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Half of people living in the USA do not consume tap water. Surveys have assessed perceptions of water and water utilities, but less is known about how these perceptions relate to the preference for tap or bottled water. The present analysis examined whether beliefs about tap water and the water utility were associated with drinking water preferences.
Design:
In a cross-sectional survey, six water beliefs were measured: trust in tap water, the water utility, and the local government; perceived safety and quality of tap water; and awareness that the water utility frequently tests tap water. Regression models adjusted for sociodemographic characteristics were used to estimate the odds of preferring tap over bottled water dependent on respondents’ beliefs about their tap water.
Setting:
Virginia, USA.
Participants:
Adults aged 18 years and older (n 808).
Results:
More than two-thirds of respondents had positive beliefs about their tap water, but only 54 % reported tap as their preferred drinking water source. All water beliefs, except for awareness of the frequency of water testing, were associated with higher odds of preferring tap water over bottled (adjusted OR range: 1·56–3·2).
Conclusions:
Our findings suggest that favourable tap water beliefs may be necessary, but not sufficient, to motivate people to drink from the tap. There remains a critical need for future research to bridge the gap between tap water perceptions and consumption, which should include enhancing the trustworthiness of tap water and the water utility as well as improving consumers’ perceptions of water quality and safety.
To examine how school food policies and perceived barriers influence food provision in New Zealand primary school canteens, using the ‘Healthy Food and Drink Guidance for Schools’.
Design:
Cross-sectional analyses of school food menus and school food policy and practices surveys completed by school leaders/principals.
Setting:
New Zealand primary schools.
Participants:
239 primary schools completed the school food policies and practices survey, and eighty schools provided canteen menus.
Results:
Most schools reported having a healthy food and drink policy in their school (76·2 %) and promoted healthy eating during school hours (87·4 %). Two-thirds (69·5 %) identified barriers to healthy food and drink provision, most commonly the convenience of ready-made foods (39·3 %), and resistance from parents (34·3 %). The number of reported barriers was not a significant predictor for the presence of a school food policy (OR-1·034, P = 0·841). School menus (n 80) consisted of 16·4 % ‘green’ items, 34·7 % ‘amber’ items and 36·8 % ‘red’ items. There was no relationship between the percentage of ‘green’, ‘amber’ and ‘red’ items and the presence of a school food policy or reported barriers. More than a third (38·9 %) of menus from schools that reported they had a ‘Plain Milk and Water’ only policy still contained sugar-sweetened beverages.
Conclusions:
Although most New Zealand primary schools had healthy food policies, this was not consistently reflected in healthy food items on canteen menus. Further research is needed to understand how systemic barriers, such as cost, convenience and parental influence, affect policy implementation and school food provision.
Nutrition plays a key role in shaping children’s eating behaviours, which can be influenced by environment and social interactions, making careful management essential at home and school. This cross-sectional study aimed to evaluate the perceptions of caregivers in these settings regarding the consumption and eating behaviours of children aged 3–6 years. Food preferences and frequency questionnaires were administered to children, and their teachers and caregivers, supplemented by free drawing and colouring activities. The results revealed discrepancies between parents and teachers, with parents recognising the importance of fruits and vegetables for health and reporting that children have access to these foods at home. Although parents recognised the importance of vegetable consumption, teachers did not share this perception, as they observed limited access to these foods among children and even reported difficulties in introducing them into the school environment. The most consumed foods during main meals were rice, beans, vegetables and meats, while fruits and dairy products were predominant in breakfast and snacks. Children frequently mentioned fruits such as watermelon, strawberry, and apple using free drawing and colouring activities. These findings highlight significant differences in perceptions between parents and teachers regarding children’s access to healthy foods, underscoring the need for improved communication to promote healthier eating habits.
To co-design a systems approach aimed at promoting the wide-scale adoption of whole-school approaches to food in UK primary schools to improve school food environments, food provision and dietary intake in children.
Design:
A systems framework (Action Scales Model) was used to guide the co-design of the systems approach. The process involved identifying leverage points within the UK primary school food system that, if influenced, could alter the way in which the system functions. Actions were then agreed upon to influence those leverage points.
Setting:
Co-design workshops were held online between September 2021 and February 2022.
Participants:
Members of the co-design team comprised twelve school stakeholders (headteachers, school food improvement officers, catering leads, representatives of UK school food organisations and a dietician) and a team of researchers with expertise in school food, systems thinking and intervention development. Our partnership board included decision-makers and advocates of the whole-school approach to food in England and Northern Ireland.
Results:
Identified leverage points included the priorities of headteachers, who are instrumental in instigating whole-school approach to food adoption. Direction from local and national policymakers was also identified. Actions to influence these leverage points included providing direct support to schools (through an online resource) and encouraging policymakers to monitor the adoption of the approach.
Conclusion:
The methods described here can be replicated by others to promote the adoption of whole-school approaches to food in other contexts and contribute to the growing literature on developing systems-wide approaches to promote the adoption of public health initiatives.
Traditional diets are culturally accepted and adapted to local environments, but globalisation has shifted towards unhealthy, unsustainable eating habits. This study aims to assess the literature on the effects of traditional, place-based diets on health and sustainability and examines the suitability of common tools used to evaluate them.
Design:
A systematic search was conducted using the PRISMA 2020 guidelines across seven databases (CINAHL, Cochrane Library, MEDLINE, Scopus, Web of Science, PubMed and Google Scholar), and the protocol was registered with PROSPERO (CRD42023445750). The inclusion criteria were traditional place-based diets, studies examining the nutritional, health benefits and sustainability impacts of traditional food consumption, published in English, with no date restriction.
Results:
Eleven studies from Spain, Romania, Portugal, Mexico, Chile, Japan, Uganda and India met the criteria. Assessment tools included carbon footprints (via LCA), nitrogen footprints, NRF9.3, Nutri-Score and EAT-Lancet; some incorporated qualitative methods. Mediterranean, Atlantic and Japanese diets aligned well with health and sustainability, whereas meat-heavy or nutrient-deficient patterns raised concerns. Most studies relied on standardised tools and secondary datasets, with limited use of region-specific environmental data or qualitative insights. Only one intervention study was identified.
Conclusions:
Traditional diets show promise as culturally appropriate models for sustainable and healthy eating. Current tools designed around standardised, reductionist frameworks often fail to capture the complexity of traditional food systems, including local practices, preparation methods and cultural meaning. To better assess traditional diets, future research should develop regionally adapted indicators and integrate quantitative measures with qualitative insights from local communities.
Obesity is characterised by chronic low-grade inflammation, which is a key factor in the development of obesity-related co-morbidities. Intake of n-3 long-chain PUFAs is associated with anti-inflammatory effects. Recent studies suggest that also n-11 long-chain MUFAs may reduce the concentrations of inflammatory markers, possibly by increasing the biosynthesis of EPA. The primary aim was to investigate if diets added herring oil containing cetoleic acid (CA, C22:1n-11) or a CA concentrate (CECO) affected the fatty acid composition in tissues from obese rats with chronic inflammation. Secondary aims included investigating the effects on inflammatory markers. Thirty male obese Zucker fa/fa rats were fed diets containing herring oil (HERO) or a CECO, containing 0·70 or 1·40 wt% CA, respectively, with a comparable content of EPA (0·17 and 0·20 wt%, respectively), or a control diet with soyabean oil for 5 weeks. Data were analysed using one-way ANOVA. CA from HERO and CECO diets were recovered in liver, adipose tissue, muscle and blood cells. The EPA concentration was similar between HERO and CECO groups in tissues, whereas the hepatic concentrations of fatty acid desaturases were lower or similar to Controls. The concentrations of TNFα, matrix metalloproteinase-3, IL6, monocyte chemotactic protein 1 and integrin α M in adipose tissue, and the hepatic concentration of CD68 were lower after CECO intake but were not affected by the HERO diet. To conclude, rats fed the CECO diet had lower concentrations of inflammatory and macrophage infiltration markers, but this effect was probably not mediated through increased EPA biosynthesis.
There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors; however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster-randomised Mediterranean diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Programme costs ($AUD2024) covered staff to deliver the MedWalk programme and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained or improved) was determined using a cross-tabulation test. MedWalk programme costs were estimated at $2695 AUD per participant and control group cost at $165 per person – a differential cost of $2530. Mean change in utility scores from baseline to 12 months was not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20·3 % MedWalk v. 42·6 % control group) (P = 0·020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians; however, longer-term follow-up would be beneficial to see if this is maintained.
The objective of this study was to evaluate the impact of incorporating group-based nutritional education into usual care on adherence to nutritional counselling among outpatients with type 2 diabetes (T2DM). This parallel-group, randomised controlled superiority trial was conducted with outpatients diagnosed with T2DM and poor glycaemic control. The control group received individual usual care, while the intervention group received usual care plus group-based nutritional education, which included three sessions: ‘Let’s Go Shopping,’ ‘Healthy Plate’ and ‘Hunger and Satiety.’ Baseline and four-month follow-up assessments were conducted, and outcome measures included adherence to nutritional counselling, glycaemic control, weight and physical activity. A total of 213 participants were included: 61·9 % were women, aged 60 years (interquartile range (IQR) = 53–65), 67·6 % with low socio-economic status, 67·3 % had obesity and the glycated Hb (HbA1c) was 9·3 % (IQR = 8·3–10·2 %). The intervention did not result in superior glycaemic control; however, short-term reductions in HbA1c were observed across all participants (–0·3 % (IQR = –0·7–0·3 %)). The intervention group demonstrated an increase in physical activity levels between visits (262 metabolic equivalent tasks (IQR = 99–257); P = 0·038), but no significant difference between the groups. Participants in the intervention group adhered to 67 % of combinations, compared with 50 % in the control group (P = 0·012), and adherence to the diabetes plate method was significantly higher in this group (75·9 % v. 62·2 %; P = 0·05). In conclusion, no significant between-group differences in glycaemic control were found, although both groups improved HbA1c short-term. Group-based nutritional education increased dietary adherence, particularly to the diabetes plate method and physical activity. Long-term effects on metabolic outcomes warrant further study.
Sepsis affects 50 million people globally, contributing to 20 % of all deaths and significantly increasing healthcare costs due to intensive care needs. Although the role of n-3 fatty acids in reducing sepsis mortality remains debated, recent studies suggest their potential in modulating immune responses and improving outcomes. This umbrella review aims to clarify the benefits of n-3 supplementation on mortality rate, length of intensive care unit (ICU) stays and days on mechanical ventilation in patients with sepsis. Following Cochrane and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodologies, a systematic search was conducted across multiple databases up to February 2025. After independent screening, data extraction and critical appraisal, meta-analyses were reassessed using the DerSimonian and Laird model. Evidence was graded using the GRADE approach, categorising outcomes based on strength and quality. A comprehensive search identified 934 records, of which thirty-four randomised controlled trials (RCT) from twenty-one systematic reviews and meta-analyses focused on n-3 supplementation in sepsis patients. n-3 significantly reduced mortality (risk ratio: 0·79, 95 % CI 0·69, 0·90), length of ICU stays (mean difference (MD): −3·6 d, 95 % CI −4·39, −2·81) and ventilation days (MD: −2·86 d, 95 % CI −4·46, −1·26). Parenteral nutrition showed slightly better outcomes than enteral nutrition, and EPA and DHA provided superior results compared with mixed oils. These findings suggest n-3 supplementation could improve mortality, ICU stays and ventilator dependency in patients with sepsis. However, the certainty of the evidence ranges from low to very low, emphasising the need for further high-quality RCT to validate these benefits. Also, clinicians should prescribe n-3 supplements cautiously in this regard.
Dietary phytosterols exert hypocholesterolemic effects by inhibiting cholesterol absorption in the small intestine. However, oxidised phytosterols exert harmful effects. In this study, we compared the effects of dietary stigmasterol or oxidised stigmasterol (OS) on cholesterol absorption and metabolism in mice. Institute of Cancer Research (ICR) male mice were fed one of the following diets: a standard American Institute of Nutrition (AIN) diet; the standard diet plus 0·25 % cholesterol; the standard diet plus 0·25 % cholesterol and 0·25 % stigmasterol or the standard diet plus 0·25 % cholesterol and 0·25 % OS. Stigmasterol, but not OS, decreased plasma total cholesterol levels. Unlike stigmasterol, dietary OS increased the cholesterol levels in micellar solutions. Thus, OS could not exert hypocholesterolemic effects as it could not displace cholesterol in micellar solutions. In contrast, dietary OS downregulates the mRNA expression of genes involved in cholesterol synthesis and upregulates the mRNA expression of genes involved in cholesterol catabolism in mice fed cholesterol. In addition, dietary stigmasterol and OS increased the levels of faecal-neutral steroids by downregulating the mRNA expression of Niemann-Pick C1-like 1 protein (NPC1L1) in the small intestine. Dietary stigmasterol may directly regulate the mRNA expression of NPC1L1, whereas dietary OS may reduce the mRNA expression of sterol regulatory element-binding protein 2 and act as a Liver X receptor α agonist, reducing the mRNA expression of NPC1L1. Therefore, OS may affect cholesterol absorption and metabolism through a mechanism different from that of stigmasterol.
Skinfold callipers are used internationally in research, clinical and field settings to assess body composition and nutritional status. Notably, currently available instruments differ in important specificities that impact measurement. In this sense, this report proposes a methodological approach that organises skinfold callipers into three categories (Original, Generic and Hybrid) and three configurations (Type A, Type B and Type C) based on physical-mechanical properties and characteristics. Therefore, this concept provides technical support for choosing the most appropriate skinfold calliper in different contexts.
Inadequate eating habits in adolescence are an important risk factor for obesity and other chronic non-communicable diseases in adulthood. The school environment can have a relevant impact on adolescent behaviour, since many habits acquired in this phase affect the individual throughout life, with visible effects on health. In this study, we aimed to evaluate the association between food sales at Brazilian schools and ultra-processed food consumption among adolescents. The Study of Cardiovascular Risk Factors in Adolescents (ERICA) was a nationwide, school-based survey conducted from 2013 to 2014, including public and private schools in 121 Brazilian cities. Dietary intake was assessed via a 24-h recall, and foods were divided according to the Nova classification based on the degree of processing. Unadjusted and adjusted linear regression models were used to assess the association between exposure to school food sales and intake of ultra-processed food. The prevalence of exposure to food sales was 55·2 %, and the mean diet share of ultra-processed foods was 34·5 %. Exposure to food sales in schools was associated with higher consumption of ultra-processed food (β = 0·11; P = 0·002). The results were similar when the analyses were stratified according to sex, usual intake of school meals and public school attendance (β = 0·11; P = 0·002). The association between exposure to food sales in schools and higher consumption of ultra-processed food suggests that school sales can influence adolescents’ food choices.
To describe the drivers of dietary behaviours among young South Asian adults (18–35 years) in Australia and examine the influence of acculturation and the host environment in shaping these behaviours.
Design:
A cross-sectional qualitative study design was used to collect data through Zoom focus groups. The analysis of the qualitative data followed Vears and Gilliam’s inductive content analysis approach. Demographic data were presented descriptively, and the findings were reported in accordance with the standard for reporting qualitative research.
Setting:
Sydney, New South Wales, Australia.
Participants:
A total of twenty-one young South Asian migrants (aged 18–35 years), mostly from India and Pakistan, participated in four online focus groups.
Results:
Six main themes were identified, highlighting the complex interplay of acculturation, cultural identity, family influence and other socio-economic factors in shaping dietary behaviours. (1) Acculturation and exposure to diverse cuisines, (2) interplay between religion and culture during special occasions, (3) influence of social networks and community norms, (4) structural and practical constraints shaping food choices, (5) shifting perceptions around healthy eating and (6) empowerment through knowledge. Participants reported incorporating Western and multicultural cuisines, often balancing convenience and cultural preferences.
Conclusions:
Numerous drivers, including but not limited to acculturation and the host environment, influence the dietary behaviours of young South Asian adults in Australia. Despite limitations in representativeness, the study provides valuable insights highlighting the need for inclusive health promotion efforts for Australia’s growing South Asian population.
Regular physical activity for adults is associated with optimal appetite regulation, though little work has been performed in adolescents. To address this gap in the literature, we conducted a study examining appetite across a range of physical activity and adiposity levels in adolescent males. Healthy males (n 46, 14–18 years old) were recruited across four body weight and activity categories: normal weight/high active (n 11), normal weight/low active (n 13), overweight, obese/high active (n 14), overweight and obese/low active (n 8). Participants from each group completed a 6-h appetite assessment session on Day 0, followed immediately by a 14-day free-living physical activity and dietary assessment period on Days 1–14, and a fitness test session occurring between Days 15–18. Subjective and objective assessment of appetite, resting energy expenditure, body composition using dual energy absorptiometry and thermic effect of feeding (TEF) was conducted on Day 0. Physiological variables in the normal weight low active group that were different than their peers included lower fat-free mass, cardiorespiratory fitness, glucose/fullness response to a standardised meal, TEF in response to a standardised meal, lower self-rated fullness and satiety and higher self-rated hunger to a standardised meal. Conversely, the overweight, obese high active group displayed better subjective appetite responses, but higher insulin responses to a standardised meal. Taken together, these results suggest that physical inactivity during adolescence has a negative impact on metabolic health and appetite control, which may contribute to future weight gain.
To describe changes in the community food environment between 2010 and 2022 in all municipalities in the state of Rio Grande do Sul (RS), Brazil, and to evaluate the possible associated sociodemographic inequities.
Design:
This ecological study was based on an analysis of the distribution and density of food retail establishments between 2010 and 2022 and their associations with the sociodemographic characteristics of the municipalities. Sociodemographic and food retail variables were extracted from secondary government databases. The establishments were classified according to the degree of processing of the foods they predominantly sold. Non-parametric tests and linear and Prais–Winsten regressions were used to analyse data.
Setting:
State of RS, Brazil.
Participants:
All 497 municipalities.
Results:
There was a significant reduction in overall food retail density (Coef.: –2·97; 95 % CI: –3·34, –2·61; P < 0·001). The greatest reduction occurred in establishments that sourced ultra-processed foods (Coef.: –3·34; 95 % CI: –3·65, –3·02; P < 0·001), which, despite the decrease, remained the most widely present. In 2022, the density of these establishments (median: 24·5; min/max: 4·4–124·8) was twice the density of establishments supplying fresh/minimally processed foods and culinary ingredients (median: 13·1; min/max: 0·0–95·8). Cities with greater social vulnerability had lower densities of establishments and greater reductions in the density of establishments over the evaluated period.
Conclusions:
The reduction in food retail outlets disproportionately affected the most vulnerable municipalities and negatively impacted the availability of healthy foods. These findings reinforce the need for food and nutrition policies that promote equity in the food environment.