The objective of this study was to develop, implement, and refine a food environment survey to capture people’s perceptions of their food environments in low-and middle-income countries: the Food Environment Perceptions Survey (FEPS).

Identifying aspects of food environment to include: drawing from existing survey instruments; a Delphi survey with food environment experts working globally; workshops with local experts in India and Cambodia; cognitive testing of the survey items; and piloting the tools in diverse field settings in India and Cambodia.

Rural, peri-urban, and urban communities in India and Cambodia.

Global food environment experts for Delphi survey; food environment experts in India and Cambodia for workshops; convenience sample of participants in India (n=44) and Cambodia (n=60) for FEPS piloting.

The FEPS underwent many iterations prior to piloting. The initial versions of the survey were long, leading us to remove questions and reconfigure the survey to streamline it. The workshop participants rated the revised survey versions relatively favorably. The final survey consists of 109 questions covering six sections: accessibility and availability (48 questions); affordability (5 questions), convenience (17 questions); quality and safety (3 questions); information, promotion, and labeling (16 questions); and an optional sustainability section (20 questions). Based on pilot data, we found significant differences in how participants interacted with different food environment types across rural, peri-urban, and urban transects.

The finalized FEPS is a newly developed survey instrument that can be incorporated by other researchers to characterize diverse perceptions of food environments in LMICs.

We applied an innovative agent-based modeling (ABM) approach to investigate how and to what extent spillover effects occur beyond dietary interventions.

We developed an agent-based-model (ABM) in NetLogo to simulate the dietary practices of the Dutch adult population during lunch and dinner, representing participants in the Dutch National Food Consumption Survey.

The model assessed spillover effects beyond a hypothetical workplace canteen intervention targeting increased plant-based protein consumption during lunch. Direct effects were defined as the percentage of non-vegetarian employees consuming a vegetarian lunch. Spillover effects were indicated by the percentage of plant-based protein consumed at dinner, influenced by dietary identity, habituation, social networks, and eating location. Scenarios with varying direct effect sizes were simulated to compare plant-based protein consumption at dinner.

Simulations demonstrated a positive spillover effect at the population level, with plant-based protein consumption at dinner increasing over three years compared to baseline (no intervention). At direct intervention effect sizes up to 0.5, there was a linear increase in plant-based protein consumption at dinner (from 23.0% [95%CI 22.9–23.2] at baseline to 32.3% [95%CI 31.8–32.8]). Spillover effects plateaued beyond an effect size of 0.5, with no significant further increases observed.

Our application of ABM revealed that positive spillover effects of dietary interventions from workplace to home can be achieved. Despite challenges, ABM might complement other approaches for studying spillover effects and supporting dietary behavior change towards more sustainable diets.

Genetic predisposition to obesity can stimulate an increase in adiposity throughout adulthood. However, the interaction between genetic factors and dietary habits may modify the genetic association with obesity. Thus, this study aimed to investigate the dietary patterns that influence the genetic risk of obesity in a Korean population using a large cohort study and genome-wide association study.

Prospective cohort study.

The genetic risk score (GRS) was calculated based on six identified single nucleotide polymorphisms of the OTOL1, NMBR, DNAJB9, ASCC1, NT5C2, and FTO genes associated with obesity, as ascertained by body mass index. Dietary patterns were determined using food intake data from a food frequency questionnaire and factor analysis.

This study included data from 8,458 adults aged 40-69 years from the Ansan and Ansung cohorts of the Korean Genome and Epidemiology Study.

The refined carbohydrate dietary pattern showed a significant inverse association with obesity in the highest GRS group with a non-significant interactive association (odds ratio [OR], 0.801; 95% confidence interval [CI], 0.662–‒0.969; P for trend = 0.0251, P for interaction = 0.571). However, participants with the highest refined carbohydrate dietary pattern score and highest GRS had an increased prevalence of obesity (OR: 1.288, 95% CI: 1.068‒1.554, P for trend = 0.0251) compared with the prevalence of those with the lowest dietary pattern score and GRS.

Reducing refined carbohydrate consumption may be helpful for Korean adults with a greater genetic susceptibility to obesity.

The major aim was to examine the interaction between visiting Kuwaiti Diwaniyyah, dietary habits, and daily activities during Ramadan among Kuwaiti men.

An electronic questionnaire was used to collect data. The questionnaire included questions about various sociocultural factors, frequency of visiting Diwaniyyah, dietary habits, and physical activity variables. For the sociocultural variables, age, level of education, and governorate was collected. ANOVA, t-test, Pearson correlation, and regression were used.

Respondents came from different and various subgroups of the Kuwaiti population and from all six governorate

A total of 736 Kuwaiti men were selected from an opportunistic sample.

The results show that the food most eaten at night after Iftar in general was rice, meat, and dairy products. Younger age groups eat more sweets, pastry, traditional sweets, dairy products, and rice than the other age groups. The higher the frequency of visiting Diwaniyyah, the greater the consumption of these types of food at night. Also, older men eat fewer types of food and have lower physical activity levels at night during Ramadan than other age groups. Men with graduate educational levels who regularly visit Diwaniyyah consume more types of food at night than those who do not visit the Diwaniyyah. Age, social individuals, and number of days visiting Diwaniyyah were associated with and predicted the number of types of food eaten at night during Ramadan.

The study findings reveal that during Ramadan, lifestyle behavior changes among men, including the timing and number of meals, type and portion of food consumption, and physical activity behavior.

Toddler drinks, sometimes referred to as toddler milk and formula, are not recommended by health authorities because they have a higher sugar and lower protein content than cow’s milk. However, advertisement spending and retail sales of these products have grown in the United States (U.S.), and there is a nutrition surveillance gap in purchaser characteristics.

Household purchases of toddler drinks between 2004-2020.

NielsenIQ consumer panel.

Panelists across the U.S.

Panelists purchased 66 unique toddler drinks between 2004-2020. Out of 202,207 households in the panel, 2,644 panelists purchased toddler drinks at least once during the study period. Most panelists who purchased toddler drinks had a household income above $60,000 and had graduated from college. Households purchasing toddler drinks spent an average of $102 dollars, 1.5% of their total food spending, on toddler drinks annually. The share of spending on toddler drinks increased by approximately 0.02 percentage points each year during the study period, which was equivalent to a 54% increase between 2004 and 2020 (95% CI: 0.04 – 4 x 10-3). The highest average household spending on toddler drinks was among Asian households, households with a single male head of household, and households with children 2-6 years old.

Findings indicate that toddler drink purchasing patterns vary by household demographics and have increased over time. Proactive efforts, including continued surveillance of toddler drink purchases and regulation of toddler drink marketing, are critical to promote consumption of age-appropriate beverages for young children.

In a world under a triple planetary crisis of climate change, biodiversity loss, and pollution, this study aimed to evaluate the types, features, and impacts of environmental sustainability and social responsibility food labels on consumers’ choices and purchasing decisions.

A systematic review encompassing three electronic databases was conducted. The initial search was conducted in May 2022 and updated in July 2025, identifying 364 studies. After screening, 41 studies were included. Data were extracted using a standardized form and analysed by topic.

Studies included were conducted in various consumer and market settings, primarily focusing on packaged food products.

The studies represented a range of consumers across demographic and geographic contexts, but mostly focused on Western Europe, the US, and other high-income countries.

Most studies were experimental (‘choice experiments’) and evaluated purchasing intentions. Environmental sustainability labels generally elicit positive consumer responses, with high preferences for organic and animal welfare claims. Consumers often desire additional information to better understand label meanings. While some evidence supports the influence of environmental sustainability labels on consumer choices, their impact on actual purchasing behaviour remains mixed. Research on social responsibility labels is notably limited.

There is insufficient evidence to determine the real-world impacts of environmental sustainability and social responsibility labels on food choices. Future studies could focus on purchasing behaviours in real-life consumer interactions with labels, the impacts of the exposure to varying levels of information, and a potential integration of domains. Given pressing social and environmental challenges, integrative strategies are required to develop labels that effectively guide consumers towards healthier, sustainable, and socially responsible food options.

The childhood composite index of anthropometric failure (CIAF) effectively identifies multiple anthropometric deficits among under-five children. This study aimed to analyze undernutrition among under-five children, as measured by childhood CIAF, to evaluate trends, determinants, and disparities in Bangladesh between 2007-2022.

The study utilized data from five rounds of the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, 2017–18, and 2022. The CIAF was estimated using six mutually exclusive anthropometric failure categories in accordance with the World Health Organization (WHO) child growth standards. Multivariable logistic regression was performed to explore determinants of CIAF. The concentration index and concentration curve were used to assess the changes in inequity.

Bangladesh.

32,096 under-five children.

The prevalence of childhood CIAF declined significantly from 56% (95% CI: 55–58) in 2007 to 35% (95% CI: 33–36) in 2022. The significant reduction in “stunting and underweight” from 23% (95% CI: 22–24) in 2007 to 11% (95% CI: 10–12) in 2022 was a major contributor to the decrease in childhood CIAF. Child age, household socioeconomic status (SES), and mother’s education were significant determinants of childhood CIAF across all study periods. Negative concentration index for SES, residence, mother’s and father’s education indicate pro-poor inequality in childhood CIAF, which declined from 2007 to 2022.

Despite significant progress, disparities in childhood CIAF across SES, residence, and parental education persist in Bangladesh. Targeted policy interventions are crucial to mitigating childhood undernutrition and achieving Sustainable Development Goal 2.2.

To estimate the prevalence of nutrition security and examine its association with community food environment factors, including food access and affordability.

This cross-sectional study used data from the 2012-2013 National Household Food Acquisition and Purchase Survey, including its restricted-use Geography Component (FoodAPS-GC). Household nutrition security measure was derived by combining self-assessed food security and self-rated diet quality indicators into four categories: food secure with high diet quality (FSHD), food secure with low diet quality (FSLD), food insecure with high diet quality (FIHD), and food insecure with low diet quality (FILD). Only FSHD households were considered nutrition secure. Multinomial logit analysis identified factors associated with nutrition security.

4,685 households with primary respondents aged 20 years or older

Nationally representative sample of US households

Approximately 31.0% of households were classified as nutrition insecure, including 15.0% as FSLD, 9.3% as FIHD, and 6.7% as FILD. The remaining 69.0% were nutrition secure (FSHD). Nutrition insecurity was significantly associated with younger age, lower educational attainment, lower income, obesity, smoking, and poorer self-rated health. Food environment factors, including low geographic access to food and higher local food prices, were not significantly associated with nutrition security. Relying on someone else’s car to reach a primary food store was linked to higher odds of nutrition insecurity.

The proposed nutrition security measure can be used to monitor nutrition security in national surveys. Comprehensive measures of the food environment are needed to understand its relationship with nutrition security and to guide targeted policy interventions.

Existing evidence suggests a potential association between coffee consumption and Non-alcoholic fatty liver disease (NAFLD，now known as MASLD), yet the nature of this relationship remains ambiguous. The primary objective of this study was to comprehensively investigate and clarify the association between coffee intake and the occurrence of NAFLD.

A cross-sectional study design was employed, analyzing data from NHANES(National Health and Nutrition Examination Survey,NHANES) spanning from 2013 to 2018. Weighted univariate and multivariate logistic regression models were utilized to assess the relationship between coffee consumption and NAFLD. RCS analysis was conducted to explore any potential nonlinear associations. Forest plots were generated to visualize the impact of coffee consumption on NAFLD across different subgroups, and threshold effect analysis was performed to evaluate the nonlinear relationship between coffee consumption and NAFLD prevalence specifically in women.

Data were from the US - representative NHANES.

8062 subjects aged ≥20 years were included.

The weighted prevalence of NAFLD among the participants was 44.18%. After controlling for confounding variables, coffee consumption was found to be negatively associated with the risk of NAFLD (OR = 0.96, 95%CI: 0.94, 0.99). The association between coffee consumption and NAFLD was observed to vary by gender and education level. For the prevention of NAFLD in women, the optimal coffee intake was determined to be 2 cups.

Increasing coffee intake emerges as a potentially effective non-pharmacological strategy for the prevention and management of NAFLD. Notably, for women, consuming 2 cups of coffee appears to represent the optimal threshold for maximizing this beneficial effect.

To assess the feasibility of using large language models (LLMs) to develop research questions about changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages.

We conducted a controlled experiment using ChatGPT-4 and its plugin, MixerBox Scholarly, to generate research questions based on a section of the USDA summary of the final public comments on the WIC revision. Five questions weekly for three weeks were generated using LLMs under two conditions: fed with or without relevant literature. The experiment generated 90 questions, which were evaluated using the FINER criteria (Feasibility, Innovation, Novelty, Ethics, and Relevance). T-tests and multivariate regression examined the difference by feeding status, AI model, evaluator, and criterion.

The United States.

Six WIC expert evaluators from academia, government, industry, and non-profit sectors.

Five themes were identified: administrative barriers, nutrition outcomes, participant preferences, economics, and other topics. Feeding and non-feeding groups had no significant differences (Coeff. = 0.03, P = 0.52). MixerBox-generated questions received significantly lower scores than ChatGPT (Coeff. = –0.11, P = 0.02). Ethics scores were significantly higher than feasibility scores (Coeff. = 0.65, P < 0.001). Significant differences were found between the evaluators (P < 0.001).

The LLM applications can assist in developing research questions with acceptable qualities related to the WIC food package revisions. Future research is needed to compare the development of research questions between LLMs and human researchers.

This study aimed: 1) to characterize the use and prevalence of nutrition and health claims (NHC), and 2) to examine the association between NHC and the potential presence of Health Canada’s front-of-pack (FOP) nutrition symbol indicating high saturated fats, sugars and/or sodium on a sample of Canadian prepackaged food products.

A cross-sectional analysis was conducted on five categories of prepackaged food products. Label components were classified using the INFORMAS labelling taxonomy. Products’ nutritional profile was evaluated using Health Canada’s FOP symbol nutrient thresholds for saturated fats, sugars and sodium.

Data were obtained from the Food Quality Observatory database, collected between 2018 and 2022 from food retailers in Québec City and the Greater Montreal Area or online.

A total of 2,937 food products were evaluated from five food categories: Breakfast cereals (n=392), Cookies and granola bars (n=983), Flavoured milks and plant-based alternative beverages (n=202), Salty snacks and crackers (n=1063) and Yogurts and plant-based yogurt alternatives (n=297).

Overall, 74.2% of food products had a NHC and 28.9% had a NHC and would require to display the FOP symbol. Food products that would require the FOP symbol were less likely to carry a NHC.

The results demonstrate substantial use of marketing techniques highlighting positive product attributes. Given the potential for inconsistent messaging on food products carrying NHC and the FOP symbol, these results highlight an opportunity to improve Canadian labelling regulations by restricting the use of NHC on products high in saturated fats, sugars and/or sodium.

To examine how race, income, and food insecurity (FI) interact during pregnancy, and whether FI contributes to disparities in maternal and infant health outcomes.

Observational cohort study employed sequential explanatory mixed methods design, with a survey phase (including HFSSM 6-item) and medical record abstraction followed by semi-structured interviews.

Online survey, virtual interviews.

Individuals who gave birth in Louisiana, USA, between June 2020 - June 2021. The quantitative phase comprised 1,691 individuals who completed the survey. A nested cohort of 40 individuals (evenly split by race [Black vs. White] and income [low vs. high]) subsequently completed semi-structured interviews.

Race and income were independently associated with both FI and maternal and infant health outcomes. When considering both income and FI, low-income individuals with FI were 1.73 times more likely to deliver low birthweight (LBW) infants (aOR 95% CI; 1.07, 2.82) and 1.43 times more likely to experience adverse infant outcomes (aOR 95% CI; 1.02–2.00) than high-income individuals without FI. Black individuals with FI were 2.49 times more likely to deliver LBW infants (aOR 95% CI; 1.45–4.29) than White individuals without FI. Interview findings revealed low-income individuals faced disproportionate barriers to accessing healthy food and making dietary choices, which were further complicated by pregnancy-related conditions.

The interplay between race, income, and FI significantly increases the risk of adverse infant health outcomes, demonstrating a synergistic effect. Targeted efforts to address FI, particularly among low-income pregnant individuals, are essential to improving maternal and infant health outcomes.

This study sought to explore how food company representatives perceive the food industry’s role in responding to and driving consumer demand for healthy and unhealthy foods.

Semi-structured interviews were conducted in 2022 by 2-3 researchers to explore food company representatives’ perspectives related to consumer demand for healthy and unhealthy food. Detailed field notes, including verbatim quotes, were recorded, and the data analysed thematically.

This study was part of a government funded 12-month intervention program to assess the impact of tailored support for food companies on company nutrition-related policies and practices.

32 food company representatives from 13 large food and beverage manufacturers in Australia.

Six themes were identified. Company representatives acknowledged that manufacturers actively shaped demand for both healthy and unhealthy foods. Healthy reformulation and aspects of nutrition labelling were constrained by anticipated consumer resistance, while demand for ‘less healthy’ products was driven by non-health attributes such as taste, comfort and affordability. Internal company marketing teams held significant influence regarding product development, promotion and labelling. Supermarkets were perceived as shaping demand via their marketing strategies. The competitive landscape, driven by pursuit of market share, was seen to fuel an ongoing cycle of promotion of ‘less healthy’ products.

Food companies acknowledge playing an active role in influencing consumer demand for healthy and unhealthy food and beverages. A whole-of-system response, including changes in government regulation and practice change by the food industry, is needed to drive stronger action and accountability from food companies to support healthier diets.

To determine whether gestational vitamin D status modulates the effect of pre-pregnancy obesity on gestational diabetes mellitus (GDM) risk while stratifying by maternal age.

Birth cohort.

A major maternity hospital in Kuwait.

Pregnant women in their second/third trimester of gestation were enrolled. Pre-pregnancy body mass index (BMI, kg/m2) was categorized as under/normal weight (<25.0), overweight (25.0 to <30.0), and obesity (≥30.0). Gestational 25-hydroxyvitamin D concentrations were categorized as deficiency (<50 nmol/L) or insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using logistic regression.

Data from 957 pregnant women were analyzed, with GDM affecting 166 (17.4%) pregnancies. Pre-pregnancy obesity and gestational vitamin D deficiency was ascertained in 275 (28.7%) and 533 (55.7%) pregnant women, respectively. The association between pre-pregnancy obesity and GDM risk differed according to maternal age and gestational vitamin D status (Pinteraction[BMI × age × vitamin D]=0.041). Among women aged <35 years (n=710), pre-pregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 2.72, 95% CI: 1.18–6.23) and vitamin D insufficiency/sufficiency (2.55, 1.15–5.62). In contrast, among women aged ≥35 years (n=247), pre-pregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (6.92, 1.45–33.04), but not among women with vitamin D insufficiency/sufficiency (1.13, 0.36–3.56).

Gestational vitamin D status modulates the effect of pre-pregnancy obesity on GDM risk in an age-specific manner.

To investigate the extent to which the associations of socioeconomic position (SEP) with stunting and wasting are mediated by minimum acceptable diet (MAD) and a family care indicator (FCI) in Sri Lanka.

Secondary data analysis of children from the 2016 Sri Lanka Demographic and Health Survey. The outcomes were stunting and wasting, the exposure was a composite measure combining maternal education and household wealth, and the mediators were binary MAD and FCI variables (adequate vs inadequate). Analyses were performed using counterfactual mediation models adjusted for age, sex and residence place.

A nationally representative sample of children from Sri Lanka.

Mothers/caregivers of children under 36 months (4,325).

Twenty percent of children were stunted and 14% were wasted. Lower SEP was associated with higher odds of stunting and wasting, and inadequate MAD and FCI. Inadequate FCI was associated with higher odds of stunting (OR=1.47, 95%CI= 1.24, 1.74) but not wasting (OR=1.14, 95%CI= 0.94, 1.38), whereas MAD was not associated with stunting or wasting. Neither MAD nor FCI significantly mediated the relationship between SEP and stunting and wasting. All mediation estimates were statistically non-significant at the 5% level. For example, the proportion mediated by FCI on the association between the lowest composite SEP and stunting was 13% (Mean Difference=0.13, 95%CI= -0.64, 0.90).

We did not find consistent or strong evidence that the associations of SEP with childhood stunting and wasting in Sri Lanka are mediated by MAD and FCI. Research with larger samples is needed for more precise estimates.