Food Banks as a "Treasure Trove": Users' Experiences of a Western Australian Food Relief Organization.

Food banks are providing crucial relief as food insecurity increases worldwide. While these services are essential for vulnerable populations, there is variability in foods available and users may experience poor nutritional quality, and an overabundance of discretionary foods, contributing to public health risks including overnutrition and obesity. Understanding how customers perceive food availability, variety, and quality is important to inform relief services and health interventions. This study reports the findings of a convergent parallel mixed-methods investigation of user experiences and perceptions of food availability, variety, and quality at a major food bank in Western Australia. Food bank customers (N = 207) at a food bank branch and mobile van locations completed a survey, with an option to complete a subsequent semi-structured interview (n = 15). Approximately 80% of the survey sample had low (48%) or very low (30%) food security, half of the sample had been using the food bank for longer than 6 months, and 77% reported the food bank as their first choice for food. Three-quarters (77%) reported financial barriers to a balanced diet in the past twelve months and described how limited availability and variety complicated shopping. Interviewees explained complex perceptions of these issues, including favouring healthy food while considering discretionary food as a "luxury" that enhanced their quality of life. Our findings suggest that food bank users experience barriers to maintaining a balanced diet, encounter variable supplies of healthy and nutritious foods, and have concerns about the impacts of frequent discretionary food consumption. These findings have implications for public health promotion.

Intake of Snacks and Sweets in a National Study of Built and Social Environments: the REasons for Geographic And Racial Differences in Stroke Study.

BACKGROUND: Few national studies across the United States' rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults. OBJECTIVES: This study examines associations of urbanicity/rurality-tailored measures of food store availability and neighborhood socioeconomic status (NSES) with the intake of snacks and sweets in a national sample of middle and older age adults. METHODS: This cross-sectional study used food frequency questionnaire data collected in the REasons for Geographic And Racial Differences in Stroke study (N = 21,204). What We Eat in America food group categorizations guided outcome classification into 1 main category (total snacks and sweets) and 4 subcategories (savory snacks and crackers; sweet bakery products; candy and desserts; nutrition bars and low-fat snacks and sweets). NSES and food store availability were determined using geographic information systems. Food store availability was characterized as geographic access to primary food stores (e.g., supermarkets, supercenters, and select food retailers) in urbanicity/rurality-tailored neighborhood-based buffers. Multiple linear regression was used to predict each outcome. RESULTS: Living in neighborhoods with a high density of primary food stores was associated with 8.6%, 9.5%, and 5.8% lower intake of total snacks and sweets, sweet bakery products, and candy and desserts, respectively. Living in the highest NSES quartile was associated with 11.3%, 5.8%, and 18.9% lower intake of total snacks and sweets, savory snacks and crackers, and sweet bakery products, respectively. Depending on primary food store availability, higher household income was associated with significantly greater intake of nutrition bars and low-fat snacks and sweets. Living in a United States Department of Agriculture-defined food desert was not associated with intake. CONCLUSIONS: In a geographically diverse sample of middle and older age United States adults, living in neighborhoods with no primary food stores or neighborhoods of low-SES was associated with higher intake of total snacks and sweets and subgroups of snacks and sweets.

Reduction in intake of discretionary foods and drinks among Danish schoolchildren: dietary results from the real-life cluster-randomised controlled trial 'Are You Too Sweet?'

OBJECTIVE: To evaluate the effectiveness of the multicomponent intervention trial 'Are You Too Sweet?' in reducing discretionary foods and drinks intake among young schoolchildren. DESIGN: The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups. SETTING: Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2). PARTICIPANTS: A total of 153 children aged 5-7 years. RESULTS: No significant reduction in the children's intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002). CONCLUSION: The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

Variety Predicts Discretionary Food and Beverage Intake of Australian Adults: A Cross-Sectional Analysis of an Online Food Intake Survey.

BACKGROUND: Variety has been used as a strategy for increasing intakes of healthy foods, but has not been well explored with respect to discretionary food/beverages. The diverse sensory properties of these foods suggests that variety could play an important role in total intake. OBJECTIVE: This study explored variety as a predictor of intake of discretionary food/beverages, and described the variety of these items consumed by Australian adults. DESIGN: Secondary analyses of cross-sectional data from a validated, online survey that assesses participants' dietary intake using frequency and portion-based questions. Discretionary food/beverages are grouped into 11 categories. PARTICIPANTS/SETTING: Participants included 235,203 Australian adults, aged 18 years or older, who provided data from May 2015 to November 2020. OUTCOME MEASURES: Variety was the number of categories of discretionary food/beverages consumed. Servings were estimated from usual intake questions, and percent contribution summarized by category. Consumption prevalence was the proportion of the sample/subgroup consuming each category. Consumption was calculated as the mean of the sample and per capita in servings. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to present variety and percent contribution to total intake across the sample and subgroups, and multiple regression was used to examine whether or not variety predicted intake of discretionary food/beverages. RESULTS: Participants consumed a median of 8 categories of discretionary food/beverages, with every additional category associated wit h an increase in intake of half a serving of discretionary food/beverages per day (B = 0.48; P < 0.001). Alcohol, cakes and cookies, takeaway, and confectionary collectively contributed around two-thirds of total daily intake of discretionary food/beverages, with alcohol contributing the largest proportion (28.3% of total daily intake). CONCLUSIONS: Variety is related to total intake of discretionary food/beverages. Intervention approaches targeting a reduction in variety, as an alternative to a focus on portion size or frequency of intake, would be a novel way of addressing overconsumption of discretionary food/beverages in future research.

Snacking Behaviours of Australian Young Adults: Secondary Analysis of the MYMeals Cross-Sectional Study.

Snacking outside main meals may contribute to the high intakes of discretionary foods (i.e., unhealthful foods) among young adults. This study assessed the snacking behaviours of Australian young adults including the contribution of snacking to energy and nutrient intakes, the main foods consumed, and portion sizes. A secondary analysis of the MYMeals study of adults aged 18-30 years who consumed at least one snack food during the recording period (n = 889) was conducted. All food consumed over 3 consecutive days was recorded using a purpose-designed smartphone app. Snack foods contributed 13.2% of energy, 23.4% of total sugars, and 16.2% of saturated fat. Females consumed more energy (13.8% vs. 12.2%, p = 0.007) and total sugars (25.8% vs. 20.8%, p = 0.009), from snacking than males. Fruit (20.2%), chocolate (9.9%), cake-type desserts (8.4%), sweet biscuits (6.1%), and ice-cream-type desserts (5.6%) were the most frequently consumed snacks by young adults. The median portion sizes for the top five snack foods consumed were fruit-106 g (IQR: 73), chocolate-26 g (IQR: 36), cake-95 g (IQR: 88), sweet biscuits-26 g (IQR: 29), and ice cream-75 g (IQR: 42). The current findings may inform population-wide strategies to encourage healthful snacks such as fruit, inform portion control by individuals, and persuade the food industry to reduce the serving size of discretionary snack foods such as cake.

Discretionary foods and drinks in Norwegian children and adolescents' diet: data from the national dietary survey Ungkost 3.

OBJECTIVE: This study aimed to identify the amount of discretionary foods and drinks consumed by Norwegian children and adolescents, describe how such products contribute to the intake of total energy and nutrients, and study the distribution in intake of discretionary foods and drinks across different meals. Secondly, the aim was to explore factors associated with those children and adolescents having the highest consumption of discretionary foods and drinks. DESIGN: Secondary analysis of data from a national survey of dietary intake among Norwegian children and adolescents. SETTING: Schools in fifty randomly selected municipalities in Norway. PARTICIPANTS: The study population included 636 pupils in 4th grade (9-11 years) and 687 pupils in 8th grade (12-14 years). RESULTS: Discretionary foods and drinks contributed to about 20 % of the children and adolescents' total energy intake. These products contributed to about two-thirds of the participants' intake of added sugar, and limited amounts of dietary fibre, vitamins and minerals. The quartile which had the lowest proportion of their energy intake from discretionary foods and drinks seemed to have a higher intake of whole grains, and fish and seafood. CONCLUSIONS: Almost all 4th and 8th graders in Norway consumed discretionary foods and drinks, and these products contributed to a substantial proportion of the total energy intake and limited amounts of nutrients. Those children and adolescents consuming the least discretionary foods and drinks had a higher intake of whole grains, fish and seafood, indicating healthier and more sustainable food habits.

Associated substitution and complementation patterns of processed discretionary foods and drinks on total energy and added sugar intake.

BACKGROUND: Processed discretionary foods and drinks (industrialised sugary drinks, sweet and savoury snacks, and grain-based sweets) are often target of policies aimed at regulating the food environment. We aimed to understand if a lower intake of processed foods or drinks is associated with substitution or complementation patterns and overall intake. METHODS: We analysed a subsample with two 24-h dietary recalls of the Mexican National Health and Nutrition Survey 2012 (358 children, 253 adolescents and 278 adults). We compared within-person, energy and added sugar intakes between days with and without consumption of each food group with fixed-effects regressions. We estimated the relative change (change in intake when not consumed/average intake when consumed × 100). RESULTS: Processed discretionary foods were not fully substituted, as total energy was 200-400 kcal/day lower when these foods were not consumed. The change in total intake was larger than the intake when consumed (i.e., complemented) for industrialised sugary drinks in adolescents (-136%) and adults (-215%), and sweet, savoury snacks for children (-141%). The change was lower (i.e., partially substituted) for grain-based sweets among children (-78%) and adolescents (-73%). For added sugars, most processed discretionary groups were complemented. CONCLUSIONS: Days without intake of processed discretionary foods were associated with lower total energy and lower added sugar intake compared to days when those foods were consumed. This suggests that regulatory policies to reduce the intake of processed foods could have a meaningful impact on improving the overall diet.

From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines.

OBJECTIVE: The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences. DESIGN: A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'. SETTING: National FBDG from all world regions. PARTICIPANTS: None. RESULTS: Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms. CONCLUSION: Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.

Systematic review of the portion size norm of discretionary foods.

CONTEXT: Portion size norm is described as the perception of how much of a given food people choose to eat. Reducing the portion size norm of foods that are high in saturated fat, added sugar, and added salt toward smaller sizes might be a potential strategy to promote appropriate portion size selections. However, an overview of existing portion size norms for discretionary foods has yet to be established. OBJECTIVE: The aim of this systematic review was to examine the portion size norm of discretionary foods and assess the methodologies used to investigate the norm. DATA SOURCES: The literature search was conducted in 6 databases following the PRISMA guidelines (from inception to January 2022). DATA EXTRACTION: Forty studies were eligible and grouped into 3 categories by portion size norm measures: normal (n = 26), appropriate (n = 8), and preferred portion sizes (n = 3). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. DATA ANALYSIS: A wide range of portion sizes were considered normal for each food type, with means/medians varying from 2- to 4-fold among studies. Studies differed considerably in design, with variables including the setting, food type, food presentation, the manner in which portion-size-related questions were formulated, and the range and number of displayed serving size options. The quality of reviewed studies was mixed (25 studies had low or moderate risk of bias, 15 had high risk of bias), and the method of assessing portion size was not validated in 15 of 33 quantitative studies. CONCLUSION: The assessment of portion size in future studies should be conducted using tools that are validated for the population of interest so that more definitive conclusions can be drawn regarding portion size norms for discretionary foods. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42021249911.

The 'sugar tax' in Bermuda: a mixed methods study of general population and key stakeholder perceptions.

BACKGROUND: Taxes on discretionary foods and sugar-sweetened beverages have emerged as a strategy for health promotion. Between 2018-2019, the Bermuda government introduced a phased tax on imported sugar-sweetened beverages, confectionery, products containing cocoa and pure sugar, and eliminated import duties on select healthy food items. The aim of this study was to conduct an mixed methods evaluation of perceptions of the tax among the general population and key stakeholders. METHODS: We conducted a survey of the general population (N = 400), and semi-structured interviews with key informants (N = 14) from the government, food and beverage, and health sectors to understand awareness, acceptability, and perceived impact of the tax after implementation. Survey data was analysed using thematic analysis, summary statistics, and Chi-squared tests. Key informant interviews were analysed using the framework method. RESULTS: General population respondents had high awareness of the sugar tax (94%) but low awareness of the healthy food subsidy (32%). Most respondents (67%) felt the tax was not an appropriate way to motivate healthier consumption due to beliefs the tax would not be effective (44%), and because of the high price of healthy food (20%). However, nearly half (48%) reported consuming fewer taxed products, primarily for health reasons but also motivated by price increases. Key informants indicated there was high awareness but limited understanding of the tax policy. Informants expressed support for taxation as a health promotion strategy, conditional on policy implementation. The lack of clear price differentiation between taxed and un-taxed products and the absence of accompanying health education were key factors believed to affect the impact of the tax. No informants were aware of use of tax revenues for health purposes and tax revenue was reportedly re-directed to other priorities after implementation. CONCLUSIONS: There was high awareness, but limited acceptability of the Bermuda sugar tax as implemented. Clarity in the tax policy, appropriateness of the tax mechanism, and use of revenue in alignment with the tax aim are critical components for acceptance. The absence of complementary education and health promotion affected acceptance and may limit potential health impacts. The lessons learned in Bermuda can inform similar policies in other settings.

Does Food Intake of Australian Toddlers 12-24 Months Align with Recommendations: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Food-based dietary guidelines promote population health and well-being through dietary patterns that reduce chronic disease risk while providing adequate energy and nutrients. In Australia, recommended dietary patterns based on servings per day from the five food groups-fruits, vegetables, cereals and grains, meats and alternatives, and dairy-have been developed for toddlers 1-2 years of age. However, no study has assessed the intake of the five food groups in this age group nationally. (2) Aim: To compare daily servings and the percentage of energy from the five food groups and discretionary foods in toddlers 1-2 years old to the Australian Dietary Guidelines. (3) Methods: Dietary intake was assessed using a one-day food record for 475 toddlers. (4) Results: Apart from fruit and dairy, servings of the five food groups were below the recommendations. Two-thirds of toddlers did not consume enough vegetables, and only 10% consumed the recommended number of servings for cereals and grains. On average, toddlers consumed only half the recommended servings of meat and alternatives. Nearly all toddlers (89%) consumed discretionary foods, which accounted for ~12% of total energy. Forty-five percent of toddlers received breastmilk. On average, breastfed toddlers consumed fewer servings from the five food groups than non-breastfed toddlers. Dairy contributed 20% of daily energy in all toddlers; however, this food group accounted for 13% in breastfed and 32% in non-breastfed toddlers on the day of the food record. (4) Conclusions: Compared to the recommendations, alignment with the servings of the five food group foods was not achieved by most toddlers, except for fruit and dairy. Discretionary foods may have displaced nutritious family foods. Consistent with Australian Infant Feeding Guidelines, many toddlers in this study continued to receive breastmilk but the recommended dietary patterns do not include breastmilk. Dietary modeling, including breastmilk as the primary milk source, is urgently needed, along with practical advice on incorporating breastmilk in a toddler's diet while optimizing food consumption.

Comparison of Discretionary Food and Drink Intake Based on a Short Web-Based Sugar-Rich Food Screener and a Validated Web-Based 7-Day Dietary Record.

A high consumption of discretionary foods and drinks has been associated with increased risk of multiple adverse health outcomes, including risk of overweight and dental caries. The family-based cluster randomized intervention study "Are you too sweet?" aimed at reducing the intake of discretionary foods and drinks in a population of children starting pre-school. As part of the intervention a new short web-based sugar-rich food screener (SRFS), was developed to make the parents and the school health nurses aware of the children's intake of discretionary foods and drinks. In addition to the short assessment tool the parents also completed a validated web-based 7-day dietary record for the children. In the present study, estimates for intake of discretionary foods and drinks from the two assessment tools were compared (n = 80). There was significant correlation between estimates from the two assessment tools, but the SRFS provided lower estimates for intake of discretionary foods and drinks compared to the 7-day dietary record. The correlation coefficient between the two assessment tools was 0.49 (p < 0.001) and Kappa coefficient was 0.33. It is concluded that the SRFS can provide a fairly ranking of participants according to their intake of discretionary foods and drinks when compared to a validated 7-day dietary record. The screener may be a useful tool in practical settings, such as school health nurse consultations, in order to gain insight into the child's sweet intake habits.

Dietary patterns, genetic risk, and incidence of obesity: Application of reduced rank regression in 11,735 adults from the UK Biobank study.

Few studies have derived dietary patterns based on intake of discretionary foods and beverages and examined associations with genetic risk and obesity. We examined associations between dietary patterns based on discretionary foods, saturated fatty acids (SFA), and fiber, with a polygenetic risk score (PRS) for obesity and risk of overall obesity, central obesity and high body fat (BF) up to 9.7 years later. Data from 11,735 adults from the UK Biobank cohort study were used. Dietary patterns were derived from 24-h dietary assessments using reduced rank regression (response variables: discretionary foods and beverages [%E]; SFA [%E]; fiber density [g/MJ]). Cox proportional hazard models were used to investigate associations between dietary patterns and incident overall obesity, central obesity and high BF, with interactions by PRS. Three dietary patterns (DP) were identified. DP1, correlated positively with discretionary foods and SFA, inversely with fiber, was associated with higher risk of central obesity (hazard ratio: 1.08; 95% confidence interval: 1.02, 1.14). DP2, correlated positively with discretionary foods and fiber, inversely with SFA, was not associated with obesity incidence. DP3, correlated positively with SFA and fiber, inversely with discretionary foods, was associated with lower risk of central obesity (hazard ratio: 0.92; 95% confidence interval: 0.87, 0.98). There was limited evidence of interactions with PRS. A dietary pattern high in high-SFA and low-fiber discretionary foods and beverages was associated with higher risk of obesity, independent of genetic predisposition.

Socio-Psychological Factors Associated with Young Australian Adults' Consumption of Energy Dense and Nutrient Poor (EDNP) Foods.

Young Australian adults' exhibit high consumption of Energy Dense and Nutrient Poor (EDNP) foods; however, there is limited research concerning the factors influencing their consumption. This study aimed to explore socio-psychological factors associated with young Australian adults' (18-30 years) consumption of EDNP foods with consideration of the Food Related Lifestyle Model (FRLM) as a potential framework. Through qualitative descriptive research methodology, 38 young adults were interviewed. Data were thematically analyzed. Participants were classified into three groups based on their living arrangements namely, parental, shared and independent households. Five themes emerged, (1) psychological factors (2) intrinsic qualities of EDNP foods, (3) social factors, (4) accessibility and affordability and (5) health related beliefs. The FRLM takes into consideration some of the factors reported in this study as influencers of EDNP food intakes. However, the FRLM omits important psychological factors (motivation, restraint, cravings, coping strategies and habits) identified by participants as influencers over their EDNP food intakes. The FRLM may need to be extended in its application to EDNP food intakes of young Australian adults. Social marketing campaigns highlighting health risks, addressing social and environmental factors are suggested. The social desirability of healthier alternatives in social gatherings of young adults could be increased.

Sensory swap: Modelling the impact of swapping discretionary choices for similar tasting core foods on the energy, nutrients and sensory properties of Australian diets.

Food choice is strongly driven by the sensory characteristics of foods with sweet, salty and fatty mouthfeel considered highly palatable and rewarding. Attempts to improve diet quality have not addressed sensory characteristics of diets before. This report describes a data modelling exercise that could underpin a dietary strategy to help support consumption of higher quality diets without compromising sensory preferences. This study used the Australian National Nutrition and Physical Activity Survey data (in 9341 adults) and the CSIRO sensory-diet database. A method was developed to find core food swaps which had a similar sensory profile as discretionary foods. This study investigated the impact of such swaps on energy and nutrient intake and the impact of the swaps on servings of food groups. The modelling resulted in a similar sensory profile of core foods to that of discretionary foods with hardness, sweetness and fatty mouthfeel all within 1-3% but the saltiness approached a 4% change. There was a small (3.6%) increase in energy intake. This swap strategy decreased the intake of risk nutrients such as saturated fat and added sugars, but not sodium, while increasing the intake of beneficial nutrients like calcium, zinc and vitamin C. Results also show that there was an increase in the intake of servings of core food groups such as fruits, grains, and dairy products but little change in vegetables. In conclusion, similar sensory swaps are possible and could underpin a diet strategy, that could be further refined through food appropriateness, to improve quality.

An Alternative Nutrient Rich Food Index (NRF-ai) Incorporating Prevalence of Inadequate and Excessive Nutrient Intake.

Most nutrient profiling models give equal weight to nutrients irrespective of their ubiquity in the food system. There is also a degree of arbitrariness about which nutrients are included. In this study, an alternative Nutrient Rich Food index was developed (NRF-ai, where ai denotes adequate intake) incorporating prevalence of inadequate and excessive nutrient intake among Australian adults. Weighting factors for individual nutrients were based on a distance-to-target method using data from the Australian Health Survey describing the proportion of the population with usual intake less than the Estimated Average Requirement defined by the Nutrient Reference Values for Australia and New Zealand. All nutrients for which data were available were included, avoiding judgements about which nutrients to include, although some nutrients received little weight. Separate models were developed for females and males and for selected age groups, reflecting differences in nutrient requirements and usual intake. Application of the new nutrient profiling models is demonstrated for selected dairy products and alternatives, protein-rich foods, and discretionary foods. This approach emphasises the need to identify foods that are rich in those specific nutrients for which intake is below recommended levels and can be used to address specific nutrient gaps in subgroups such as older adults. In addition, the new nutrient profiling model is used to explore other sustainability aspects, including affordability (NRF-ai per AUD) and ecoefficiency (NRF-ai/environmental impact score).

Association between food-outlet availability near secondary schools and junk-food purchasing among Australian adolescents.

OBJECTIVES: We sought to investigate the association between food-outlet availability near Australian secondary schools and frequency of Australian students' discretionary food purchases. METHODS: Secondary-school students in Perth (Western Australia) reported the frequency of their discretionary food purchases from food outlets near their school (17 schools, n = 2389 students grades 7-12, ages 12-17 y). Food-outlet availability was sourced from local governments, then geocoded. A mixed-effects model was used in analyses. RESULTS: Almost half of students (45%) purchased discretionary foods from food outlets near their secondary school at least weekly. Only the density of top-ranking fast-food chain outlets near secondary schools was associated with a significant increase in the frequency of discretionary food purchases. CONCLUSIONS: Availability of major fast-food chains near Australian secondary schools appears to be a key driver of Australian students' discretionary food purchasing. Restricting these outlets near schools may help reduce adolescents' discretionary food intake.

The food and nutrient intake of 5- to 12-year-old Australian children during school hours: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey.

OBJECTIVE: School food intake of Australian children is not comprehensively described in literature, with limited temporal, nationally representative data. Greater understanding of intake at school can inform school-based nutrition promotion. This study aimed to describe the dietary intake of primary-aged children during school hours and its contribution to daily intake. DESIGN: This secondary analysis used nationally representative, cross-sectional data from the 2011 to 2012 National Nutrition and Physical Activity Survey. Dietary intake was assessed using validated 24-h dietary recalls on school days. Descriptive statistics were undertaken to determine energy, nutrients, food groups and food products consumed during school hours, as well as their contributions to total daily intake. Associations between school food intake and socio-demographic characteristics were explored. SETTING: Australia. PARTICIPANTS: Seven hundred and ninety-five children aged 5-12 years. RESULTS: Children consumed 37 % of their daily energy and 31-43 % of select nutrient intake during school hours, with discretionary choices contributing 44 % of school energy intake. Most children consumed less than one serve of vegetables, meat and alternatives or milk and alternatives during school hours. Commonly consumed products were discretionary choices (34 %, including biscuits, processed meat), bread (17 %) and fruit (12 %). There were limited associations with socio-economic position variables, apart from child age. CONCLUSIONS: Children's diets were not aligned with national recommendations, with school food characterised by high intake of discretionary choices. These findings are consistent with previous Australian evidence and support transformation of the Australian school food system to better align school food consumption with recommendations.

The Contribution of Foods and Beverages of Low Nutritional Value to the Diets of Swedish Adolescents, by Food Group, Time and Place. A Nationally Representative Study.

Adolescence is a time in life when lifestyle behaviours are acquired. One indicator of poor diet quality is the intake of foods and beverages with a relatively low nutritional value. Using the Australian classification of such foods, termed "discretionary", we classified the intakes of Swedish adolescents who participated in the Riksmaten Adolescent 2016-17 national dietary survey. From selected schools, 3099 adolescents in age groups 11-12, 14-15 and 17-18 years provided two 24-h recalls. Intakes and healthy dietary scores were calculated. Plasma ferritin, folate and 25(OH)D were available for a third. Almost 40% of total energy came from discretionary foods/beverages. Adolescents with higher intakes were more likely to be female, older, from a low socioeconomic position-household and born in Sweden. Most discretionary foods/beverages were consumed on weekend days and during in-between meals, outside of the home and at school. Percent energy from discretionary intake was associated with healthy dietary scores but not nutritional status. A substantial amount of energy was obtained from discretionary foods/beverages, and we found that consumption is pervasive across sociodemographic factors, time and place. Addressing this pattern will require a comprehensive approach to food environments and behaviours to reach all adolescents in an equitable manner.

Personalised nutrition advice reduces intake of discretionary foods and beverages: findings from the Food4Me randomised controlled trial.

BACKGROUND: The effect of personalised nutrition advice on discretionary foods intake is unknown. To date, two national classifications for discretionary foods have been derived. This study examined changes in intake of discretionary foods and beverages following a personalised nutrition intervention using these two classifications. METHODS: Participants were recruited into a 6-month RCT across seven European countries (Food4Me) and were randomised to receive generalised dietary advice (control) or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Dietary intake was derived from an FFQ. An analysis of covariance was used to determine intervention effects at month 6 between personalised nutrition (overall and by levels) and control on i) percentage energy from discretionary items and ii) percentage contribution of total fat, SFA, total sugars and salt to discretionary intake, defined by Food Standards Scotland (FSS) and Australian Dietary Guidelines (ADG) classifications. RESULTS: Of the 1607 adults at baseline, n = 1270 (57% female) completed the intervention. Percentage sugars from FSS discretionary items was lower in personalised nutrition vs control (19.0 ± 0.37 vs 21.1 ± 0.65; P = 0.005). Percentage energy (31.2 ± 0.59 vs 32.7 ± 0.59; P = 0.031), percentage total fat (31.5 ± 0.37 vs 33.3 ± 0.65; P = 0.021), SFA (36.0 ± 0.43 vs 37.8 ± 0.75; P = 0.034) and sugars (31.7 ± 0.44 vs 34.7 ± 0.78; P < 0.001) from ADG discretionary items were lower in personalised nutrition vs control. There were greater reductions in ADG percentage energy and percentage total fat, SFA and salt for those randomised to L3 vs L2. CONCLUSIONS: Compared with generalised dietary advice, personalised nutrition advice achieved greater reductions in discretionary foods intake when the classification included all foods high in fat, added sugars and salt. Future personalised nutrition approaches may be used to target intake of discretionary foods. TRIAL REGISTRATION: Clinicaltrials.gov NCT01530139 . Registered 9 February 2012.