Investigating differences between traditional (paper bag) ordering and online ordering from primary school canteens: a cross-sectional study comparing menu, usage and lunch order characteristics.

OBJECTIVE: To assess differences between traditional paper bag ordering and online ordering from primary school canteens in terms of menu, usage and lunch order characteristics. DESIGN: A cross-sectional study. SETTING: New South Wales (NSW) primary schools that offered both paper bag and online canteen ordering. PARTICIPANTS: Students (aged 5-12 years) with a lunch order on the day of the observation. RESULTS: Across the six school canteens, 59-90 % of all available items were listed on both the online and paper menus, with no significant differences in the nutritional quality ('Everyday'/'Occasional') or nutritional content (kJ/saturated fat/sugar/sodium) of menu items. In total, 387 student lunch orders were placed, containing 776 menu items. Most orders (68 %) were placed online. There were no significant differences between order modality in the quantity of items ordered or the cost of orders, or the nutritional quality of orders based on the classification system of the NSW Healthy School Canteen Strategy ('Everyday'/'Occasional'). However, nutritional analysis revealed that paper bag orders contained 222 fewer kJ than online orders (P = 0·001), 0·65 g less saturated fat (P = 0·04) and 4·7 g less sugar (P < 0·001). CONCLUSIONS: Online canteens are commonly used to order canteen lunches for primary school children. This is the first study to investigate differences between traditional paper bag ordering and online ordering in this setting. Given the rapid increase in the use of online ordering systems in schools and other food settings and their potential to deliver public health nutrition interventions, additional research is warranted to further investigate differences in ordering modalities.

The effect of nutrition knowledge and dietary iron intake on iron status in young women.

UNLABELLED: Previous research on the relationships between general nutrition knowledge and dietary intake, and dietary iron intake and iron status has produced inconsistent results. Currently, no study has focused on knowledge of dietary iron and its effect on dietary iron intake. OBJECTIVES: This study aimed to determine whether nutrition knowledge of iron is related to dietary iron intake in young women, and subsequently whether greater knowledge and intake translates into better iron status. METHODS: A cross-sectional assessment of nutrition knowledge of iron, dietary iron intake and iron status was conducted in women aged 18-35 years living in Newcastle, NSW, Australia. Iron status was assessed by serum ferritin, haemoglobin, soluble transferrin receptor and alpha-1-glycoprotein. RESULTS: One hundred and seven women (27.8 ± 4.7 years) completed the nutrition knowledge questionnaire and FFQ. Of these, 74 (70%) also had biomarkers of iron status measured. Mean iron intake was 11.2 ± 3.8 mg/day. There was no association between nutrition knowledge score and whether the women met the RDI for iron (F (1, 102) = .40, P = .53). A positive correlation was shown between nutrition knowledge score and iron intake (mg/day) (r = 0.25, P = .01). Serum ferritin was positively associated with the frequency of flesh food intake (r = .27 P = .02). Vegetarians (including partial vegetarians) had significantly lower serum ferritin levels than non-vegetarians (F (1, 71) = 7.44, P = .01). CONCLUSIONS: Significant positive correlations found between higher flesh food intake and biomarkers of iron status suggest that educating non-vegetarians about the benefits of increased flesh food consumption and vegetarians about dietary iron enhancers and inhibitors may have potential for addressing the high rates of iron deficiency among young women.

Do modifiable risk factors for cardiovascular disease post-pregnancy influence the association between hypertensive disorders of pregnancy and cardiovascular health outcomes? A systematic review of observational studies.

Hypertensive disorders of pregnancy (HDP) are associated with increased risk of developing cardiovascular disease (CVD) in later life. This systematic review aimed to evaluate the impact of modifiable risk factors for CVD following pregnancy on the relationship between HDP and cardiovascular health outcomes. Seven databases (Medline, CENTRAL, CINAHL, Cochrane Reviews, Embase, PsycINFO and Scopus) were searched from date of inception to July 24, 2019. Observational studies that included female adults with a history of HDP and analysed whether modifiable risk factors for CVD following pregnancy (dietary intake, physical activity, smoking status, alcohol intake, body weight and mental health status) influenced associations between HDP and cardiovascular health outcomes (morbidity, mortality or related risk markers) were eligible for inclusion. In total, 4704 articles were identified, with 11 studies included. The modifiable risk factors measured included body weight (11 studies), physical activity and dietary intake (one study) and smoking (one study). Overall, five of seven studies provided convincing evidence that the relationship between HDP and blood pressure was adversely impacted by excess body weight post-pregnancy. The current systematic review provides evidence that excess body weight post-pregnancy impacts associations between HDP and hypertension in later life. However, there is a lack of evidence exploring the impact of a variety of modifiable risk factors for CVD on associations between HDP and cardiovascular health outcomes. This evidence is imperative to inform development of effective CVD prevention interventions for women with a history of HDP.

Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged < 20 years. A systematic review and meta-analysis.

BACKGROUND: This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged <20 years with subsequent tobacco use. METHODS: We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged < 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use. FINDINGS: A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035). CONCLUSION: There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.

Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis.

BACKGROUND: There are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years. METHODS: In this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485. FINDINGS: The most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17·2% (95% CI 15-20, I2=99·9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7·8% (6-9, I2=99·8%). The pooled estimate for occasional use was 0·8% (0·5-1·2, I2=99·4%) for daily use and 7·5% (6·1-9·1, I2=99·4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS. INTERPRETATION: There is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems. FUNDING: World Health Organization and the Bill & Melinda Gates Foundation.

Early childhood education and care-based healthy eating interventions for improving child diet: a systematic review protocol.

INTRODUCTION: Diet during infancy and early childhood can have implications on child growth, health, and developmental trajectories. Yet, poor dietary habits are common in young children, who often consume diets that are not aligned with dietary recommendations. Early childhood education and care (ECEC) is a recommended setting to deliver healthy eating interventions as they offer existing infrastructure and access to a large number of children. This protocol aims to describe the methods of a systematic review to assess the effectiveness of healthy eating interventions conducted within the ECEC setting to improve child diet. METHODS AND ANALYSIS: Eight electronic databases including Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, EMBASE, CINAHL Complete, PsycINFO, ERIC, SCOPUS, and SPORTDiscus will be searched from conception to March 2020. Randomised controlled trials (RCT) of dietary interventions targeting children aged up to 6 years conducted within the ECEC setting (including pre-schools, kindergartens, long day care, and family day care) will be included in the review. The primary review outcome is any measure of child dietary intake. Secondary outcomes include (i) child anthropometrics, (ii) child cognition, (iii) child mental health, (iv) child quality of life, (v) the absolute cost or cost-effectiveness of included interventions, and (vi) any reported adverse effects. Study inclusion, data extraction, and risk of bias assessments will be performed independently by two reviewers. Meta-analyses will be performed if adequate data is available, else review findings will be described narratively. DISCUSSION: This systematic review seeks to synthesise the effectiveness of healthy eating interventions conducted within the ECEC setting for improving child diet. This review will also seek to describe the effect of ECEC-based healthy eating interventions on a variety of important secondary outcomes (adverse events and cost-effectiveness) that will enhance the public health policy and practice relevance of review findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO [ID CRD42020153188 ].

Recruitment and retention of young women into nutrition research studies: practical considerations.

BACKGROUND: Successful recruitment and retention of participants into research studies is critical for optimising internal and external validity. Research into diet and lifestyle of young women is important due to the physiological transitions experienced at this life stage. This paper aims to evaluate data related to recruitment and retention across three research studies with young women, and present practical advice related to recruiting and retaining young women in order to optimise study quality within nutrition research. METHODS: Recruitment and retention strategies used in three nutrition studies that targeted young women (18 to 35 years) were critiqued. A randomised controlled trial (RCT), a crossover validation study and a cross-sectional survey were conducted at the University of Newcastle, Australia between 2010 and 2013Successful recruitment was defined as maximum recruitment relative to time. Retention was assessed as maximum participants remaining enrolled at study completion. RESULTS: Recruitment approaches included notice boards, web and social network sites (Facebook and Twitter), with social media most successful in recruitment. The online survey had the highest recruitment in the shortest time-frame (751 participants in one month). Email, phone and text message were used in study one (RCT) and study two (crossover validation) and assisted in low attrition rates, with 93% and 75.7% completing the RCT and crossover validation study respectively. Of those who did not complete the RCT, reported reasons were: being too busy; and having an unrelated illness. CONCLUSION: Recruiting young women into nutrition research is challenging. Use of social media enhances recruitment, while Email, phone and text message contact improves retention within interventions. Further research comparing strategies to optimise recruitment and retention in young women, including flexible testing times, reminders and incentives is warranted.

A study of the effects of latent iron deficiency on measures of cognition: a pilot randomised controlled trial of iron supplementation in young women.

Rates of iron deficiency are high amongst healthy young women. Cognitive impairment occurs secondary to iron deficiency in infants and children, but evaluation of the impact on cognition among young women is inconsistent. The aim was to determine the suitability of the IntegNeuro test battery for assessing cognitive function in iron-deficient and iron-sufficient young women. A pilot double-blinded, placebo-controlled intervention trial was conducted in iron-deficient (serum ferritin ≤ 20 µg/L and haemoglobin > 120 g/L) and iron-sufficient young women (18-35 years). Cognitive function and haematological markers of iron status were measured at baseline and follow-up. Iron-deficient participants (n = 24) were randomised to receive placebo, 60 mg or 80 mg elemental iron daily supplements for 16 weeks. A control group of iron-sufficient participants (n = 8) was allocated to placebo. Change scores for Impulsivity and Attention were significantly greater in plasma ferritin improvers than in non-improvers (p = 0.004, p = 0.026). IntegNeuro was easy to administer and acceptable to young women. Based on the differences in Memory and Attention scores between iron-deficient participants on iron treatment and those on placebo, it was decided that between 26 and 84 participants would be required in each iron treatment group for an adequately powered extension of this pilot RCT.

Comparison of two doses of elemental iron in the treatment of latent iron deficiency: efficacy, side effects and blinding capabilities.

Adherence to iron supplementation can be compromised due to side effects, and these limit blinding in studies of iron deficiency. No studies have reported an efficacious iron dose that allows participants to remain blinded. This pilot study aimed to determine a ferrous sulfate dose that improves iron stores, while minimising side effects and enabling blinding. A double-blinded RCT was conducted in 32 women (18-35 years): 24 with latent iron deficiency (serum ferritin < 20 µg/L) and 8 iron sufficient controls. Participants with latent iron deficiency were randomised to 60 mg or 80 mg elemental iron or to placebo, for 16 weeks. The iron sufficient control group took placebo. Treatment groups (60 mg n = 7 and 80 mg n = 6) had significantly higher ferritin change scores than placebo groups (iron deficient n = 5 and iron sufficient n = 6), F(1, 23) = 8.46, p ≤ 0.01. Of the 24 who completed the trial, 10 participants (77%) on iron reported side effects, compared with 5 (45%) on placebo, but there were no differences in side effects (p = 0.29), or compliance (p = 0.60) between iron groups. Nine (69%) participants on iron, and 11 (56%) on placebo correctly guessed their treatment allocation. Both iron doses were equally effective in normalising ferritin levels. Although reported side-effects were similar for both groups, a majority of participants correctly guessed their treatment group.