Nut consumption is low, with concern regarding weight gain a barrier to intake. However, evidence indicates no association between nut consumption and body weight. The metabolisable energy of nuts may partly explain this phenomenon. This study aims to qualitatively explore perceptions of presenting nut metabolisable energy on nutrition labels, and the potential influence this may have on consumption.

Semi-structured focus groups and interviews, with an inductive, reflexive approach to thematic analysis.

Online (Australia).

18 years or older, with either no formal nutrition education (consumer group) or formal training and working in nutrition/dietetics, public health, food industry, food regulation, or nut growing (stakeholder group).

Four focus groups and nine interviews consisting of 20 participants (n=8 consumers, n=12 stakeholders) in total were conducted. Five major themes were generated: i) knowledge of nuts varies, and the healthfulness of nuts is conditional on use and preparation, ii) nuts are versatile in the diet; intake is low, iii) consumers perceive over-eating nuts leads to weight gain, while stakeholders consider the whole dietary pattern, iv) nutrition labelling is confusing for consumers and needs to be transparent and positively framed, if used, and v) knowing nut metabolisable energy will have limited perceived impact on nut consumption and advice, and is dependent on the individual and product.

The findings suggest that perceptions of presenting nut metabolisable energy on labels are multi-layered, indicating this strategy may not be straightforward in resolving concerns about weight. Other strategies should be considered to promote nut consumption.

To identify politico-economic factors relating to policy surrounding the production, processing, and trade of sugar in Indonesia, and to identify strategies to support improved integration national nutrition and food security priorities with respect to sugar.

This study was a qualitative policy analysis, informed by political economy and power analysis approaches, and drawing on both documentary policy data and interviews.

Indonesia.

Interviewees from various national and sub-national government, and non-government sectors, with expertise in health and food safety (n=7), finance and economics (n=2), trade and industry (n=3) and other (n=4).

Sugar was articulated as a policy priority in three distinct ways: (1) sugar as an economic good; (2) sugar in relation to health and; (3) sugar as a commodity for food security. High political priority was given to national economic development, as well as concerns relating to farmer rights and welfare. Nutrition priorities and objectives to reduce sugar consumption were addressed in health policies; however, they were not reflected in production and economic policies promoting sugar.

Creating opportunities to diversify agricultural production and ensuring a just transition to protect the livelihoods of sugar farmers in Indonesia will be crucial in enabling achievement of nutrition priorities to reduce sugar consumption.

To assess the degree to which cohabiting couples (men and women) in Cameroon responded differently to the Food Insecurity Experience Scale and, where discordance exists, to test hypothesized drivers of difference.

This cross-sectional study employed descriptive statistics and multivariate regression analyses using R.

Nationally representative sample of cohabiting adults in Cameroon.

2,889 couples (male/female; 5,778 total adults) from the Cameroon Demographic and Health Survey (2018) couples recode.

Food insecurity was more prevalent and reported with higher severity among males compared to females. Discordance in reported food insecurity was evident in 57% - 79% of cohabiting couples in the dataset, depending on the measure used. Discordance was not clearly associated with household wealth. Further, among couples with discordant food insecurity experiences, males more often affirmed items that their female partners did not affirm. Contrary to our hypotheses, items reflecting household food security did not show greater agreement among couples than did individual items. Of our hypothesized predictors, only current employment status among males was significantly associated with the difference in food security scores among couples.

This study highlights the importance of examining intrahousehold differences in food security. Understanding how individuals within a household experience and perceive their food situation and the underlying factors driving disparities is crucial for improving the effectiveness of targeted food and nutrition policies.

This study aims to assess consumer preferences for 15 proposed front-of-package (FOP) “Healthy” label candidates under the Food and Drug Administration’s (FDA) of the United States updated guidelines for the “Healthy” label. The goal of this study is to identify which label designs best align with consumer preferences, thereby supporting the FDA’s efforts to promote healthier dietary choices through effective labeling.

A Best-Worst Scaling (BWS) experiment was conducted using a balanced incomplete block design (BIBD) to assess consumer preferences for the 15 FDA-proposed “Healthy” labels. Participants completed 15 BWS choice tasks where they identified the “best” and “worst” design from three randomly presented options in each task.

The experiment was conducted in a controlled laboratory setting in the United States.

Three hundred and eight US adult consumers who are primary household shoppers without dietary restrictions.

Results from the Random Parameter Logit (RPL) model indicate that labels 12 and 8 emerged as the most preferred designs, with preference shares of 16.7% and 16.1%, respectively. These two labels featured a prominent “Healthy” display with bold blue font, balanced color themes, and check marks, which likely contributed to their appeal. The Krinsky and Robb bootstrapping method confirmed the statistical significance of the preferences for these labels over others.

This study identifies two labels as the most preferred FDA-proposed “Healthy” label designs, offering clear guidance to policymakers on effective labeling strategies. By adopting a consumer-preferred design, the FDA’s “Healthy” label may have greater potential to influence healthier food choices.

To describe menu item prices and promotions on a meal delivery app in the United Kingdom and explore their socioeconomic patterns.

Cross-sectional descriptive analysis

We analysed over 21 million menu items from 71,532 food outlets listed on JustEat across the United Kingdom. We assessed median prices and types of promotions, examining variations by cuisine (e.g., chicken dishes, pizza) and outlet type (i.e., grocery, chain takeaways). Promotions were categorised into six types: percentage off, stamp cards, free items, meal deal notifications, buy one get one free, and low delivery fees.

The median number of food outlets accessible via JustEat was 69 per postcode district with delivery access (IQR=14, 225). The median menu item price was £6.25, with small/independent takeaways showing the highest prices. Menu item prices were generally lower in more deprived areas. Promotions were prevalent, with 65.95% of outlets offering at least one. Outlets delivering to more deprived areas tended to offer more promotions, with the most common being low delivery fees, stamp cards, and percentage off. Price and promotion strategies differed across cuisines and outlet types.

Online menu item prices are relatively high, and promotions are widespread in the United Kingdom. Food outlets serving deprived areas often offer lower prices and more promotions. These targeted pricing and promotional strategies may influence purchasing behaviour and contribute to diet and health inequalities. Further research is needed to assess their impact on dietary behaviours and population health, and to guide policy interventions in the digital food environment.

Young adulthood is a transitional period between childhood and adulthood characterized by unique stressors that increase the risk of food insecurity and poor mental health. This study examined the association between food insecurity and mental health outcomes among U.S. young adults aged 18-25.

A cross-sectional survey was completed by young adults between the ages of 18-25 years between January and April 2022. Key measures included food insecurity, perceived stress, anxiety, depressive symptoms, and insomnia. Descriptive statistics and linear regression analyses were used to determine the prevalence of and associations between food insecurity and mental health outcomes, controlling for key demographic and social factors.

Online survey

1,630 U.S. young adults

Among the analytic sample of 1,041 young adults, nearly 70% of participants identified as being food insecure in the last year. Participants reported moderate to high levels of perceived stress, anxiety, depressive symptoms, and insomnia. Food insecurity was positively associated with each mental health outcome including perceived stress (β=2.28, p<0.01), anxiety (β=2.84, p<0.01), depressive symptoms (β=2.74, p<0.01), and insomnia (β=1.28, p<0.01) after controlling for all other factors.

Food insecurity is associated with mental health problems among young adults. Future efforts should explore the directionality of this relationship to determine if food insecurity initiates or exacerbates poor mental health outcomes or if poor mental health contributes to food insecurity. Interventions to improve food security status may also help support mental health among young adults.

To estimate the effect of integrating responsive care, early learning, and development monitoring into a community-based package of activities on nutrition, sanitation, and hygiene, on improvements in early childhood development outcomes.

This was a quasi-experimental study with nonequivalent comparison groups. The study primary outcome, early childhood development, was measured using the Ages and Stages Questionnaire (ASQ-3) and the Global Scales for Early Development (GSED). We also collected data on the early learning home environment, nutritional practices, and caregiver depressive symptoms as secondary outcomes.

This study was conducted across 12 districts in Nampula Province, Mozambique. Half of the districts received holistic nurturing care with responsive care, early learning, nutrition, sanitation, and hygiene packages (intervention), and the other half received only nutrition, sanitation, and hygiene packages (comparison).

We recruited an age-stratified random sample of 961 caregivers and their children, aged 0–23 months.

We found a significantly higher mean caregiver engagement total score (mean difference: 0.36; P ≤ .001) and higher number of activities to support learning (mean difference: 0.30, P = 0.004) in the intervention group than in the control. There were no measurable impacts on the remaining early stimulation activities or on the primary outcomes of the ASQ and GSED developmental scores.

We discuss the challenges in the integration of nurturing care interventions into existing programs in high-vulnerability contexts, highlighting the aspects needed to achieve effective caregiver behavioral changes that can translate into improved early childhood development outcomes.

This study aimed to adapt and validate the NOVA 27 Ultra-Processed Food (UPF) Screener for use in Ecuador by identifying commonly consumed foods, classifying them using the NOVA system, and testing the screener’s validity in an urban sample and a national food survey.

A cross-sectional study was conducted in two phases: screener validation with a convenience sample of 327 adults in Quito through an online questionnaire (2021), and assessment of its applicability using data from the 2012 Ecuadorian National Health and Nutrition Survey (ENSANUT-Ecu). The method, adapted from a similar study in Brazil, compared NOVA UPF scores to the 24 Hour-Recall (24-HR) Automated Multiple-Pass Method (AMPM), used as the gold standard.

The study included Quito’s urban population for validation and secondary data from ENSANUT-Ecu.

327 adults aged 18 to 64 from Quito were included in the validation phase, and 3510 adults from the ENSANUT-Ecu dataset were analyzed in the secondary analysis.

The screener adaptation identified 27 subgroups of commonly consumed UPFs, summarizing 90% of UPF caloric intake. Validation results indicated significant agreement between the NOVA-UPF score and UPF intake, with PABAK indices above 0·8 for most socio-demographic groups. Higher NOVA-UPF scores corresponded to increased UPF dietary shares, mirroring patterns observed in the ENSANUT-Ecu dataset.

The adapted NOVA 27 UPFs Screener is a valid tool for assessing UPF intake in Ecuador, offering a practical resource for future dietary surveys to monitor and address UPF intake among Ecuadorian adults.

To describe the design and psychometric assessment of the Adolescent Home Food Environment Questionnaire (Acronym in Portuguese: QAAD).

This was a cross-sectional study. Data were collected between August 2021 and January 2022 through self-administered questionnaires via a survey management application accessible by computer or smartphone. The instrument was subjected to analysis by a panel of experts and to a pretest that enabled the adjustment of the language and the reformulation of the questions. The psychometric evaluation included the assessment of test-retest reliability (intraclass correlation coefficient), internal consistency (composite reliability), structural validity (Exploratory Structural Equation Modelling and Confirmatory Factor Analysis), and construct validity (Mann‒Whitney test; p<0.05). The following food environment aspects were evaluated: family eating practices, food availability and accessibility, cooking equipment availability, and parental feeding style. Moreover, the weekly frequency of fruit, bean, and added sugar beverage consumption was assessed.

A public high school in Rio de Janeiro, Brazil.

14-to-19-year-old students (n=34 in the test‒retest reliability study; n=501 in the validation analysis).

The final version of the QAAD included 32 questions allowing the assessment of seven dimensions of the home food environment. The QAAD demonstrated satisfactory reliability (ICC ranging from 0.44−0.78), adequate internal consistency (composite reliability >0.70), and satisfactory structural and construct validity.

The careful QAAD design provided a valid, reliable, and consistent instrument for characterizing adolescents’ home food environments, which may provide information for tailoring and targeting healthy eating promotion actions aimed at adolescents.

We investigated vitamin D (VitD) nutritional status in children aged 2–6 years to provide a basis for prevention and intervention strategies for VitD deficiency (VitDD) in Chinese children.

From November 2018 to September 2019, a total of 2192 healthy children aged 2–6 years were enrolled. The serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by liquid chromatography tandem MS.

Twelve jurisdictions in eight provinces and cities across northern and southern China were selected through stratified cluster sampling.

2192 children aged 2–6 years were enrolled.

(1) A serum 25(OH)D concentration of 23·87 (sd 8·24) ng/ml, a VitDS rate of 65·2 %, an insufficiency rate of 29·6 % and a deficiency rate of 5·2 % were noted. (2) Age (OR = 2·22, 95 % CI 1·86, 2·64) and spring (OR = 1·35, 95 % CI 0·91, 2·01) are risk factors for VitDD and VitDI. The male (OR = 0·68, 95 % CI 0·52, 0·90), the temperature (OR = 0·89, 95 % CI 0·86, 0·93), summer (OR = 0·25, 95 % CI 0·09, 0·68), autumn (OR = 0·26, 95 % CI 0·09, 0·74) the intake of VitD supplements (OR = 0·08, 95 % CI 0·03, 0·28), the intake frequency of dairy products (OR = 0·86, 95 % CI 0·78, 0·96) and egg products (OR = 0·83, 95 % CI 0·74, 0·93) are protective factors for VitDD and VitDI.

VitDD in children aged 2–6 years is still prevalent in China, but the influencing factors of VitD nutrition have changed. Latitude is not the main factor in the 25(OH)D concentrations of children aged 2–6 years; temperature, intake of eggs and dairy products and sampling season have more obvious impacts.

This study aims to investigate diet-related cancer risk awareness and behaviors among cancer survivors compared to non-cancer individuals.

It is a cross-sectional study initiated from the Health Information National Trends Survey (HINT).

Relevant survey questions from different iterations of HINTS were harmonized. Chi-square test and logistic regression models were performed to identify differences in diet-related cancer risk awareness and behaviors between the two groups.

Participants in the study were drawn from the HINT survey with various variables including age, gender, race/ethnicity, education, marital status, and body mass index.

The analysis revealed no significant differences in diet-related cancer risk awareness or behaviors between cancer survivors and non-cancer individuals. Those dietary factors included red and processed meat, alcohol, fiber, sugar-sweetened beverages, fruits, and vegetables. Specifically, 82% of both survivors and non-survivors failed to meet the American Cancer Society (ACS) recommendations for daily fruit consumption (OR= 0.91; 95% CI= 0.77, 1.06), and approximately 75% did not meet the daily vegetable intake guidelines (OR= 0.96; 95% CI= 0.83, 1.11). The findings suggest that a cancer diagnosis does not inherently lead to improved dietary awareness or healthier eating behaviors.

The lack of improvement in diet-related cancer risk awareness and behaviors among cancer survivors indicated missed education opportunities. The “teachable moment” of cancer diagnosis was not effectively utilized, which highlighted a need for stronger guidance from healthcare providers. This gap may also reflect barriers, including limited training, time constraints, and limited interprofessional collaboration among health professionals in delivering targeted dietary advice.

This study investigated how the belief systems and interests of policy actors shaped their framing of the causes and solutions to obesity and how this influenced policy recommendations.

Submissions to the Select Committee into Obesity Epidemic in Australia (SCOEA) were collected, and actors were classified according to their interests in commercial and non-commercial groups. A framework grounded in social constructionism was used to code frames and underlying belief systems. The SCOEA report was analysed to identify the representative distribution of belief systems in recommendations.

Australia.

None.

150 submissions were collected and analysed. 120 submitters were actors with non-commercial interests, including governments (n=13), non-government organisations (n=49), civil society groups and citizens (n=24), and academia (n=34). 30 submitters were actors with commercial interests including food industry representatives (n=23) and health enterprises (n=7). Conflicting belief systems in the framing of obesity were identified among policy actors, particularly between commercial and non-commercial groups. Non-commercial actors framed obesity in biomedical, lifestyle and socioecological terms, whereas commercial actors exclusively framed obesity as an issue of individual choices and proposed behavioural change interventions. A broad range of belief systems expressed by the submitters was represented in the SCOEA final report.

These findings illustrate how policy actors’ beliefs and interests shaped their frames and influenced the development of a key policy report. Policymakers seeking to advance obesity prevention policy must critically evaluate strategic framing by various actors and ensure that policy decisions are evidence-based and aligned with health, equity and ecological perspectives.

Energy drinks can cause cardiovascular, gastrointestinal, and other health disorders. These effects are particularly pronounced in youth. The aim of this study was to systematically review the literature on the consumption of energy drinks in European countries.

A systematic bibliographic search was performed in November 2024 in EMBASE, MEDLINE (Ovid), Scopus and Cochrane databases with no restrictions on country, study period, study design and language.

Energy drinks are beverages high in caffeine, sugar, and other stimulants.

A total of 2008 studies were identified and reviewed by four researchers. Ninety-four met the inclusion criteria and were extracted in a table designed ad hoc.

The included studies showed differences regarding their design, definition of consumption, and time frame under study. The most studied frequency of energy drink consumption was weekly consumption, and the most studied population was school students. An increase in prevalence of consumption was observed when tracking energy drink consumption over time. Variables most related to consumption were low socioeconomic status, alcohol and tobacco consumption, physical activity, age, and sex.

It is difficult to have a clear picture of the extent of energy drink consumption in Europe, mainly due to differences in the design of the studies and the lack of periodicity of the estimates in different countries. However, given the health problems that have been associated with energy drink consumption, regulation of these beverages is essential, especially in youth.

To identify trajectories of Indonesian children and adolescent’s BMI-z scores between 1993 and 2014, examine whether the pattern differs by sex and assess associations with host, agent and environmental factors.

Longitudinal data were from the Indonesian Family Life Survey with up to five measurements of height and weight. Group-based trajectory models investigated changes in BMI-z score across time; differences by sex were investigated using random effect (mixed) models. The association between the trajectories and host, agent and environmental factors were examined using multinomial logistic regression.

Thirteen provinces in Indonesia.

Indonesian children and adolescents aged 6–18 years (n 27 394 for BMI-z trajectories; n 8805 for risk factor analyses).

Mean BMI-z score increased from –0·743 sd in 1993 to –0·414 sd in 2014. Four distinct trajectory groups were estimated with mean BMI-z increasing more rapidly in the most recent time periods. One group (11·7 % of participants) had a mean BMI-z entirely within the moderately underweight range; two had trajectories in the normal range and one (5·6 %) had a mean BMI-z starting in the overweight range but within the obesity range by 2014. There were differences in trajectory groups by sex (P< 0·001). Those born in 2000s, frequent consumption of meat, fast foods, soft drinks and fried snacks, and living in urban areas were associated with rapid gain weight.

These trajectories highlight the double burden of malnutrition and suggest that the prevalence of overweight and obesity is likely to increase substantially unless public health interventions are implemented.

This study aimed to evaluate the association between food addiction (FA), food environment, and consumption of ultra-processed foods (UPF) in socially vulnerable women.

A population-based cross-sectional study was conducted in Favelas and Urban Communities of Maceió-Brazil. The availability of ultra-processed foods in the food environment was evaluated through the audit of retailers with the support of the AUDITNOVA instrument. The women taking part in the study were interviewed, and a 24-hour food recall was used to assess the proportion of UPF in their diet. The modified Yale Food Addiction Scale 2.0 was also used to determine FA. Association analysis was performed using binary logistic regression and generalized estimation equations.

1,702 adult women of reproductive age (20-44 years) residents in Favelas and Urban Communities.

It was found that 14.6% of the women had FA. The adjusted multivariate association analysis showed that the high availability of ultra-processed foods in food retail increased the chance of women having FA by up to 47% (p=0.02 OR: 1.53; 95% CI: [1.07; 2.18]). It was also possible to observe that the greater calorific contribution of UPF in the diet increased the chance of women presenting FA by up to 61% (p< 0.01 OR: 1.39; 95% CI: [1.48; 1.97]).

The environment and what is available in it is associated with additive behavior independent of individual factors, and UPF consumption increases the chance of FA. This demonstrates the need for changes in the food environment in Brazilian favelas, contributing to improving women’s health.

The marketing of foods and non-alcoholic beverages (hereafter: food) high in fat, salt, and/or sugar (HFSS) is implicated in the development of poor dietary habits, overweight, and obesity. Digital media, including videogame livestreaming platforms (VGLSPs), are an increasingly prominent source of food marketing exposure, particularly for young people. This study aimed to experimentally examine the impact of food marketing via VGLSPs on eating behaviour in young people.

A between-subjects randomised controlled trial (RCT) design was used to explore the impact of exposure to HFSS food marketing in a videogame livestream (a static food banner advert present throughout the footage) on immediate consumption of the marketed snack and an “alternative brand” of the same snack in a sample of adolescents (N = 91, Mage = 17.8, 69% female). Relationships with food-advertising-related attentional bias and inhibitory control in relation to branded food cues were also examined.

University Psychology laboratory.

Exposure to HFSS food marketing, compared with non-food marketing, did not significantly impact immediate marketed or overall snack intake. Additionally, no significant effects for attentional bias or inhibitory control were found. However, although the overall model was non-significant, greater weekly use of VGLSPs was significantly associated with greater marketed snack intake.

Findings suggest that while acute exposure to food marketing in VGLSPs did not impact snack intake, perhaps more sustained exposure is impactful. Further exploration of this effect is needed, as well as studies investigating the potential impacts of other food marketing formats within VGLSPs.

To determine the minimum cost and affordability of three levels of diet quality in urban households in Cali, Colombia: a caloric-adequate diet, a nutrient-adequate diet, and a recommended diet.

Least-cost diets were estimated for different demographic groups. The Cost of Caloric Adequacy (CoCA) and the Cost of Nutrient Adequacy (CoNA) were computed using linear programming models. The Cost of Recommended Diet (CoRD) adheres to Colombia’s Food-Based Dietary Guidelines. Individualized costs were aggregated for a representative household, and affordability was assessed by comparing these costs with household food expenditures. Data sources included the National Administrative Department of Statistics, the Ministry of Health and Social Protection, and the Colombia Institute of Family Welfare.

Cali, Colombia

The per capita income and food expenditures of 885 urban households in Cali, taken from Colombia’s Great Integrated Household Survey.

The CoNA per 1,000 kcal indicates that women require more nutrient-dense diets than men. Limiting nutrients include vitamin C, vitamin A, vitamin B12, and calcium. Three food groups ―(1) meat, eggs, legumes, nuts, and seeds; (2) milk and dairy products; and (3) vegetables and fruits― account for about 70% of the CoRD. The affordability analysis shows that 42.66% of households in the 10th income percentile cannot afford the CoCA, none below the 20th percentile can afford the CoNA, and only those above the 40th percentile can afford the CoRD.

Urban households face significant barriers not only to affording diets that promote long-term health, but also to those that meet nutritional requirements.