Front-of-package labelling informs consumers about the ‘healthiness’ of foods based on different classification schemes. These schemes reflect competing worldviews for assessing a food’s healthiness, represented by nutrient-, food- or diet-based indices. The Health Star Rating scheme (HSR) has been criticised for failing to appropriately score unhealthy products. Updates to the HSR algorithm were implemented over a two-year period from November 2020. This study investigated alignment between a nutrient-based scheme (HSR), food-based scheme (Nova food processing system) and diet-based scheme (Australian Dietary Guidelines (ADG)).

Mintel Global New Products Database

Retail foods displaying HSR launched or updated onto the Australian market between November 2020 and June 2023.

Products were categorised according to the ADG and Nova, descriptive statistics performed for each category and proportion displaying HSR ≤ 2·0 and ≥ 2·5 calculated for discretionary foods, five food group foods, ultra-processed foods (UPF) and non-UPF. Agreement between categories obtained by Kappa.

Median HSR for UPF and discretionary foods were 3·5 and 2·5, respectively, and 73·7 % of UPF and 58·2 % of discretionary foods displayed HSR ≥ 2·5. Agreement between HSR and Nova was none to slight (k = 0·09, P < 0·001) and HSR and ADG was fair (k = 0·38, P < 0·001). Between 2020–2023, the proportion of UPF displaying HSR ≥ 2·5 increased from 60·2 % to 78·5 % and for discretionary foods 47·0 % to 62·5 %.

The HSR algorithm calculates ‘healthy’ HSR (≥ 2·5) for a high proportion of UPF and discretionary foods. The HSR’s nutrient-based approach to translate food-and diet-based nutrition recommendations into accurate food ‘healthiness’ assessments is still problematic.

To examine the prevalence, financial value and marketing leveraging methods of food sponsorship agreements and food service contracts in Canadian recreation and sport facilities (RSF).

Cross-sectional survey using descriptive analysis. RSF managers and directors reported the number, value and types of marketing leveraging methods used in food-related sponsorship agreements and food service contracts.

Publicly funded RSF in nine Canadian provinces that provide indoor sport programming for children and youth.

Eighty-six RSF representatives completed the survey (response rate: 73·9 %). Most facilities were municipally owned and located in urban settings; over 70 % served children under 13 years of age.

Food sponsorship agreements and food service contracts were reported by 36·5 % and 65·5 % of RSF, respectively. Financial donations were included in 88·6 % of sponsorship agreements and 27·4 % of contracts. Sponsors contributed a median of 25·0 % (IQR: 13·9–83·3 %) of total sponsorship income, with a median annual donation per sponsor of $500 (IQR: $288–$1375). Nearly all agreements and contracts included at least one food marketing leveraging method. Branded signage was the most common in sponsorship agreements (64·6 %), while equipment donation was the most common in food service contracts (52·2 %).

Food sponsorship and service agreements are prevalent in Canadian RSF and include financial and in-kind contributions that may benefit facilities. However, the marketing leveraging methods used – such as branded signage and product provision – may also increase children’s exposure to food marketing. Greater monitoring and evaluation of these marketing practices are needed, especially in the context of proposed national marketing restrictions.

To analyse food and nutrition labelling policies in Mongolia, with the aim to identify key facilitators and barriers in the policy process and to propose priority actions to address these challenges.

A qualitative study utilising semi-structured individual interviews explored opinions and views of policy stakeholders on Mongolian food and nutrition labelling policies.

Ulaanbaatar city, Mongolia

Eighteen policy stakeholders, including government officials, representatives of consumer organisations and food producers.

Food labelling regulations in Mongolia were developed as part of broader reforms of the food system control to respond to changes related to the country’s transition to a market economy. Government leadership, along with technical support from international agencies, facilitated the development of these regulations. Key barriers identified in policy development were industry opposition, lack of consumer engagement, disruptions from government changes and funding shortages. Policy implementation was hindered by delays in operational regulations, inadequate infrastructure and limited knowledge and funding.

To date, the development and implementation of food and nutrition labelling policies in Mongolia have been limited and insufficient. Given the health and nutritional impacts of the nutrition transition, prioritising nutrition labelling policies is essential and should emphasise consumer needs. Key actions should include the establishment of clear regulations, active stakeholder engagement, well-resourced implementation, capacity building among regulators and producers, and consumer education.

There is growing public health interest in ultra-processed foods (UPF), but limited research exploring consumers’ perceptions of these foods in the United States. We aimed to characterise consumers’ beliefs about UPF, the association between perceived food processing and perceived food healthfulness and alignment between consumers’ perceptions and objective measures of food processing and healthfulness.

In a cross-sectional survey, participants answered questions regarding their beliefs about UPF. They rated the healthfulness and processing levels of a random selection of ten out of forty possible foods. We used descriptive statistics to examine participant beliefs about UPF. We used linear regression models to test associations between perceived processing and perceived healthfulness and between objective and perceived measures of food healthfulness and processing.

We fielded an online survey in the USA in November 2023.

This study included US adults aged ≥ 18 years (n 4455).

Fifty-four percent of participants correctly identified UPF as ‘Food products submitted to a series of industrial processing’ and 52 % correctly identified UPF as, ‘Food products that contain artificial ingredients’. However, one-third of participants believed UPF were genetically modified products. While foods with higher perceived processing tended to have lower perceived healthfulness and individuals perceived UPF as more processed and less healthful than minimally processed foods, healthfulness perceptions better aligned with Food Compass 2.0, a measure that integrates food processing and nutrient-profile.

Educational and policy efforts (e.g. food labeling) are needed to help consumers distinguish UPF and holistically assess the healthfulness of foods and beverages.

Food insecurity (FI) prevalence has increased globally, including in the USA, and disproportionately affects certain subgroups (e.g. women). Both food-related and non-food-related sociopolitical indicators may impact FI rates; however, these associations are underexplored. This study assessed select state-level sociopolitical indicators among states with higher and lower FI rates compared to the national average.

Cross-sectional

US

We identified twenty-five states representing lower (n 18) and higher (n 7) FI prevalence compared to the 2021–2023 US average (12·2 %) and used national data sources to characterise sixteen sociopolitical indicators (selected via prior review) across three categories: (1) proximal to FI (related to food access/income/resources), (2) inequality (contributing to disparities) and (3) tobacco/alcohol/cannabis regulation (may exacerbate/perpetuate financial constraints). We described each indicator and explored their associations (using t tests or Fisher’s tests) with state FI status (high v. low).

For proximal indicators, low-FI (v. high-FI) states had greater food environment scores, nutrition assistance programme participation, minimum wage and insured individuals. For inequality indicators, low-FI (v. high-FI) states had narrower gender wage gaps, greater racial equity and more protective policies for sexual/gender minority populations and abortion rights. For substance-related indicators, low-FI (v. high-FI) states had higher cigarette taxes and were more likely to have comprehensive smoke-free laws, legalised non-medical cannabis and provisions for expunging/pardoning prior cannabis-related convictions.

Low-FI states had more sociopolitical indicators aimed at improving food access, financial resources, equality and substance use-related regulations. Findings highlight the importance of adopting a holistic, sustainable, multilevel approach to effectively address the broader determinants of FI.

To co-create with rangatahi (young people) evidence-based eating and wellbeing guidelines for young people in Aotearoa New Zealand (NZ), informed by mātauranga Māori (traditional Māori knowledge).

Rangatahi collaborated with Māori and non-Māori experts to review existing health guidelines covering sustainable eating, physical activity, screen time, sleep and mental wellbeing and develop their own set of guidelines. Peer feedback on the draft guidelines was used to produce the final guidelines. The process integrated scientific evidence with mātauranga Māori, following tikanga Māori (Māori custom) to ensure a culturally centred process.

Wānanga (learning workshops) were held at a local marae (traditional meeting house), and feedback presentations were held in four secondary schools in Hawke’s Bay, NZ.

Seventeen rangatahi from four schools with high Māori student enrolment participated in the wānanga, and ninety-four students provided peer feedback through surveys.

The rangatahi created ten eating and ten wellbeing guideline messages. These messages were invitational (beginning ‘Let’s try to…’) acknowledging the challenging journey for many rangatahi from current to recommended behaviours. Only one quantification (8–10 h of sleep) was included. Three eating and three physical activity guidelines incorporated the concepts of ‘mauri’ (life force). The guidelines addressed contemporary issues including sustainable eating, ultra-processed foods, social dimensions of eating and physical activity, screen time and cyberbullying. They also emphasised respect, rights and responsibilities, concluding with a motivational whakatauki (proverb) about aspirations.

Innovative, relevant and contemporary eating and wellbeing guidelines have been successfully co-created by rangatahi Māori for all young people across NZ.

To evaluate food marketing techniques used in Canadian recreation and sport facilities and assess the healthfulness of foods and beverages marketed by the techniques.

Cross-sectional content analysis of photographed food marketing instances coded for marketing techniques according to Health Canada’s Monitoring Protocol, developed for monitoring food marketing techniques across settings, supplemented with new inductively identified codes and sport-related marketing techniques. Healthfulness was classified as ‘of concern’ or ‘not of concern’ according to cut-offs of sodium, sugar and saturated fat established by Health Canada.

Recreation and sport facilities in Canada

134 facilities with 2576 food marketing instances

91·4 % of food marketing instances included at least one general marketing technique. Branded infrastructure, displays and furniture was the most prevalent (87·9 %) and appeared with another technique half of the time. Sport-related marketing appeared in 12·2 % of marketing instances, with most referring to sponsors. Most (86·5 %) marketing instances were ‘of concern’. Food marketing instances with sport-related marketing (97·6 %) were significantly more likely to be ‘of concern’ than without sport-related marketing (84·6 %) (χ2 = 20·54, P < 0·001). Three new indicators – appeals to taste, appeals to emotion, and cross-channel references – captured persuasive elements not addressed by the current monitoring protocol.

This study highlights the presence of food branding and the use of sport-related marketing to promote unhealthy products/brands in recreation and sports facilities. Monitoring protocols may underestimate exposure to persuasive food marketing by overlooking subtle, symbolic and cross-channel techniques. Future research can be improved by including subtle techniques and reinforced messages across marketing channels.

Large inequalities in fruit and vegetable consumption (FVC) persist, yet it remains unclear how intersecting factors such as socio-economic status, ethnicity and sex influence FVC in the UK. Using an intersectional framework allows us to explore complex realities and double burdens faced by certain population groups.

Cross-sectional data from the UK Household Longitudinal Study Wave 9 (2017–2018) were analyzed. FVC was measured as a binary variable, indicating whether individuals met the recommended five daily portions of fruits and vegetables (400 grams in total). An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy was used, nesting participants into forty-eight social strata based on sex, ethnicity, age and educational level.

United Kingdom.

A total of 16 275 individuals from the UK Household Longitudinal Study sample were included, with one adult randomly selected per household.

Overall, 69·2 % of the sample did not meet the recommended daily FVC. Inequalities were predominantly explained by additive effects of sex, ethnicity, age and educational level. Men, individuals with lower educational levels, ethnic minority groups and younger participants were at higher risk of insufficient FVC, particularly those experiencing combinations of these factors.

Low FVC across the population, combined with strong additive effects of social determinants, underscore the need for proportionate universal interventions. Policies targeting improved access to fruits and vegetables across all neighbourhoods, especially those predominantly inhabited by individuals with lower educational levels, are warranted to reduce these inequalities.

To synthesise and quantify the association between household food insecurity (HFI) and various forms of malnutrition that include stunting, wasting, underweight, overnutrition and anaemia among Indonesian children under 5 years of age.

A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study included literature search, screening, data extraction, quality assessment using Joanna Briggs Institute (JBI) tools and meta-analysis using Review Manager 5.4.

Studies conducted in Indonesia, covering urban, rural and mixed settings across multiple provinces.

Children under 5 years of age residing in Indonesia, from households assessed for food insecurity using validated tools.

A total of thirty-two studies met the inclusion criteria, of which twenty-six were eligible for meta-analysis. HFI was significantly associated with higher odds of stunting (case–control: OR = 4·66; 95 % CI: 3·39, 6·40; P < 0·001; cross-sectional: OR = 4·61; 95 % CI: 4·17, 5·11; P < 0·001), wasting (OR = 1·92; 95 % CI: 1·60, 2·32; P < 0·001), underweight (OR = 5·26; 95 % CI: 2·12, 13·04; P < 0·001) and overnutrition (OR = 1·66; 95 % CI: 1·49, 1·85; P < 0·001). Children in food-secure households had significantly lower odds of anaemia (OR = 0·41; 95 % CI: 0·30, 0·58; P < 0·001).

HFI is strongly associated with multiple forms of malnutrition among Indonesian children under 5 years of age. These findings highlight the urgent need for integrated, nutrition-sensitive strategies that address food security to improve child health and reduce malnutrition in Indonesia.