Advancing assessment of responsive feeding environments and practices in child care.

Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of '3' indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were 'educators not using food to calm or encourage behaviour' (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and 'not requiring children to sit at the table until finished' (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were 'educator prompts for children to drink water' (M = 0.78, SD = 0.94) and 'children self-serving' (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were 'enthusiastic role modelling during mealtime' (M = 0.70, SD = 0.68) and 'praise of mealtime behaviour unrelated to food intake' (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.

Parent Perceptions of School Meals Influence Student Participation in School Meal Programs.

OBJECTIVE: To evaluate if parent perceptions of school meals influence student participation. DESIGN: In May 2022, an online survey was used to evaluate parents' perceptions of school meals and their children's participation. PARTICIPANTS: A total of 1,110 California parents of kindergarten through 12th-grade students. MAIN OUTCOME MEASURES: Student participation in school lunch and breakfast. ANALYSIS: Principal component analysis and Poisson regression models. RESULTS: Three groups of parental perceptions were identified: (1) positive perceptions (eg, liking school meals and thinking that they are tasty and healthy), (2) perceived benefits to families (eg, school meals save families money, time, and stress), and (3) negative (eg, concerns about the amount of sugar in school meals and stigma). More positive parental perceptions about school meals and their benefits to families were associated with greater student meal participation. In contrast, more negative parental perceptions were associated with reduced student participation in school meals (P < 0.05). CONCLUSION AND IMPLICATIONS: Parent perceptions of school meals may affect student participation in school meal programs. Working to ensure parents are familiar with the healthfulness and quality of school meals and the efforts schools are making to provide high-quality, appealing meals may be critical for increasing school meal participation rates.

Gastric emptying of a glucose drink is predictive of the glycaemic response to oral glucose and mixed meals, but unrelated to antecedent glycaemic control, in type 2 diabetes.

BACKGROUND: Gastric emptying (GE), with wide inter-individual but lesser intra-individual variations, is a major determinant of postprandial glycaemia in health and type 2 diabetes (T2D). However, it is uncertain whether GE of a carbohydrate-containing liquid meal is predictive of the glycaemic response to physiological meals, and whether antecedent hyperglycaemia influences GE in T2D. We evaluated the relationships of (i) the glycaemic response to both a glucose drink and mixed meals with GE of a 75 g glucose drink, and (ii) GE of a glucose drink with antecedent glycaemic control, in T2D. METHODS: Fifty-five treatment-naive Chinese adults with newly diagnosed T2D consumed standardised meals at breakfast, lunch and dinner with continuous interstitial glucose monitoring. On the subsequent day, a 75 g glucose drink containing 150 mg 13C-acetate was ingested to assess GE (breath test) and plasma glucose response. Serum fructosamine and HbA1c were also measured. RESULTS: Plasma glucose incremental area under the curve (iAUC) within 2 hours after oral glucose was related inversely to the gastric half-emptying time (T50) (r = -0.34, P = 0.012). The iAUCs for interstitial glucose within 2 hours after breakfast (r = -0.34, P = 0.012) and dinner (r = -0.28, P = 0.040) were also related inversely to the T50 of oral glucose. The latter, however, was unrelated to antecedent fasting plasma glucose, 24-hour mean interstitial glucose, serum fructosamine, or HbA1c. CONCLUSIONS: In newly diagnosed, treatment-naive, Chinese with T2D, GE of a 75 g glucose drink predicts the glycaemic response to both a glucose drink and mixed meals, but is not influenced by spontaneous short-, medium- or longer-term elevation in glycaemia.

Unlocking gender dynamics in food and nutrition security in Ghana: assessing dietary diversity, food security, and crop diversification among cocoa household heads in the Juaboso-Bia cocoa landscape.

BACKGROUND: Malnutrition is a worldwide problem that impacts every country, affecting one in three individuals, including Ghana. According to estimates from the Food and Agriculture Organization (FAO), 690 million people were undernourished globally in 2019. Malnutrition is no exception in rural cocoa communities in Ghana. The expansion of cocoa is causing food insecurity and low dietary diversity in most cocoa-growing areas. There is little information on the food security status and dietary diversity among male-headed and female-headed cocoa households in the Juaboso-Bia cocoa landscape. Thus, this study sought to explore the dietary diversity distribution, food security status, sources of staple food, food unavailability periods, food production status, themes contributing to low dietary diversity and food insecurity, and perception of the impact of cocoa expansion on crop diversification among male-headed and female-headed cocoa households in the study area. METHODS: Both quantitative and qualitative research methods were employed to address the research questions. The study collected 200 semi-structured questionnaire data and 14 in-depth interview data from cocoa household heads in the Juaboso-Bia landscape. The survey data was cleaned and analysis, such as household dietary diversity status, food security status, and binary logistic regression were performed in the Statistical Package for Social Scientists (SPSS). The in-depth interviews were analyzed using thematic analysis. RESULTS: Through this study, it was revealed that 62.8% of the male-headed cocoa households had medium to high dietary diversity compared to their female counterparts 39.3%. About 47.9% of the male-headed households were food secure than the female-headed households (29.1%). Moreover, the months that both male and female-headed households recalled facing severe food unavailability were July and June. In addition, climate change/variability, unavailable lands, poverty, large household size, and gender stereotypes were themes promoting low dietary diversity and food insecurity among male and female-headed households. Furthermore, sex, total household income, and cropland conversion to cocoa were the variables influencing household heads' perception of the impact of cocoa expansion on crop diversification. CONCLUSIONS: The study showed that the male-headed cocoa households had high dietary diversity and were food secure than the female-headed cocoa households, lending credence to the conceptual framework applied in this study. There is a significant relationship between household head gender and food security status. Therefore, this study recommends the following interventions to improve dietary diversity and food security among male and female-headed cocoa households: raise awareness about the need for diverse diets and provide practical information on how to incorporate a greater variety of food groups into their daily meals; and promote gender equity and inclusivity in food security interventions. Future research could investigate how gender mainstreaming policies in agriculture have helped empower and improve the food security of female-headed households in Ghana.

Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003-2018.

BACKGROUND: Currently, it is still largely unknown whether the proportion of calcium intake at breakfast and dinner is associated with cardiovascular disease (CVD) in the general population. OBJECTIVES: The aim of this study was to evaluate the association of dietary calcium intake at dinner versus breakfast with CVD in a nationally representative sample of US adults. METHODS: The study population consisted of 36,164 US adults (including 4,040 CVD cases) from the NHANES 2003 to 2018. According to the ratio of dietary calcium intake at dinner and breakfast (Δ = dinner/breakfast), 36,164 participants were divided into five groups. After adjustment for a series of confounder factors, logistic regression analyses were performed to examine the association between Δ and CVD. Dietary substitution models were used to explore the changes in CVD risk when a 5% dietary calcium intake at dinner was substituted with dietary calcium intake at breakfast. RESULTS: Compared with participants in the lowest quintile, participants in the highest quintile were more likely to have CVD, with an adjusted OR of CVD of 1.16 (95% CI, 1.03 to 1.31). When the total calcium intake remained constant, replacing a 5% dietary calcium intake at dinner with dietary calcium intake at breakfast was associated with a 6% lower risk of CVD. CONCLUSIONS: Compared to the lowest quintile of Δ, participants in the highest quintile of Δ were likely to experience CVD in the general population. It is necessary to scientifically allocate dietary calcium intake at breakfast and dinner.

Microbiological quality of gluten-free meals, naturally gluten free foods, and gluten free-labelled products.

Background: The rising prevalence of gluten-related disorders such as celiac disease explains the increased consumption of gluten-free foods (GFF). However, these foods must be safe in terms of both gluten content and contamination by pathogenic microorganisms in order to avoid food poisoning. Objective: The objective of this study was to assess the microbiological quality of gluten-free meals, naturally gluten free foods, and gluten free-labelled products. Material and Methods: We collected 62 GFF samples including 20 meals (M-GF), 22 naturally gluten free (N-GFF) and 20 labelled (L-GFF) products, which were investigated for microbiological contamination according to Moroccan regulations guidelines, issued by the International Organization for Standardization (ISO). The analysis consisted of the detection of Salmonella and Listeria monocytogenes in each sample, and the quantification of the microbial load of the following six micro-organisms: total aerobic mesophilic flora, total coliforms, fecal coliforms, Staphylococcus aureus, Sulphite-Reducing Anaerobic, and yeasts and molds. Results: A total of 372 analyses were carried out, showing a microbiological contamination rate of 5.1%. This contamination concerned N-GFF in 8.3% (predominantly with yeasts and molds), and meals prepared at home in 11.7 (predominantly with Staphylococcus aureus and coliforms). Only one case (0.8%) of contamination was observed in products labelled gluten-free and no contamination was noticed in meals prepared in food services. Listeria monocytgenes and Salmonella were not detected in any samples of food analyzed. These results indicate a good compliance of L-GFP and M-GF prepared in food services, while unsatisfactory quality was observed in N-GFF and M-GF prepared at home. Conclusion: Therefore, rigorous hygienic practices and adequate corrective measures should be considered by celiac patients, especially regarding the N-GFF and M-GF prepared at home.

Deacetylated Konjac Glucomannan with a Slower Hydration Rate Delays Rice Digestion and Weakens Appetite Response.

The physical characteristics of chyme during gastrointestinal digestion are considered to significantly affect nutrient digestion and absorption (such as glucose diffusion), which has an impact on postprandial satiety. The present study aims to analyze the hydration rate (HR) and rheological properties of deacetylated konjac glucomannan (DKGM) at different degrees and then explore their effects on rice texture, digestive properties, and the subjects' post-meal appetite. The present results show that, as the deacetylation degree (DD) of KGM increased, the intersection point of the viscoelastic modulus shifted to a high shear rate frequency, and as the swelling time of the DKGM was prolonged, its HR decreased significantly. The results of the in vitro gastrointestinal digestion tests show that the hardness and chewability of the rice in the fast-hydration group (MK1) were remarkably reduced. In contrast, the slow-hydration group (MK5) exhibited an outstanding ability to resist digestion. The kinetics of starch hydrolysis revealed that the HR of the rice in the fast-hydration group was 1.8 times faster than that of the slow-hydration group. Moreover, it was found that the subjects' appetite after the meal was highly related to the HR of the MK. Their hunger (p < 0.001), desire to eat (p < 0.001), and prospective food consumption (p < 0.001) were significantly inhibited in the slow-hydration group (MK5) compared to the control. This study explored the nutritional effects of the hydration properties derived from the DKGM, which may contribute to modifying the high glycemic index food and provide ideas for the fabrication of food with enhanced satiating capacity.

What Is Quality Food? The Opinion of Key of the Brazilian Food System.

The aim of the study was to explore the concept of quality food in the opinion of key informants of the food system. This qualitative research included 208 key informants related to the food supply for Brazilian public food services. The participants were grouped into three groups according to their participation in the food system: 1. Food production; 2. Management and marketing; 3. Meal's production process. Key informants answered the following question: "In your opinion, what is quality food?". The answers were analysed through qualitative content analysis. The data analysis resulted in 52 codes grouped into eight categories, expressing the opinion of the study participants about what quality food is: nutritional, sustainable, sensory, hygienic-sanitary, care, regulatory, dependability and symbolic. Nutritional and sustainable dimensions were predominantly considered. The activities carried out in the food system seem to influence the opinion on food quality. The groups linked to food production put more emphasis on the sustainable dimension, followed by the nutritional dimension, while the groups linked to management and marketing and to the meals production process put more emphasis on the nutritional and sensory dimensions. These differences may indicate a difficulty in the transition towards a more sustainable and healthy food system.

Association of Nightly Fasting, Meal Frequency, and Skipping Meals with Metabolic Syndrome among Kuwaiti Adults.

Mounting evidence suggests that meal timing and frequency are associated with cardiometabolic health by influencing circadian rhythms. However, the evidence is inconsistent and limited, especially in non-Western cultures. This cross-sectional study aims to investigate the association between temporal habits of dietary intake, such as nightly fasting duration and meal frequency, and metabolic syndrome among Kuwaiti adults. A 24-hour recall was used to assess temporal habits of dietary intake. Meal frequency was defined as the number of daily eating episodes. The study included a total of 757 adults aged 20 years and older. The participants' mean age was 37.8 ± 12.3 years. After adjusting for all confounders, higher meal frequency was found to be associated with a lower prevalence of metabolic syndrome in adults (OR, 0.43; 95%CI, 0.19-0.96) and a lower prevalence of elevated triglycerides in men only (OR, 0.23; 95%CI, 0.09-0.60). No association was found between nightly fasting and metabolic syndrome, but a longer fasting duration was associated with a lower prevalence of elevated triglycerides (OR, 0.19; 95%CI, 0.06-0.63). The findings suggest that having frequent meals and longer durations of nightly fasting may help decrease the risk of metabolic syndrome and elevated triglycerides.

Effectiveness of personalized meal recommendation in improving dietary behaviors of Chinese community-dwelling elders: study protocol for a cluster randomized controlled trial.

BACKGROUND: Inappropriate eating behaviors, particularly a lack of food diversity and poor diet quality, have a significant impact on the prognosis of certain chronic conditions and exacerbate these conditions in the community-dwelling elderly population. Current dietary interventions for the elderly have not adequately considered the nutritional needs associated with multiple chronic conditions and personal dietary preferences of elderly individuals. A personalized recommendation system has been recognized as a promising approach to address this gap. However, its effectiveness as a component of an elderly-targeted dietary intervention in real-world settings remains unknown. Additionally, it is unclear whether this intervention approach will be user-friendly for the elderly. Therefore, this study aims to examine the effectiveness of a personalized meal recommendation system designed to improve dietary behavior in community-dwelling elders. The implementation process in terms of System usability and satisfaction will also be assessed. METHODS: The trial has been designed as a 6-month, non-blinded, parallel two-arm trial. One hundred fifty community-dwelling elders who meet the eligibility criteria will be enrolled. Subjects will be allocated to either the intervention group, receiving personalized meal recommendations and access to corresponding food provided as one component of the intervention, as well as health education on elder nutrition topics, or the control group, which will receive nutritional health education lectures. Outcomes will be measured at three time points: baseline at 0 months, 3 months, and 6 months. The primary outcomes will include dietary diversity (DDS) and diet quality (CDGI-E) of enrolled community-dwelling elders, representing their dietary behavior improvement, along with dietary behavior adherence to recommended meals. Secondary outcomes will measure the perceived acceptability and usability of the personalized meal recommendation system for the intervention group. Exploratory outcomes will include changes in the nutritional status and anthropometric measurements of the community-dwelling elders. DISCUSSION: This study aims to examine the effectiveness, acceptability, and usability of a personalized meal recommendation system as a data-driven dietary intervention to benefit community-dwelling elders. The successful implementation will inform the future development and integration of digital health strategies in daily nutrition support for the elderly. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300074912. Registered on August 20, 2023, https://www.chictr.org.cn/showproj.html?proj=127583.

Family Meals and Social Eating Behavior and Their Association with Disordered Eating among Spanish Adolescents: The EHDLA Study.

PURPOSE: The aim of this study was to examine the association of family meals and social eating behavior with disordered eating behavior in Spanish adolescents. METHODS: This was a cross-sectional study that included 706 adolescents (43.9% boys) from the Eating Habits and Daily Life Activities (EHDLA) study (aged 12 to 17) from Valle de Ricote, Region of Murcia, Spain. The frequency of family meals was assessed by asking participants to report how often their family, or most household members, had shared meals in the past week. Social eating behavior was evaluated using three statements: "I enjoy sitting down with family or friends for a meal", "Having at least one meal a day with others (family or friends) is important to me", and "I usually have dinner with others". To evaluate disordered eating, two psychologists administered the Sick, Control, One, Fat and Food (SCOFF) questionnaire. RESULTS: After adjusting for several covariates, for each additional family meal, the likelihood of having disordered eating behavior was lower (odds ratio (OR) = 0.96; 95% confidence interval (CI) 0.93 to 0.9997, p = 0.049). On the other hand, a lower likelihood of having disordered eating behavior was observed for each additional point in the social eating behavior scale (OR = 0.85; 95% CI 0.77 to 0.93, p = 0.001). The likelihood of having disordered eating behavior was 0.7% lower for each additional family meal (95% CI 0.01% to 1.4%, p = 0.046). Furthermore, for each additional point in the social eating behavior scale, a lower probability of having disordered eating behavior was observed (3.2%; 95% CI 1.4% to 5.0%, p < 0.001). CONCLUSIONS: While disordered eating behavior is complex and can be shaped by various factors, both family meals and social eating behavior emerge as significant factors inversely associated with this condition among adolescents. Promoting regular engagement in family meals and fostering positive social eating experiences could serve as effective strategies in public health initiatives aimed at mitigating the incidence of disordered eating behavior among the young population.

Factors That Most Influence the Choice for Fast Food in a Sample of Higher Education Students in Portugal.

The frequency of fast food consumption among higher education students is high, causing worrying implications for public health. This study aims to relate the factors that influence the choice for fast food with social factors, nutritional status, and fast food consumption in a sample of higher education students in Portugal. An online questionnaire was developed and disseminated by social networks among students during the first half of 2023. Two hundred and thirty-seven students participated, mainly female (65.4%), who were attending public higher education institutions (59.1%), with a median of age of 20.0 (19.0; 22.0) years, and about 20% of the sample had overweight. Approximately 80% consumed fast food, and almost 40% consumed it more than once or twice a week. Predominantly (78.0%), they chose hamburger meals, spending EUR 8.0 per meal. The factors that most influenced the choice of fast food were ease or convenience of preparation (59.9%), price (48.5%), and flavor (28.3%). There were also differences between sexes and between those attending public and private higher education institutions regarding whether they usually consume fast food or not. The body mass index was positively associated with age (r: 0.142; p = 0.029) and with fast food spending (r: 0.146; p = 0.024). The results have implications for public health and clinical nutrition, and can support more effective strategies to improve food choices in higher education students.

The Positive Association between Melatonin-Containing Food Consumption and Older Adult Life Satisfaction, Psychoemotional State, and Cognitive Function.

The purpose of this study was to test the hypothesis that melatonin-containing food (FMT) consumption is associated with a better sleep schedule and cognitive and psychoemotional state in older adults. A cross-sectional study of 557 (79% females) older adults living in the community with a mean age of 68.9 ± 7.7, ranging from 50 to 90 years, was conducted. The study, conducted in May and September 2023 using a face-to-face interview, collected personal data and assessed FMT intake during the day (FMTday) and for dinner (FMTdinner), life satisfaction, positive and negative affect, depression severity, cognitive functions, and sleep characteristics. Multiple regression and logistic regression analysis, adjusted for co-factors, were used to assess the association between the studied indicators. Multiple regression analysis showed that older adults with higher FMT consumption are more satisfied with life (FMTdinner: ß = 0.107; ∆R2 = 0.011; p = 0.020), have a lower level of depression (FMTday: ß = -0.124; ∆R2 = 0.015; p = 0.003), and higher scores in positive affect (FMTday: ß = 0.169; ∆R2 = 0.016; p = 0.007; FMTdinner: ß = 0.136; ∆R2 = 0.019; p = 0.003). Logistic regression analysis showed that older adults with higher FMT consumption are less likely to have depression (FMTday: OR, 0.614; 95% CI, 0.436-0.864; p = 0.005; FMTdinner: OR, 0.671; 95% CI, 0.476-0.945; p = 0.023), and they perform better on logical thinking tests (FMTday: OR, 2.066; 95% CI, 1.131-2.204; p = 0.013; FMTdinner: OR, 1.887; 95% CI, 1.183-2.138; p = 0.033). A greater life satisfaction as well as a decrease in the cognitive impairment and psychoemotional state of older adults is associated with a higher consumption of melatonin-containing foods.

Biodiversity or ultra-processed food: an analysis of school meals offered in a riverside school in the Brazilian Amazon.

BACKGROUND: Rural schools in Amazonas, Brazil, often offer ultra-processed foods in school meals for students, which can lead to health problems and loss of regional food culture. We show an analysis of the menu offered in a riverside school in the Brazilian Amazon and the acceptability of students regarding the consumption of the food they are served with. METHODS: Data were collected in situ, in a riverside school in southern Amazonas, through the analysis of the school menu and the application of an investigative questionnaire to 37 students in the 9th grade of Junior High School. FINDINGS: The research revealed that the foods most consumed by students in school meals are canned beef, canned meatballs, canned sardines, sausage, biscuits, juice, rice porridge, corn porridge, pasta, meat soup, and rice with beans. In the questionnaire that was applied to students, there is a wide variation in the acceptability of the foods offered. However, 57% of students reported not liking the lunch offered at the educational institution. INTERPRETATION: To tackle this problem, it is essential that, local food culture and biodiversity food can be more valued, elements that are often excluded from school menus. This work showed that is also essential to fully adhere to the National School Meal Program (PNAE) in Brazil, which recommends that at least 30% of food intended for school meals must come from family farming, highlighting that quality food is crucial for cognitive development of students. Therefore, the meals offered in the chosen riverside school not only do not meet the PNAE guidelines but are also not well accepted by students. This study shows a significant need to consider the direct relationship between planetary health, school meals food security, and food sovereignty, given the various negative effects of foods that are rich in fat, sodium, preservatives, and other substances. Furthermore, it is imperative to integrate food into the students' context, valuing regional products from the Amazon region. FUNDING: FAPEAM (Amazonas State Research Foundation).

Association between a malnutrition screening tool and mealtime observation checklist items in older people receiving oral intake support: A cross-sectional study of four long-term care facilities.

BACKGROUND: Multiple nutritional screening tools are available for older people; however, few screening tools include specific eating behaviours as risk factors that could lead to poor food intake. The 24-item mealtime observation checklist (MOCL), developed by the Japanese Ministry of Health, Labour and Welfare in 2015, comprises signs, symptoms and conditions during mealtime that reflect eating and swallowing functions and oral conditions. OBJECTIVES: To examine factors associated with malnutrition among the MOCL items in older people. METHODS: A cross-sectional study was conducted using data from a retrospective cohort study conducted at four long-term care facilities in Japan. Among the older people residing in the facilities, 198 who received oral intake support were included in the analyses. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA®-SF), and comparisons were made between 'malnutrition' and 'at-risk or well-nourished'. The association between each MOCL item and malnutrition was assessed using multivariable logistic regression analysis. RESULTS: Of the 198 participants, 98 (49.5%) were classified as 'malnutrition', 98 (49.5%) as 'at-risk' and 2 (1%) as 'well-nourished' by MNA®-SF. After adjusting for participant characteristics such as age and sex, significant associations with malnutrition were observed for four items from the 24-item MOCL: 'Has fatigue due to extended mealtime (odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.36-7.53)', 'Food residues in the oral cavity are conspicuous (OR = 2.77, 95% CI: 1.38-5.52)', 'Has difficulty swallowing food and takes time to swallow (OR = 3.78, 95% CI: 1.45-9.84)' and 'Assisted feeding is required (OR = 3.70, 95% CI: 1.73-7.91)'. CONCLUSIONS: The four signs, symptoms and conditions during mealtime identified in this study may be associated with malnutrition in older people. IMPLICATIONS FOR PRACTICE: These may indicate the potential eating problems that can lead to malnutrition. By incorporating them into early intervention and prevention measures, health care providers may help prevent malnutrition and improve the nutritional status of older people.

Has food security in the EU countries worsened during the COVID-19 pandemic? Analysis of physical and economic access to food.

The aim of the paper is to provide an ex-post assessment of the impact of the COVID-19 pandemic on food insecurity in the EU-27 countries expressed by physical and economic food access. We analysed trade and price effects, together with food insecurity and malnutrition indicators. Actual levels of the indicators were compared with their pre-pandemic magnitudes and/or with counterfactual levels derived from predictive models. We also aimed to compare the objective statistics with the subjective consumers' perception of their households' food security. Our research indicates that the EU food trade was more resilient to COVID-19 impacts than the trade in non-food products, while food trade decreases were of a temporary nature. This did not affect the trade balance significantly; however, the import reduction threatened the physical food access in most EU countries. Regarding economic food access, the results indicate that the increase in food prices was offset by the increase in disposable income. It may suggest that the COVID-19 pandemic did not significantly affect the deterioration of economic access to food in the EU countries. However, the prevalence of severe food insecurity in the total population or the proportion of households reporting inability to afford a meal with meat, chicken, fish, or a vegetarian equivalent increased in 2020-2021 compared to 2019. This means that the comparative analysis of the real data on prices and households' income, as well as consumer financial situation and food consumption affordability, does not offer a clear answer concerning the impact of the COVID-19 pandemic on the food security of EU households.

Meal timing and its role in obesity and associated diseases.

Meal timing emerges as a crucial factor influencing metabolic health that can be explained by the tight interaction between the endogenous circadian clock and metabolic homeostasis. Mistimed food intake, such as delayed or nighttime consumption, leads to desynchronization of the internal circadian clock and is associated with an increased risk for obesity and associated metabolic disturbances such as type 2 diabetes and cardiovascular diseases. Conversely, meal timing aligned with cellular rhythms can optimize the performance of tissues and organs. In this review, we provide an overview of the metabolic effects of meal timing and discuss the underlying mechanisms. Additionally, we explore factors influencing meal timing, including internal determinants such as chronotype and genetics, as well as external influences like social factors, cultural aspects, and work schedules. This review could contribute to defining meal-timing-based recommendations for public health initiatives and developing guidelines for effective lifestyle modifications targeting the prevention and treatment of obesity and associated metabolic diseases. Furthermore, it sheds light on crucial factors that must be considered in the design of future food timing intervention trials.

Universal Free School Meals Policy and Childhood Obesity.

BACKGROUND AND OBJECTIVES: The Community Eligibility Provision (CEP), a universal free school meals policy, increases school meal participation by allowing schools in low-income areas to provide free breakfast and lunch to all students; however, its impact on obesity remains uncertain. The objective of this study is to estimate the association of CEP with child obesity. METHODS: School obesity prevalence was calculated using BMI measurements collected annually between 2013 and 2019 from students in California public schools in grades 5, 7, and 9. To estimate the association of CEP with obesity, we used a difference-in-differences approach for staggered policy adoption with an outcome regression model conditional on covariates, weighted by student population size. RESULTS: The analysis included 3531 CEP-eligible schools using school-level obesity prevalence calculated from 3 546 803 BMI measurements. At baseline, on average, 72% of students identified as Hispanic, 11% identified as white, 7% identified as Black, and 80% were eligible for free or reduced-price meals. Baseline obesity prevalence was 25%. Schools that participated in CEP were associated with a 0.60-percentage-point net decrease in obesity prevalence after policy adoption (95% confidence interval: -1.07 to -0.14 percentage points, P = .01) compared with eligible, nonparticipating schools, corresponding with a 2.4% relative reduction, given baseline prevalence. Meals served increased during this period in CEP-participating schools only. CONCLUSIONS: In a balanced sample of California schools, CEP participation was associated with a modest net decrease in obesity prevalence compared with eligible, nonparticipating schools. These findings add to the growing literature revealing potential benefits of universal free school meals for children's well-being.

Food Security and Diet Quality Improvements among At-Risk, Low-Income, Older Adults following a Free Meal Pilot Program.

Older adults are at a greater risk for food insecurity compared to the general population. This study aimed to describe changes in diet quality and food insecurity following a free meal program at low-income, older adult housing complexes. Study participants were recruited from two low-income older adult public housing complexes in Kentucky. Fifty participants were enrolled and received 1-4 free weekly meals across 3 months as part of the Meals on Wings pilot program. Surveys and a 24 h dietary recall were completed at baseline and 3 months. Participants were predominately female, 69 years of age, and Black or African American race. Food security status (FSS) and dietary quality through the Healthy Eating Index (HEI) were assessed as primary measures. Participants were placed in "at-risk" categories of the (1a) lower quartile of the HEI and (1b) lower than 51% HEI, or (2) "low" or "very low" food security status based on the USDA Household Food Security Screener (FSS). Multiple linear regression (MLR) models were conducted for HEI and FSS scores to include time, group, time*group interaction, and control of meal utilization percentage (i.e., dose). The MLR for the HEI quartile had a significant time by quartile interaction that was present for an increase in the HEI in Q1 (n = 12; 32.42 ± 5.95% to n = 6; 46.10 ± 10.62%; p < 0.0001) and a decrease in the HEI for Q4 (n = 12; 70.68 ± 7.13% to n = 9; 52.36 ± 11.57%; p < 0.0001). For those low food security participants (n = 24; 48.0%), the average food insecurity score from the 6-item USDA screener improved from 4.09 ± 1.62 at baseline to 2.63 ± 2.41 at 3 months (p = 0.0064). The MLR for the FSS had a significant group*time interaction (p = 0.0071). In our population, particularly those vulnerable with lowest dietary quality and food insecurity status, we did see improvements across the free meal pilot program. However, a small sample, limited generalizability, and limited data collection measures urge caution when using these results to extrapolate for the general population. However, the current results are promising and should encourage further investigation of the effects of meal assistance programs on the health and well-being of older adults.

Responsive Feeding Practices to Promote Healthy Diets: A Mixed Method Study among Low-Income Caregivers with Toddlers.

Responsive feeding (RF), the reciprocal feeding approach between caregiver and child that promotes child health, is understudied among low-income caregivers. This mixed methods study with low-income caregivers of 12-to-36-month-olds aimed to (1) assess variability in RF and associations with children's dietary intake, and (2) explore caregivers' perceptions of RF. Caregivers (n = 134) completed an online survey with RF questions (n = 25), grouped into environmental (meal environment, caregiver modeling, caregiver beliefs) and child (self-regulation, hunger/satiety cues, food for reward, food acceptance) influences scores. Children's recent food group consumption was loaded onto healthy and less healthy intake scores. In an adjusted multiple linear regression analysis, greater RF scores for environmental and child influences were associated with greater healthy intake scores (p's < 0.01). Greater scores for environmental influences were also associated with lower scores for unhealthy intake (p < 0.01). From focus groups with a separate sample of caregivers (n = 24), thematic analysis uncovered that two themes aligned (trust in child cues, positive strategies to encourage children to eat non-preferred foods) and two misaligned (lack of trust in child cues, use of force/bribery) with RF. Complementary integration of quantitative and qualitative findings can inform future interventions with low-income caregivers, encouraging trust in young children's hunger/satiety cues and positive strategies for food acceptance to improve diet quality.