"Then you raise them with Shirchoy or cookies": Understanding influences on delayed dietary diversity among children in Tajikistan.

Dietary diversity is a key component of infant and young child feeding (IYCF) as well as adult health. In Tajikistan, a predominantly rural, former Soviet country in Central Asia, we conducted formative research to identify barriers to dietary diversity and strategies for nutrition behaviour change. In Spring, 2016, mixed-methods data collection took place across 13 villages in all five regions, collecting collaborative mapping; structured assessments of stores and markets; home visits for dietary recalls; food storage, preparation, and meal observations; focus groups with pregnant women, mothers of young children, fathers, and mothers-in-law; and in-depth expert interviews with local nutrition and health influentials. Overall, maternal diet was adequate in terms of diversity (only 13% reported <5/10 food groups in the past 24 hr); however, only 42% of index children 6-24 months met WHO guidelines for diversity, and only 34% met minimum acceptable diet criteria. In addition to issues of poverty and food scarcity, qualitative data reveal many behavioural barriers to timely introduction of diverse complementary foods. Women's strategies focused on gradual introduction of household diet components, without regard for diversity or nutrition. Foods such as meat were seen as costly and thus inappropriate for IYCF, and food taboos (i.e., fresh vegetables) further reduced diversity. Infant food preparation methods such as grinding were seen as impractical, and many foods were withheld until children develop teeth. Possible nutrition education strategies include point-of-purchase campaigns to improve availability and appeal of IYCF-friendly foods, as well as influencing other key household members through mosques, schools, and health care providers.

Nutritional value of meals at full-service restaurant chains.

OBJECTIVE: To assess the nutritional value of meals at full-service national restaurant chains with outlets in the Philadelphia region in 2011. METHODS: Chains were eligible if nutritional information for all menu items was on company Web pages or printed menus at Philadelphia outlets. Nutrient profiles were analyzed for 2,615 items from 21 eligible chains (out of 29) and compared with United States Department of Agriculture guidelines. RESULTS: Adult meals (entree, side dish, and one-half appetizer) approximated 1,495 kcal, 28 g saturated fat, 3,512 mg sodium, and 11 g fiber; and rose to 2,020 kcal after including a beverage and one-half dessert. Better calorie and fat profiles were observed for entrees tagged "healthy choice" or aimed at seniors or children; however, sodium far exceeded recommended limits. CONCLUSIONS AND IMPLICATIONS: Foods served at full-service restaurant chains are high in calories, saturated fat, and sodium. Standard definitions are needed for "healthy choice" tags and for entrees targeted to vulnerable age groups.

Customer responses to mandatory menu labeling at full-service restaurants.

BACKGROUND: In 2010, Philadelphia enacted a menu-labeling law requiring full-service restaurant chains to list values for calories, sodium, fat, and carbohydrates for each item on all printed menus. PURPOSE: The goal of the study was to determine whether purchase decisions at full-service restaurants varied depending on the presence of labeling. METHODS: In August 2011, this cross-sectional study collected 648 customer surveys and transaction receipts at seven restaurant outlets of one large full-service restaurant chain. Two outlets had menu labeling (case sites); five outlets did not (control sites). Outcomes included differences in calories and nutrients purchased and customers' reported use of nutrition information when ordering. Data were analyzed in 2012. RESULTS: Mean age was 37 years; 60% were female; 50% were black/African-American and reported incomes ≥$60,000. Customers purchased food with approximately 1600 kcal (food plus beverage, 1800 kcal); 3200 mg sodium; and 35 g saturated fat. After adjustment for confounders, customers at labeled restaurants purchased food with 151 fewer kilocalories (95% CI=-270, -33); 224 mg less sodium (95% CI=-457, +8); and 3.7 g less saturated fat (95% CI=-7.4, -0.1) compared to customers at unlabeled restaurants (or 155 less kilocalories from food plus beverage, 95% CI=-284, -27). Those reporting that nutrition information affected their order purchased 400 fewer food calories, 370 mg less sodium, and 10 g less saturated fat. CONCLUSIONS: Mandatory menu labeling was associated with better food choices among a segment of the public dining at full-service restaurants. Consumer education on the availability and use of nutrition information may extend the impact of menu labeling.

Exploratory analysis of fast-food chain restaurant menus before and after implementation of local calorie-labeling policies, 2005-2011.

INTRODUCTION: Since 2008, several states and municipalities have implemented regulations requiring provision of nutrition information at chain restaurants to address obesity. Although early research into the effect of such labels on consumer decisions has shown mixed results, little information exists on the restaurant industry's response to labeling. The objective of this exploratory study was to evaluate the effect of menu labeling on fast-food menu offerings over 7 years, from 2005 through 2011. METHODS: Menus from 5 fast-food chains that had outlets in jurisdictions subject to menu-labeling laws (cases) were compared with menus from 4 fast-food chains operating in jurisdictions not requiring labeling (controls). A trend analysis assessed whether case restaurants improved the healthfulness of their menus relative to the control restaurants. RESULTS: Although the overall prevalence of "healthier" food options remained low, a noteworthy increase was seen after 2008 in locations with menu-labeling laws relative to those without such laws. Healthier food options increased from 13% to 20% at case locations while remaining static at 8% at control locations (test for difference in the trend, P = .02). Since 2005, the average calories for an à la carte entrée remained moderately high (approximately 450 kilocalories), with less than 25% of all entrées and sides qualifying as healthier and no clear systematic differences in the trend between chain restaurants in case versus control areas (P ≥ .50). CONCLUSION: These findings suggest that menu labeling has thus far not affected the average nutritional content of fast-food menu items, but it may motivate restaurants to increase the availability of healthier options.