 1999, 4857 in 2000, 5845 in 2001 and 5746 in 2002) were retrieved from the databases of the national household surveys. Results showed that the Bolivian diet is characterised by higher availability of foods of plant origin (cereals, fruits, potatoes and vegetables). Meat, milk and their products follow in the dietary preferences of Bolivians. Disparities in food availability within the country were also observed. Rural households systematically recorded lower amounts of food available, in comparison with the urban ones. Households of higher social status recorded higher availability values for all food groups, except for potatoes and cereals. Findings suggest that Bolivian households of lower socio-economic status prefer energy-dense and cheaper food sources. We concluded the dietary and socio-demographic data collected in the MECOVI household surveys could serve nutrition surveillance purposes. In addition, the application of DAFNE methodology for post-harmonising the data allows both national and international comparisons.

A community-based, randomized, placebo-controlled, double-blind trial was conducted from March 2001 to March 2002 in Kilosa, a rural district of Morogoro Region in Tanzania. One hundred and fifty-eight infants were selected randomly from lists of local Maternal and Child Health Care Centres and received either processed complementary food (PCF) or unprocessed complementary food (UPCF) from age 6 to 12 months. Processing increased Zn solubility and energy density of the porridge prepared from the complementary food (CF) as determined in vitro. Phytate:Zn molar ratio of the PCF and UPCF was 25·8 and 47·5, respectively. Under the study conditions, the processing of CF did not improve Zn status as measured by hair analysis. No significant correlations were found between hair Zn values and anthropometric measurements. Our findings suggest that processing alone of cereal-based CF may be insufficient to ensure an adequate supply of Zn to improve growth and Zn status of infants. Dietary modification to tackle Zn deficiencies in similar target groups may therefore only be successful when other Zn-rich foods such as meat and fish are included.