Adoption, implementation, and sustainability of early childhood feeding, nutrition and active play interventions in real-world settings: a systematic review.

BACKGROUND: Instilling healthy dietary habits and active play in early childhood is an important public health focus. Interventions supporting the establishment of nutrition and active play behaviours in the first years of life have shown positive outcomes and long-term cost-effectiveness, however, most are research trials, with limited evidence regarding real-world application. Implementation science theories, models and frameworks (TMFs) can guide the process of research translation from trial to real-world intervention. The application of TMFs within nutrition and active play intervention studies in early childhood (< 5 years) is currently unknown. This systematic review identified the use of TMFs and barriers/ enablers associated with intervention adoption, implementation, and sustainability in early childhood nutrition and active play interventions implemented under real-world conditions. METHODS: Six databases were searched for peer-reviewed publications between 2000-2021. Studies were included if primary outcomes reported improvement in diet, physical activity or sedentary behaviours amongst children aged < 5 years and interventions were delivered under real-world conditions within a community and/or healthcare setting. Two reviewers extracted and evaluated studies, cross checked by a third and verified by all authors. Quality assessment of included studies was completed by two authors using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Eleven studies comprising eleven unique interventions were included. Studies represented low, middle and high-income countries, and were conducted across a range of settings. Five TMFs were identified representing four of Nilsen's implementation model categories, predominantly 'evaluation models'. Ninety-nine barriers/facilitators were extracted across the three intervention phases-Implementation (n = 33 barriers; 33 facilitators), Sustainability (n = 19 barriers; n = 9 facilitators), Adoption (n = 2 barriers; n = 3 facilitators). Identified barriers/facilitators were mapped to the five domains of the Durlak and DuPre framework, with 'funding', 'compatibility' and 'integration of new programming' common across the three intervention phases. CONCLUSIONS: Findings demonstrate that there is no systematic application of TMFs in the planning, implementation and/or evaluation of early childhood nutrition and active play interventions in real-world settings, and selective and sporadic application of TMFs occurs across the intervention lifespan. This apparent limited uptake of TMFs is a missed opportunity to enhance real-world implementation success. TRIAL REGISTRATION: PROSPERO (CRD42021243841).

Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers.

PURPOSE OF THE REVIEW: Food insecurity can have a negative health impact for women during pregnancy and the postpartum period; however, there are a range of barriers to meeting nutritional guidelines during pregnancy. Food insecurity is associated with an increased risk of pregnancy complications and mental and physical health outcomes. This review aims to provide insight into programmes and interventions which have targeted food insecurity in pregnant and early postpartum women. The central research question for this review is as follows: What programmes and interventions have sought to address food insecurity among pregnant and postpartum women? A systematic search of five electronic databases including Medline, CINAHL, Global Health, Embase, and Cochrane was undertaken on August 2021. Key thematic areas searched were food insecurity, pregnancy, nutritional outcomes, and interventions or programmes. Only studies that were published since 2000 in English were considered. RECENT FINDINGS: Eleven studies were included in this review. Studies employed a range of methods and outcomes measures. They were conducted in mostly low- and middle-income countries, and in general, focused on nutritional supplementation, with some studies also incorporating nutrition education or counselling. The findings of this review suggest that while there are a range of possible interventions that seek to address food insecurity and hunger among pregnant and postpartum women, the limited number of robust evaluations or long-term interventions mean that evidence for any one intervention type is limited. Furthermore, the programmes and interventions that do exist are generally embedded within a single context or structure, and as such, may not be able to be widely implemented. (Prospero Registration CRD42022245787).

Nutritional quality of new food products released into the Australian retail food market in 2015 - is the food industry part of the solution?

BACKGROUND: Food manufacturers have made public statements and voluntary commitments, such as the Healthier Australia Commitment (HAC), to improve the nutritional quality of foods. However, limited information about the nutritional quality or healthfulness of new products makes it difficult to determine if manufacturers are doing this. The purpose of this study was to assess the healthfulness of new food products released into the Australian retail market in 2015, and whether those companies who were HAC members released healthier food options compared to non-HAC members. METHODS: This cross-sectional study assessed the healthfulness of all new retail food products launched in Australia in 2015 as indexed in Mintel's Global New Products Database. Healthfulness was assessed using three classification schemes: Healthy Choices Framework Victoria, Australian Dietary Guidelines and NOVA Food Classification System. Descriptive statistics and chi-squared tests described and compared the number and proportions of new foods falling within each of the food classification schemes' categories for companies that were and were not HAC members. RESULTS: In 2015, 4143 new food products were launched into the Australian market. The majority of new products were classified in each schemes' least healthy category (i.e. red, discretionary and ultra-processed). Fruits and vegetables represented just 3% of new products. HAC members launched a significantly greater proportion of foods classified as red (59% vs 51% for members and non-members, respectively) discretionary (79% vs 61%), and ultra-processed (94% vs 81%), and significantly fewer were classified as green (8% vs 15%), core foods (18% vs 36%) and minimally processed (0% vs 6%) (all p < 0.001). CONCLUSIONS: This study found that the majority of new products released into the Australian retail food market in 2015 were classified in each of three schemes' least healthy categories. A greater proportion of new products launched by companies that publicly committed to improve the nutritional quality of their products were unhealthy, and a lower proportion were healthy, compared with new products launched by companies that did not so commit. Greater monitoring of industry progress in improving the healthfulness of the food supply may be warranted, with public accountability if the necessary changes are not seen.