Children’s exposure to unhealthy food marketing contributes to poor diets by influencing the foods that children like, request, buy and consume. This study aimed to use confirmatory mediational analyses to test a hypothetical model of marketing effects, to better understand the mechanisms behind food marketing’s impacts on children.

Children responded to a cross-sectional online survey about their attitudes towards, and purchase and consumption behaviours of, ten frequently promoted food/beverage brands and their media use. Structural equation modelling tested a priori potential pathways for the effects of food marketing exposure on children’s diets.

10–16-year-old children (n 400).

Australia.

There was a significant positive correlation between children’s commercial screen media use and their attitudes towards brands (related to perceived social norms) and their brand purchasing behaviours, including their own purchases and requests to parents. The use of strategies to avoid advertising in commercial screen media reduced but did not remove the association between media use and brand purchases. Other brand exposures (on clothing, outdoor advertising, sponsorships) had a positive association with children’s perceived social norms about brands and their brand purchases and requests. Non-commercial screen media use was not associated with any brand-related outcomes.

Commercial screen media use and other brand exposures were strongly positively associated with children’s perceptions and purchasing behaviours of frequently marketed food/beverages. Regulations to restrict children’s exposures to food marketing on-screen and through other media are required to reduce the effect of marketing exposure on children’s food purchasing behaviours.

To investigate the association between a lifestyle score and all-cause mortality in the Chilean population.

Prospective study.

The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0–2 points), moderately healthy (3–4 points) and the healthiest (5–7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated.

2706 participants from the Chilean National Health Survey 2009–2010.

After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality.

Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.

To assess whether the Mediterranean Diet (MedDiet) is associated with lower micronutrients inadequacy in a sample of Spanish preschoolers.

We conducted a cross-sectional study with 4–5-year-old children participating in the SENDO project. Information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative FFQ. The estimated average requirements or adequate intake levels as proposed by the Institute of Medicine were used as cut-off point to define inadequate intake.

Crude and multivariable adjusted estimates were calculated with generalised estimated equations to account for intra-cluster correlation between siblings.

We used baseline information of 1153 participants enrolled in the SENDO project between January 2015 and June 2022.

OR and 95 % CI of presenting an inadequate intake of ≥ 3 micronutrients associated with the MedDiet.

The adjusted proportion of children with inadequate intake of ≥ 3 micronutrients was 27·2 %, 13·5 % and 8·1 % in the categories of low, medium and high adherence to the MedDiet, respectively. After adjusting for all potential confounders, children who had a low adherence to the MedDiet showed a significant lower odds of inadequate intake of ≥ 3 micronutrients compared to those with a high adherence (OR 9·85; 95 % CI 3·33, 29·09).

Lower adherence to the MedDiet is associated with higher odds of nutritional inadequacy.

This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns.

The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet.

New Zealand.

Adults, aged ≥ 15 years (n 23 292).

The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian.

Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

To describe breastfeeding rates from early to late infancy and to examine associations between breastfeeding duration and infant growth, including rapid weight gain (RWG, > 0·67 SD increase in weight-for-age Z-score), among infants from low-income, racially and ethnically diverse backgrounds.

A short, prospective cohort study was conducted assessing breastfeeding status at infant ages 2, 4, 6, 9 and 12 months. Infant length and weight measurements were retrieved from electronic health records to calculate weight-for-length Z-scores and the rate of weight gain.

Pediatric clinic in the Southeastern USA.

Mother-infant dyads (n = 256).

Most participants were African American (48 %) or Latina (34 %). Eighty-one per cent were participating in the Special Supplemental Nutrition Program for Women, Infants and Children. Infants were breastfed for a median duration of 4·75 months, with partial more common than exclusive breastfeeding. At 12 months, 28 % of the participants were breastfeeding. Infants breastfed beyond 6 months had significantly lower growth trajectories than infants breastfed for 0–2 months (β = 0·045, se = 0·013, P = 0·001) or 3–6 months (β = 0·054, se = 0·016, P = 0·001). Thirty-six per cent of the infants experienced RWG. RWG was more common among infants who were breastfed for 2 months or less than 6+ month breastfed group (relative risk = 1·68, CI95 (1·03, 2·74), P = 0·03).

Breastfeeding beyond 6 months is associated with the prevention of accelerated growth among infants from low-income, racially and ethnically diverse backgrounds, suggesting progress toward health equity.

To estimate the cost and affordability of healthy diets recommended by the 2016–2020 Vietnamese food-based dietary guidelines (FBDG).

Cross-sectional analysis. The Cost of a Healthy Diet (CoHD) indicator was used to estimate the lowest cost of healthy diets and compare the cost differences by food group, region and seasonality. The affordability of healthy diets was measured by further comparing the CoHD to food expenditures and incomes.

Food prices of 176 food items from January 2016 to December 2020 were derived using data from monthly Consumer Price Index databases nationally and regionally.

Food expenditures and incomes of participants from three latest Vietnam Household Living Standard Surveys were used.

The average CoHD between 2016 and 2020 in Vietnam was 3·08 international dollars using 2017 Purchasing Power Parity (24 070 Vietnamese Dongs). The nutrient-rich food groups, including protein-rich foods, vegetables, fruits and dairy, comprised approximately 80 % of the total CoHD in all regions, with dairy accounting for the largest proportion. Between 2016 and 2020, the cheapest form of a healthy diet was affordable for all high-income and upper-middle-income households but unaffordable for approximately 70 % of low-income households, where adherence to the Vietnamese FBDG can cost up to 70 % of their income.

Interventions in local food systems must be implemented to reduce the cost of nutrient-rich foods to support the attainment of healthier diets in the Vietnamese population, especially for low-income households.

Most food retailers display foods in prominent locations as a marketing strategy (i.e. ‘placement promotions’). We examined the extent to which households with children change their food and beverage purchases in response to these promotions.

We analysed a novel dataset of all products promoted in two supermarkets from 2016 to 2017, including promotion dates and locations (e.g. aisle endcaps and front registers). We linked promotions to all purchases from the supermarkets from 2016 to 2017 by a cohort of households with children. We calculated the number of weekly promotions in each of thirteen food and beverage groups (e.g. bread; candy) and used fixed effects regressions to estimate associations between number of weekly promotions and households’ weekly food purchases, overall and by Supplemental Nutrition Assistance Program (SNAP) participation.

Two large supermarkets in Maine, USA.

Eight hundred and twenty-one households with children.

Most promotions (74 %) were for less healthy foods. The most promoted food groups were sweet and salty snacks (mean = 131·0 promotions/week), baked goods (mean = 68·2) and sugar-sweetened beverages (mean = 41·6). Households generally did not change their food group purchases during weeks when they were exposed to more promotions for those groups, except that a 1-sd increase in endcap candy promotions (about 1 promotion/week) was associated with $0·19/week (about 14·5 %) increase in candy purchases among SNAP nonparticipants (adjusted P < 0·001).

In-store placement promotions for food groups were generally not associated with purchases of promoted food groups, perhaps because exposure to unhealthy food marketing was consistently high. Substantial changes to in-store food marketing may be needed to promote healthier purchases.

This study aimed to examine the theoretical potential of meal kit subscription services in Australia to promote parental food literacy using the retrospective application of behaviour change frameworks.

A one-week subscription was purchased for all Australian-based meal kit subscription services (n 9) to access content and features available to subscribers. Behaviour change techniques (BCTs) identified in the subscription and meal planning features, meal kit delivery (i.e. ingredients and recipes) and website were coded using the behaviour change technique taxonomy (BCTTv1) and associated behaviour change frameworks. Identified BCTs were mapped to the theoretical domains framework to identify potential mechanisms of action for influencing parental food literacy development.

Australia.

Thirty-five BCTs were identified across the nine meal kit services reviewed, ranging from nineteen to twenty-nine BCTs per company. Sixteen BCTs were common to all meal kits services, from the hierarchical clusters of ‘goals and planning’, ‘shaping knowledge’, ‘social support’, ‘natural consequences’, ‘comparison of behaviour’, ‘repetitions and substitution’, ‘associations’, ‘reward and threat’, ‘antecedents’ and ‘regulation’. Across the meal kit services, the most frequently identified mechanisms of action were motivation (n 27) and capability (n 19).

These findings support the applicability of behaviour change frameworks to commercial meal kit subscription services and provide a theory-informed process for identifying BCTs that may be relevant for promoting parental food literacy within this context. Further research is required to explore how families engage with meal kit subscription services to determine the exposure and delivery of identified BCT content and to evaluate the potential influence on food literacy development.

To evaluate the direct and indirect associations of obesogenic and leptogenic neighborhood environments with body fat, and pro- and anti-inflammatory adipokines in Brazilian children.

Cross-sectional study. The body fat distribution was assessed using dual-energy X-ray absorptiometry (DXA). Concentrations of leptin and adiponectin were measured. Four hundred meters (0·25 miles) road network buffer was the neighborhood unit used to assess the environmental characteristics around households. Obesogenic and leptogenic environments were the latent variables obtained from the observed characteristics. The mother’s BMI, ultra-processed food consumption, and physical activity before and after school, were tested as mediating variables. A hybrid model of structural equations was used to test the direct and indirect associations of obesogenic and leptogenic environments with body fat, leptin and adiponectin concentrations.

Urban area of Viçosa, Minas Gerais, Brazil.

Children aged 8- and 9-years (n 367).

Obesogenic environment was directly associated with the mother’s BMI (β: 0·24, P = 0·02) and the child’s body fat (β: 0·19, P = 0·02). The mother’s BMI and body fat mediated the association of the obesogenic environment with leptin concentrations (β: 0·05, P = 0·02).

Obesogenic neighborhood environment was directly associated with body fat and mother's BMI, and indirectly associated with leptin concentrations in Brazilian children, mediated by the mother’s BMI and body fat.

To evaluate the acceptability of traditional Zambian dishes fortified with Complementary Food for Africa+Dried Fish Powder (ComFA+Fish), a locally sourced protein/micronutrient blend designed to impact nutrient deficiencies among infants and young children (IYC) and improve pregnancy and birth outcomes among women of reproductive age (WRA).

During two sensory panels, caregivers evaluated: (1) the acceptability of four ComFA+Fish dishes for household consumption, including fortified chibwabwa fisashi, savory Kapenta chutney, fortified complementary maize porridge and fortified bean-vegetable soup and (2) whether their IYC found the fortified complementary maize porridge acceptable.

Lake Kariba, Southern Province, Zambia.

Women of reproductive age (n 42) and their IYC aged 6–11 months (n 16) and 12–23 months (n 26) were recruited from fishing villages in Gwembe, Siavonga and Sinazongwe District.

A majority of caregivers extremely liked/liked the: (1) fortified chibwabwa fisashi’s sensory attributes (94·7 %), convenience (92·8 %) and overall acceptability (100 %); (2) savory Kapenta chutney’s sensory attributes (81·8 %), convenience (92·8 %) and overall acceptability (100 %); (3) fortified complementary porridge’s sensory attributes (83·5 %), convenience (90·5 %) and overall acceptability (88·1 %) and (4) fortified bean-vegetable soup’s sensory attributes (66·8 %), convenience (87·5 %) and overall acceptability (87·5 %). Further, a majority of caregivers evaluated the fortified complementary porridge as highly acceptable to their IYC.

Results suggest that ComFA+Fish is strategically well placed to fill nutritional gaps among IYC and WRA in Zambia and has the potential to be scaled across sub-Saharan Africa.