Diet and Food and Nutrition Insecurity and Cardiometabolic Disease.

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Precision Nutrition: The Hype Is Exceeding the Science and Evidentiary Standards Needed to Inform Public Health Recommendations for Prevention of Chronic Disease.

As dietary guidance for populations shifts from preventing deficiency disorders to chronic disease risk reduction, the biology supporting such guidance becomes more complex due to the multifactorial risk profile of disease and inherent population heterogeneity in the diet-disease relationship. Diet is a primary driver of chronic disease risk, and population-based guidance should account for individual responses. Cascading effects on evidentiary standards for population-based guidance are not straightforward. Precision remains a consideration for dietary guidance to prevent deficiency through the identification of population subgroups with unique nutritional needs. Reducing chronic disease through diet requires greater precision in (a) establishing essential nutrient needs throughout the life cycle in both health and disease; (b) considering effects of nutrients and other food substances on metabolic, immunological, inflammatory, and other physiological responses supporting healthy aging; and (c) considering healthy eating behaviors. Herein we provide a template for guiding population-based eating recommendations for reducing chronic diseases in heterogenous populations.

Unveiling viewpoints on national food environment policies in the Dutch newspaper discourse: an interpretative media content analysis.

BACKGROUND: National food environment policies can contribute to the reduction of diet-related non-communicable diseases. Yet, their implementation in the Netherlands remains low. It has been hypothesized that the media can play a pivotal role in inducing spikes in policy attention, thereby shaping political action. The aim of this study was to examine the discourse on food policies in Dutch newspaper articles between 2000-2022, by analyzing arguments used by various actors. METHODS: A systematic search in Nexis Uni was used to identify newspaper articles that covered national-level Dutch food environment policies published in seven Dutch national newspapers between 2000-2022. Covered policies were classified into six domains including food composition, labeling, promotion, prices, provision and retail and into the four stages of the policy cycle; policy formulation, decision-making, implementation, and evaluation. A grey literature search was used to identify food policies implemented during 2000-2022. Descriptive statistics were used to summarize coverage of policies over time, policy type and policy stage. An interpretive content analysis was performed on a random subsample of the newspaper articles to determine the actors, viewpoints and arguments of the food policies. RESULTS: We identified 896 relevant newspaper articles. The coverage of food policies in newspapers was initially low but peaked in 2018/2021/2022. Through grey literature search we identified 6 food policies which were implemented or adjusted between 2000-2022. The majority of the newspaper articles reported on food pricing policies and were discussed in the policy formulation stage. Academics (mainly supportive) were the most and food industry (mostly opposing) the least cited actors. Supportive arguments highlighted health consequences, health inequalities and collective responsibility, whereas opposing arguments focused on unwanted governmental interference and ineffectiveness of policies. CONCLUSIONS: Dutch newspaper articles covering food policies represented a variety of actors and arguments, with individual versus collective responsibility for food choices playing a central role in the arguments. These insights may serve as a basis for further research into why certain arguments are used and their effect on policy attention and implementation.

Assessing transnational spillover effects of Mexico's front-of-package nutritional labeling system among Mexican Americans in the US.

OBJECTIVE: In 2020, Mexico implemented innovative front-of-package nutrition warning labels (FoPWLs) for packaged foods to increase the salience and understanding of nutrition information. This study evaluated Mexican Americans' self-reported exposure to Mexican FoPWLs and self-reported effects of FoPWLs on purchasing behavior. METHODS: The 2021 International Food Policy Study surveyed online panels of adult Mexican Americans in the US (n = 3361) to self-report on buying food at Mexican-oriented stores, noticing Mexican FoPWLs, and being influenced by FoPWLs to purchase less of eight different unhealthy foods (each assessed separately). After recoding the frequency of buying foods in Mexican stores and noticing FoPWLs (i.e., "often" or "very often" vs. less often), logistic models regressed these outcomes on sociodemographics, adjusting for post-stratification weights. RESULTS: Most participants (88.0%) purchased foods in Mexican stores. Of these, 64.1% reported noticing FoPWLs, among whom many reported that FoPWLs influenced them to buy fewer unhealthy foods (range = 32% [snacks like chips] - 44% [colas]). Participants were more likely to buy foods in Mexican stores and notice FoPWLs if they were younger, had ≥two children at home vs no children (AOR = 1.40, 95%CI = 1.15-1.71; AOR = 1.37, 95%CI = 1.03-1.80, respectively), and more frequently used Spanish (AOR = 1.91, 95%CI = 1.77-2.07; AOR = 1.87, 95%CI = 1.69-2.07). Also, high vs. low education (AOR = 1.51, 95%CI = 1.17-1.94) and higher income adequacy (AOR = 1.37, 95%CI = 1.25-1.51) were positively associated with noticing FoPWLs. Being female and more frequent Spanish use were consistently associated with reporting purchase of fewer unhealthy foods because of FoPWLs. CONCLUSIONS: Many Mexican Americans report both exposure to Mexican FOPWLs and reducing purchases of unhealthy foods because of them.

Giving fruits and vegetables a tax break: lessons from a Dutch attempt.

OBJECTIVE: Food taxation can improve diets by making unhealthy foods more expensive and by making healthy foods cheaper. In the Netherlands, a political window of opportunity arose in December 2021 to reduce the value-added tax (VAT) on fruits and vegetables to zero percent. The policy is now facing institutional friction along several fronts, however, delaying and potentially averting its implementation. We analysed this institutional friction to inform future food tax policies. DESIGN: We qualitatively analysed open-access fiscal and health experts' position papers about benefits and downsides of the zero-rate that were discussed with members of parliament in June 2023. SETTING: The Netherlands. PARTICIPANTS: Not applicable. RESULTS: Health and fiscal experts expressed noticeably different viewpoints towards the utility of the zero-rate. One important argument fiscal experts based their negative advice upon pertained to the legal restrictions for distinguishing between healthier and unhealthier forms of fruits and vegetables (i.e. the principle of neutrality). A zero-rate VAT on unhealthier forms of fruits and vegetables, e.g. processed cucumber, mixed with salt and sugar, would be undesirable, but differentiating between raw and processed cucumber would offend the neutrality principle. CONCLUSIONS: The Dutch attempt to give fruits and vegetables a tax break highlights the need for crystal-clear food classifications when designing food tax policies. Public health nutritionists should combine classifications based on caloric density, palatability, degree of processing and nutrient content to provide a database for evidence-informed tax differentiation according to food item healthfulness.

Dietary intake of low-income adults in South Africa: ultra-processed food consumption a cause for concern.

OBJECTIVE: Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines. DESIGN: Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017-2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. SETTING: Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. PARTICIPANTS: In total, 2521 participants (18-50 years) were included in the study. RESULTS: Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. CONCLUSIONS: Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.

Benchmarking online food delivery applications against menu labelling laws: a cross-sectional observational analysis.

OBJECTIVE: It is unknown how well menu labelling schemes that enforce the display of kilojoule (kJ) labelling at point-of-sale have been implemented on online food delivery (OFD) services in Australia. This study aimed to examine the prevalence of kJ labelling on the online menus of large food outlets with more than twenty locations in the state or fifty locations nationally. A secondary aim was to evaluate the nutritional quality of menu items on OFD from mid-sized outlets that have fewer locations than what is specified in the current scheme. DESIGN: Cross-sectional analysis. Prevalence of kJ labelling by large food outlets on OFD from August to September 2022 was examined. Proportion of discretionary ('junk food') items on menus from mid-sized outlets was assessed. SETTING: Forty-three unique large food outlets on company (e.g. MyMacca's) and third party OFD (Uber Eats, Menulog, Deliveroo) within Sydney, Australia. Ninety-two mid-sized food outlets were analysed. PARTICIPANTS: N/A. RESULTS: On company OFD apps, 35 % (7/23) had complete kJ labelling for each menu item. In comparison, only 4·8 % (2/42), 5·3 % (2/38) and 3·6 % (1/28) of large outlets on Uber Eats, Menulog and Deliveroo had complete kJ labelling at all locations, respectively. Over three-quarters, 76·3 % (345/452) of menu items from mid-sized outlets were classified as discretionary. CONCLUSIONS: Kilojoule labelling was absent or incomplete on a high proportion of online menus. Mid-sized outlets have abundant discretionary choices and yet escape criteria for mandatory menu labelling laws. Our findings show the need to further monitor the implementation of nutrition policies on OFD.

Nutrition environments in early childhood education: do they align with best practice?

OBJECTIVE: To assess the comprehensiveness (scope of nutrition guidance) and strength (clarity of written language) of centre-based nutrition policies (CBNP) within early childhood education (ECE) centres. To also consider the applicability of an existing CBNP assessment tool and policy alignment with best practice food provision and feeding practices. DESIGN: Cross-sectional online study to assess written ECE CNBP using the Wellness Child Care Assessment Tool. SETTING: Licenced ECE centres in the state of Victoria, Australia. PARTICIPANTS: ECE centres (operating at least 8 h per d, 48 weeks per annum), stratified by location (rural and metropolitan), centre management type (profit and not-for-profit) and socio-economic area (low, middle, high). RESULTS: Included individual CBNP (n 118), predominantly from metropolitan centres (56 %) and low-medium socio-economic areas (78 %). Policies had low overall Wellness Child Care Assessment Tool scores, particularly strength scores which were low across all four domains (i.e. nutrition education, nutrition standards, health promotion and communication/evaluation). The nutrition standards domain had the lowest strength score. The communication/evaluation domain had the lowest comprehensiveness score. Content analysis indicated low scores may relate to the Wellness Child Care Assessment Tool applicability for the Australian context due to differences in best practice guidance. CONCLUSION: Despite the presence of written nutrition policies in ECE centres, many showed weak language and lacked comprehensiveness and strength. This may relate to poor implementation of best practice food provision or feeding practices. Low scores, however, may partly stem from using an assessment tool that is not country-specific. The redevelopment of country-specific tools to assess ECE CNBP may be warranted.

Qualitative multi-stakeholder evaluation of the adoption, implementation and sustainment of the school-based dietary intervention "Jump-in".

BACKGROUND: Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school's policies, physical environment, curriculum, health care and involving parents and communities, they significantly 'intrude' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam's Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective. METHODS: We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam's low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data. RESULTS: During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children's health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals. CONCLUSIONS: This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders' involvement in decision-making.

Did child obesity decline after 2016 food regulations in Chile?

We estimated trends in the prevalence of obesity and overweight among Chilean primary and secondary students before and after Chile's 2016 regulations on the marketing and availability of foods high in energy, total sugars, sodium, or saturated fat. We used data from Chile's Survey of Nutrition, which measured the body mass index (BMI) of students in government-funded schools. Using BMI thresholds defined by the World Health Organization, we calculated the prevalence of overweight and obesity for each year from 2013 to 2019 among students attending pre-kindergarten (age 4 years), kindergarten (age 5 years), first grade (6 years), and ninth grade (14 years). In ninth grade students, overweight and obesity prevalence rose by 2 percentage points over the 3 years after introduction of the 2016 regulations. In pre-kindergarten, kindergarten, and first grade, overweight and obesity fell 1 to 3 percentage points 1 year after the regulations were introduced, but rebounded to previous levels the next year. Chile's food regulations were not followed by a sustained decline in obesity in primary- and secondary-school students. Future research should examine whether and how children in Chile and other countries maintain high levels of overweight and obesity despite food regulations designed to reduce consumption of obesogenic foods and beverages.

Se estimaron las tendencias en la prevalencia de la obesidad y el sobrepeso en estudiantes chilenos de educación primaria y secundaria, antes y después de las regulaciones introducidas en Chile en el 2016 sobre la comercialización y disponibilidad de productos hipercalóricos, con un alto contenido de azúcares, sodio o grasas saturadas. Se utilizaron datos del Mapa Nutricional de Chile, una encuesta en la que se midió el índice de masa corporal (IMC) de la población estudiantil de las escuelas públicas. Tomando los umbrales de IMC definidos por la Organización Mundial de la Salud, se calculó la prevalencia del sobrepeso y la obesidad para cada año entre el 2013 y el 2019 en estudiantes de jardín de infancia (4 años), preescolar (5 años), primer grado (6 años) y noveno grado (14 años). En los estudiantes de noveno grado, la prevalencia del sobrepeso y la obesidad aumentó en 2 puntos porcentuales durante los 3 años posteriores a la introducción de las regulaciones del 2016. En el caso de los grupos de jardín de infancia, preescolar y primer grado, el sobrepeso y la obesidad disminuyeron entre 1 y 3 puntos porcentuales un año después de la introducción de las regulaciones, pero al año siguiente volvieron a los niveles anteriores. La introducción de las regulaciones alimentarias de Chile no estuvo seguida de una disminución continua de la obesidad en la población estudiantil de primaria y secundaria. En las investigaciones futuras se deberá examinar si la población infantil de Chile y otros países mantiene niveles altos de sobrepeso y obesidad a pesar de las regulaciones alimentarias diseñadas para reducir el consumo de productos y bebidas obesogénicos, así como las características específicas que adopta este problema de salud.

Foram estimadas tendências de prevalência da obesidade e do sobrepeso em alunos chilenos do ensino fundamental e médio antes e depois da regulamentação de 2016 da propaganda e disponibilidade de alimentos com alto teor calórico ou ricos em açúcares totais, sódio ou gorduras saturadas no Chile. Foram utilizados dados obtidos da Pesquisa em Nutrição do Chile, que aferiu o índice de massa corporal (IMC) de escolares da rede pública. Com base nos limiares de IMC definidos pela Organização Mundial da Saúde (OMS), calculou-se a prevalência anual de sobrepeso e obesidade em crianças na pré-escola (4 anos), no jardim da infância (5 anos), no primeiro ano (6 anos) e no nono ano (14 anos) em cada ano no período entre 2013 e 2019. Entre os alunos do nono ano, a prevalência de sobrepeso e obesidade aumentou 2 pontos percentuais nos 3 anos que se seguiram à introdução da regulamentação de 2016. Entre os alunos da pré-escola, do jardim de infância e do primeiro ano, ocorreu uma redução de 1 a 3 pontos percentuais na prevalência de sobrepeso e obesidade um ano após a introdução da regulamentação, mas os níveis voltaram a subir no ano seguinte. A regulamentação de alimentos não resultou em um declínio sustentado da obesidade nos alunos do ensino fundamental e médio do Chile. Pesquisas futuras devem ser realizadas para avaliar se, e como, a prevalência de sobrepeso e obesidade nas crianças chilenas e de outros países se mantém alta a despeito da regulamentação de alimentos visando à redução do consumo de alimentos e bebidas obesogênicos.

Policy framework that addresses malnutrition in Namibia: A retrospective qualitative review.

BACKGROUND: Although Namibia has made strides in improving the policy enabling environment, eradication of malnutrition is still elusive. OBJECTIVE: This review was aimed at determining the extent to which food and nutrition-related policies in Namibia address malnutrition. METHODS: This study used a qualitative approach by retrospectively analysing policy frameworks that address malnutrition in Namibia from 1991 to 2022. The analysis employed the policy triangle framework to elucidate the contextual factors, content, actors and process involved in the policy development. Moreover, a comparative analysis of Namibian policies and those of other southern African countries was undertaken. RESULTS: The review showed that there is a considerable degree of coherence in policy goals and strategies to address malnutrition despite parallel coordination structures. Policy process involved limited consultations with local communities which might have jeopardised the formulation of community problem-tailored interventions, ownership and participation in policy implementation. There is a strong political commitment to the eradication of malnutrition in Namibia. The Office of the Prime Minister played a leading role in policy development. Influential actors such as the UN agencies elevated the nutrition agenda. Further, the Namibian policy framework was generally similar to those of other southern African countries. CONCLUSIONS: The review showed that Namibia has relevant and comprehensive policies to address malnutrition, however, contextual factors indicated high levels of malnutrition still exist in the communities. Further research is needed to understand the barriers and enablers to optimal nutrition for children under five years in Namibia.

The lasting impact of the Go for 2&5 campaign.

ISSUE ADDRESSED: Little is known about the executional techniques that are most likely to make healthy eating messages memorable over the longer term. The aim of this exploratory study was to identify factors contributing to the ongoing salience of the Go for 2&5 social marketing campaign among older audience members. METHODS: Interviews were conducted with 75 Western Australians aged 60+ years. A peer-interviewing method was used whereby eight older people recruited and interviewed members of their extended peer groups. The interview guide included questions about interviewees' recollections of healthy eating messages across their lifespans. RESULTS: Around one in five interviewees discussed the Go for 2&5 campaign that was on air in Western Australia between 2002 and 2011. These discussions focused on either specific advertisement features that were considered to be especially memorable (in particular, humour and the use of anthropomorphised depictions of produce) and/or their recollection of the number of daily servings of fruits and vegetables recommended in the campaign. Few were able to recall other healthy eating campaigns, and in some cases it was assumed that advertisements for specific food stores or products constituted health advice. CONCLUSIONS: Different campaign attributes may influence shorter-term attitudinal and behavioural responses versus longer-term recall. The characteristics of the Go for 2&5 campaign appear to have enabled it to achieve relatively high levels of recall among older people. SO WHAT?: The study results suggest that some advertising approaches that activate the peripheral route to persuasion may achieve recall over a longer period of time.

Barriers and enablers to a healthy food environment in Australian childcare services: Exploring directors' perspectives.

ISSUE ADDRESSED: Early childhood education and care (ECEC) settings are ideal environments to optimise nutrition and positively influence children's food behaviours. However, recent research has identified the need to improve nutrition policies, food provision, and mealtime environments in Australian ECEC settings. This study explored the perceptions of ECEC directors regarding barriers and enablers to a health-promoting food environment within ECEC services. METHODS: Eleven directors from ECEC services in Nerang, Queensland, and surrounding areas, participated in qualitative interviews between March and May 2021. Transcripts were analysed using qualitative content analysis that followed a deductive-inductive approach employing nutrition-related domains from the Wellness Child Care Assessment Tool, these being: (i) nutrition policy; (ii) nutrition education; (iii) food provision; and (iv) mealtimes. Transcripts were coded independently by two researchers in NVivo and consensus for barriers and enablers was achieved through discussion. RESULTS: Barriers and enablers were reported across four domains (nutrition policy, nutrition education, food provision, and mealtimes). Comprehensive nutrition-related policies were an enabler to a healthy nutrition environment but were sometimes described as lacking detail or customisation to the service. Nutrition education for children was described as competing with other activities for time and resources in an already-crowded curriculum. Financial and time pressures faced by families were a barrier to healthy food provision in services where families provided food for children. The ability of staff to sit with children and engage in conversation during mealtimes was an enabler; however, competing demands on time and the unavailability of food for staff were cited as barriers to health-promoting mealtimes. CONCLUSIONS: Directors in ECEC services report both barriers and enablers to a healthy food environment. Nutrition policies were an enabler when comprehensive and relevant but a barrier when vague and not tailored to the service environment. ECEC services should be supported to develop and implement service-specific nutrition policies and practices by engaging with parents and staff. SO WHAT?: The barriers and enablers reported in this study should be considered when designing and implementing future evidence-based interventions to improve the nutrition environment in ECEC services.

Quality evaluation of nutrition policies in early childhood education and care services in Nerang, QLD.

ISSUE ADDRESSED: Food environments in early childhood, such as early childhood education and care services, influence the development of dietary patterns and behaviours that traverse into adulthood, where they affect health and longevity. Nutrition policies are mandatory in early childhood education and care services in Australia and can positively or negatively shape the food environment. However, the quality of such nutrition policies is unknown. This study aimed to evaluate the comprehensiveness and strength of nutrition policies of early childhood education and care services among services participating in a university-community alliance in South East Queensland. METHODS: Early childhood education and care services (n = 12) in Nerang, Queensland, Australia, participated in a cross-sectional study evaluating the comprehensiveness and strength of nutrition policies across four domains (Nutrition Education, Nutrition Standards, Promoting Healthy Eating and Communication and Evaluation) of the Wellness in Child Care Assessment Tool. RESULTS: Nutrition policies evaluated in this study had median total comprehensiveness scores of 55 (out of 100) and median total strength scores of 19 (out of 100). 'Nutrition Education' had the highest median scores for comprehensiveness (67 out of 100) and strength (33 out of 100), while 'Nutrition Standards' had the lowest comprehensiveness score (41 out of 100), and 'Communication and Evaluation' had the lowest strength score (0 out of 100). CONCLUSIONS: All services have a nutrition policy, but there are opportunities to enhance both the content and linguistic strength of statements within policies related to nutrition domains. SO WHAT?: There is a clear need to improve the comprehensiveness and strength of written statements in nutrition policies across all four domains, particularly 'Nutrition Standards' and 'Communication and Evaluation'.

A call to action in review of the Australian Dietary Guidelines: Impacts of conflicting nutrition information: A mixed methods study.

ISSUES ADDRESSED: The overabundance of conflicting nutrition information (CNI) and accompanying confusion and backlash are a public health concern; however, the complexity of responses to CNI has yet to be explored. The following mixed methods study brings depth to the perceptions and behavioural responses to CNI among Australian millennials to better inform successful nutrition guidelines. METHODS: An explanatory sequential mixed methods design explored the cognitive and behavioural responses to CNI in Australian millennials. Cross-sectional data (n = 204) on CNI exposure, confusion, and backlash was analysed via multivariate ordinal logistic regression. The qualitative phase thematically analysed 18 semi-structured interviews on experiences with and responses to CNI. RESULTS: Exposure to CNI via social media was positively associated with confusion. Nutrition confusion was positively associated with backlash. Qualitative analysis confirmed social media as a frequent, yet sometimes trusted, source of CNI. In addition, participants revealed using various methods to alleviate backlash while also relying heavily on traditional nutrition information (TNI) to inform dietary choices. CONCLUSIONS: The methods to alleviate nutrition backlash provide new and innovative ways to tailor nutrition messages for maximum impact. Nutrition promotion initiatives and dietary guidelines should consider the complexity of responses to CNI and modernise interventions across mediums, including social media, with clear and attractive dietary recommendations. SO WHAT?: Results can inform the drafting of the new Australian Dietary Guidelines in 2023 and how they are promoted to the community on an ongoing basis.

Availability of national policies, programmes, and survey-based coverage data to track nutrition interventions in South Asia.

Progress to improve nutrition among women, infants and children in South Asia has fallen behind the pace needed to meet established global targets. Renewed political commitment and monitoring of nutrition interventions are required to improve coverage and quality of care. Our study aimed to assess the availability of national nutrition policies, programmes, and coverage data of nutrition interventions for women, children, and adolescents in eight countries in South Asia. We reviewed relevant policy and programme documents, examined questionnaires used in the most recent rounds of 20 nationally representative surveys, and generated an evidence gap map on the availability of policies, programmes, and survey data to track progress on coverage of globally recommended nutrition interventions. Current policies and programmes in South Asian countries addressed almost all the recommended nutrition interventions targeted at women, children, and adolescents. There was a strong policy focus in all countries, except Maldives, on health system platforms such as antenatal and postnatal care and child growth and development. Survey data on nutrition intervention coverage was most available in India and Nepal, while Bangladesh and Bhutan had the least. Though countries in South Asia have committed to national nutrition policies and strategies, national surveys had substantial data gaps, precluding progress tracking of nutrition intervention coverage. Greater attention and effort are needed for multisectoral collaboration to promote and strengthen nutrition data systems.

Utilization of Integrated Child Development Services (ICDS) and its linkages with undernutrition in India.

The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6-59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS-4 [2015-2016] and NFHS-5 [2019-2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference-in-differences (DID) approach. Utilization of ICDS increased from 58% in 2015-2016 to 71% in 2019-2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%-12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6-59 months in this period.

Public support for food policies in Mexican adults: Findings from the International Food Policy Study, 2017-2021.

Deaths attributable to unhealthful eating underscore the need to improve dietary patterns through upstream, policy-led solutions. The approval and successful implementation of food policies is partly determined by their public acceptance. Little is known about public support for food policies in Mexico. We aimed to investigate the level of public support for 30 food policies, grouped into 5 domains, and their associated characteristics among Mexican adults. Data are from the 2017-2021 International Food Policy Study (IFPS), a cross-sectional web-based survey of adults. Differences in public support across years were estimated using linear regression models. The association between demographic characteristics and policy support was analyzed using multivariate logistic regression models. The highest mean support was for the subsidies and benefits domain, followed by the labelling and reformulation domain. The level of support varied across years and policy domains. Support was higher in 2019 compared to 2017 and 2018, and subsequently lower in 2020 and 2021 compared to previous years. Older age was associated with greater support across all domains (OR ranged from 0.002 to 0.004, p < 0.01). Female participants and those selfidentifying as indigenous showed greater support for certain policy domains, whereas higher income adequacy was associated with lower support for other policy domains. In Mexico, support for food policies varies across subpopulations. Our findings may serve as a guide to the development and promotion of food policies in Mexico, as well as to improve their feasibility and success.

Advancing college food security: priority research gaps.

Despite over a decade of both quantitative and qualitative studies, food insecurity among US college/university students remains a pervasive problem within higher education. The purpose of this perspective piece was to highlight research gaps in the area of college food insecurity and provide rationale for the research community to focus on these gaps going forward. A group of food insecurity researchers from a variety of higher education institutions across the United States identified five thematic areas of research gaps: screening and estimates of food insecurity; longitudinal changes in food insecurity; impact of food insecurity on broader health and academic outcomes; evaluation of impact, sustainability and cost effectiveness of existing programmes and initiatives; and state and federal policies and programmes. Within these thematic areas, nineteen specific research gaps were identified that have limited or no peer-reviewed, published research. These research gaps result in a limited understanding of the magnitude, severity and persistence of college food insecurity, the negative short- and long-term impacts of food insecurity on health, academic performance and overall college experience, and effective solutions and policies to prevent or meaningfully address food insecurity among college students. Research in these identified priority areas may help accelerate action and interdisciplinary collaboration to alleviate food insecurity among college students and play a critical role in informing the development or refinement of programmes and services that better support college student food security needs.

Global trends in added sugars and non-nutritive sweetener use in the packaged food supply: drivers and implications for public health.

OBJECTIVE: The health implications of excessive added sugar intakes have led to national policy actions to limit their consumption. Subsequently, non-nutritive sweeteners (NNS) may be used to maintain product sweetness. We aimed to assess trends in quantities of added sugars and NNS sold in packaged food and beverages worldwide, and the association between these trends and the number of national policy actions across regions to reduce added sugar consumption. DESIGN: (i) Longitudinal analysis of Euromonitor sales data (2007-2019) to assess the quantity of added sugars (kg) and NNS (g) sold in packaged foods and beverages globally, across regions, and across country income categories; (ii) policy-mapping of policy actions targeting added sugar consumption globally from the NOURISHING database; and (iii) Spearman's correlations to assess the association between national policy actions across regions and changes in added sugar/NNS sales. SETTING: Worldwide. PARTICIPANTS: Not applicable. RESULTS: Per capita volumes of NNS from beverage sales increased globally (36 %). Added sugars from beverage sales decreased in high-income countries (22 %) but increased in upper-middle-income countries (UMIC) and lower-middle-income countries (LMIC) (13-40 %). Added sugars from packaged food sales increased globally (9 %). Regions with more policy actions had a significant increase in NNS quantities from beverage sales (r = 0·68, P = 0·04). The sweetness of the packaged food supply (the sweetness of each NNS and added sugar, relative to sucrose, multiplied by sales volume) increased over time. CONCLUSIONS: The increasing use of NNS to sweeten beverages globally, and in packaged food in UMIC and LMIC, may have health and dietary implications in the future. Their use as a substitute for added sugar should be considered in public health nutrition policymaking.