To provide preliminary evidence in support of using ecological momentary assessment (EMA), a real-time data capture method involving repeated assessments, to measure dietary intake in children by examining the concordance of children’s dietary reports through EMA and 24 h recall.

Children completed eight days of EMA surveys, reporting on recent dietary intake of four pre-specified food categories (‘Fruits or Vegetables’, ‘Chips or Fries’, ‘Pastries or Sweets’, ‘Soda or Energy Drinks’), and completed two 24 h recalls during the same period. Concordance of children’s reports of intake during matched two-hour time windows from EMA and 24 h dietary recall was assessed using cross-tabulation. Multilevel logistic regression examined potential person-level (i.e. sex, age, ethnicity and BMI category) predictors of concordance.

Children in Los Angeles County, USA, enrolled in the Mothers’ and Their Children’s Health (MATCH) study.

One hundred and forty-four 144 children (53 % female; mean age 9·6 (sd 0·9) years; 34·0 % overweight/obese).

Two-hour concordance varied by food category, ranging from 64·9 % for ‘Fruits/Vegetables’ to 89·9 % for ‘Soda/Energy Drinks’. In multilevel models, overweight/obese (v. lean) was associated with greater odds (OR; 95 % CI) of concordant reporting for ‘Soda/Energy Drinks’ (2·01; 1·06, 4·04) and ‘Pastries/Sweets’ (1·61; 1·03, 2·52). Odds of concordant reporting were higher for Hispanic (v. non-Hispanic) children for ‘Pastries/Sweets’ (1·55; 1·02, 2·36) and for girls (v. boys) for ‘Fruits/Vegetables’ (1·36; 1·01, 1·83).

Concordance differed by food category as well as by person-level characteristics. Future research should continue to explore use of EMA to facilitate dietary assessment in children.

To describe trends of childhood stunting among under-5s in Uganda and to assess the impact of maternal education, wealth and residence on stunting.

Serial and pooled cross-sectional analyses of data from Uganda Demographic and Health Surveys (UDHS) of 1995, 2001, 2006 and 2011. Prevalence of stunting and mean height-for-age Z-score were computed by maternal education, wealth index, region and other sociodemographic characteristics. Multivariable logistic and linear regression models were fitted to survey-specific and pooled data to estimate independent associations between covariates and stunting or Z-score. Sampling weights were applied in all analyses.

Uganda.

Children aged <5 years.

Weighted sample size was 14 747 children. Stunting prevalence decreased from 44·8% in 1995 to 33·2% in 2011. UDHS reported stunting as 38% in 1995, underestimating the decline because of transitioning from National Center for Health Statistics/Centers for Disease Control and Prevention standards to WHO standards. Nevertheless, one in three Ugandan children was still stunted by 2011. South Western, Mid Western, Kampala and East Central regions had highest odds of stunting. Being born in a poor or middle-income household, of a teen mother, without secondary education were associated with stunting. Other persistent stunting predictors included small birth size, male gender and age 2–3 years.

Sustained decrease in stunting suggests that child nutrition interventions have been successful; however, current prevalence does not meet Millennium Development Goals. Stunting remains a public health concern and must be addressed. Customizing established measures such as female education and wealth creation while targeting the most vulnerable groups may further reduce childhood stunting.

Few previous studies in Latin America (LA) have provided data on dietary intake composition with a standardized methodology. The present study aimed to characterize energy intake (EI) and to describe the main food sources of energy in representative samples of the urban population from eight LA countries from the Latin American Study in Nutrition and Health (ELANS).

Cross-sectional study. Usual dietary intake was assessed with two non-consecutive 24 h dietary recalls.

Urban areas from eight countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, Venezuela), September 2014 to July 2015.

Adolescents and adults aged 15–65 years. Final sample comprised 9218 individuals, of whom 6648 (72·1 %) were considered plausible reporters.

Overall, mean EI was 8196 kJ/d (1959 kcal/d), with a balanced distribution of macronutrients (54 % carbohydrate, 30 % fat, 16 % protein). Main food sources of energy were grains, pasta and bread (28 %), followed by meat and eggs (19 %), oils and fats (10 %), non-alcoholic homemade beverages (6 %) and ready-to-drink beverages (6 %). More than 25 % of EI was provided from food sources rich in sugar and fat, like sugary drinks, pastries, chips and candies. Meanwhile, only 18 % of EI was from food sources rich in fibre and micronutrients, such as whole grains, roots, fruits, vegetables, beans, fish and nuts. No critical differences were observed by gender or age.

Public health efforts oriented to diminish consumption of refined carbohydrates, meats, oils and sugar and to increase nutrient dense-foods are a priority in the region to drive to a healthier diet.

Studies have shown that consumption of low-calorie sweeteners (LCS) may be associated with harmful health effects. The current study investigated the presence and types of LCS added to packaged foods.

Cross-sectional study analysing the presence and types of LCS in the ingredients lists of packaged foods sold at a major Brazilian supermarket. To identify types of LCS allowed for use in foods in Brazil, current legislation was consulted. Data were organised and analysed through descriptive statistics, presenting simple and relative frequencies of LCS presence categorised by food group.

Supermarket in Florianópolis, southern Brazil.

Packaged food products (n 4539) from eight food groups.

One or more LCS were found in 602 (13·3 %) of the packaged foods analysed. There were 1329 citations of LCS among these foods, with a mean of 2·2 sweeteners per food. Groups with the highest frequency of foods containing LCS were: products with energy derived from carbohydrates and fats (25·0 %); milk and dairy products (11·7 %); bakery products, cereals, legumes, roots and tubers (11·2 %); and fruits, juices, nectars and fruit drinks (8·3 %).

There was high prevalence of packaged foods with LCS, especially in food groups that form the basis of the Brazilian diet. The study was the first to extensively analyse the presence and types of LCS in packaged foods available for sale in a Brazilian supermarket and can be useful to monitor the use of LCS in these foods, as well as to support future changes in legislation to label sugars.

To determine if family childcare homes (FCCH) in Nebraska meet best practices for nutrition and screen time, and if focusing on nutrition and screen time policies and practices improves the FCCH environment.

A pre–post evaluation was conducted using the Go Nutrition and Physical Activity Self-Assessment for Childcare (Go NAP SACC).

FCCH in Nebraska, USA.

FCCH enrolled in the Child and Adult Care Food Program (CACFP; n 208) participated in a pre–post evaluation using Go NAP SACC.

At baseline, all FCCH met the minimum childcare standards for fifty-four of fifty-six practices in nutrition and screen time. After the intervention, FCCH demonstrated significant improvement in fourteen of the forty-four Child Nutrition items and eleven of the twelve Screen Time items. However, FCCH providers did not meet best practices at post-intervention. Lowest scores were found in serving meals family-style, promoting visible support for healthy eating, planned nutrition education and written policy on child nutrition. For screen time, lowest scores were reported on the availability of television, offering families education on screen time and having a written policy on screen time.

FCCH in Nebraska were able to strengthen their policies and practices after utilizing Go NAP SACC. Continued professional development and participation in targeted interventions may assist programmes in sustaining improved practices and policies. Considering the varying standards and policies surrounding FCCH, future studies comparing the current findings with childcare centres and non-CACFP programmes are warranted.

To evaluate the nutritional quality, particularly the fat and salt contents, of meals offered to children (kids’ meals) at chain restaurants in Japan.

A web-based content analysis was conducted to evaluate the type of restaurant, type of meal, incentives, health claims and nutrition data of kids’ meals. The nutritional appropriateness of kids’ meals was assessed with the Standard for the School Lunch Program, which regulates energy (≤2218 kJ), protein (20–30 g), fat (≤30 % of energy (E%)) and salt (<2 g) contents of the school lunch in Japan. Linear mixed models were employed for evaluating the relationship between the characteristics of kids’ meals and their fat (E%) or salt (g) content.

Restaurant websites providing nutritional data of kids’ meals in Japan.

A total of 438 kids’ meals offered by forty-two chain restaurant brands from across twenty food-service companies.

Overall, 58·9, 40·6 and 34·5 % of the kids’ meals were determined to be appropriate regarding their energy (≤2218 kJ), fat (≤30 E%) and salt content (<2 g). In addition, 15·5 % of kids’ meals met the multiple standards of energy, fat and salt contents. ‘Japanese-style’ (restaurant-level characteristic) was associated with a decrease in the fat E% of kids’ meals (β=−6·2; 95 % CI −11·0, −1·4) and an increase in the salt content (β=0·7; 95 % CI 0·06, 1·3).

The characteristics of the restaurant-served kids’ meals in Japan were high fat E% and high salt content from different cultural contexts of the Western and the Japanese diet.

To examine associations between household-level characteristics and underweight in a post-conflict population.

Nutritional status of residents in the Gulu Health and Demographic Surveillance Site was obtained during a community-based cross-sectional study, ~6 years after the civil war. Household-level factors included headship, polygamy, household size, child-to-adult ratio, child crowding, living with a stunted or overweight person, deprived area, distance to health centre and socio-economic status. Multilevel logistic regression models examined associations of household and community factors with underweight, calculating OR, corresponding 95 % CI and intraclass correlation coefficients. Effect modification by gender and age was examined by interaction terms and stratified analyses.

Rural post-conflict area in northern Uganda.

In total, 2799 households and 11 312 individuals were included, representing all age groups.

Living in a female-headed v. male-headed household was associated (OR; 95 % CI) with higher odds for underweight among adult men (2·18; 1·11, 4·27) and girls <5 years (1·51; 0·97, 2·34), but lower odds among adolescent women aged 13–19 years (0·46; 0·22, 0·97). Higher odds was seen for residents living in deprived areas (1·37; 0·97, 1·94), with increasing distance to health services (P-trend <0·05) and among adult men living alone v. living in an average-sized household of seven members (3·23; 1·22, 8·59). Residents living in polygamous households had lower odds for underweight (0·79; 0·65, 0·97).

The gender- and age-specific associations between household-level factors and underweight are likely to reflect local social capital structures. Adapting to these is crucial before implementing health and nutrition interventions.

Suboptimal nutrition among children remains a problem among South Asian (SA) families. Appropriate complementary feeding (CF) practices can greatly reduce this risk. Thus, we undertook a systematic review of studies assessing CF (timing, dietary diversity, meal frequency and influencing factors) in children aged <2 years in India.

Searches between January 2000 and June 2016 in MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, CINAHL, Cochrane Library, BanglaJOL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research on CF practices in SA children aged 0–2 years and/or their families. Search terms: ‘children’, ‘feeding’ and ‘Asians’ and derivatives. Two researchers undertook study selection, data extraction and quality appraisal (EPPI-Centre Weight of Evidence).

From 45 712 abstracts screened, sixty-four cross-sectional, seven cohort, one qualitative and one case–control studies were included. Despite adopting the WHO Infant and Young Child Feeding guidelines, suboptimal CF practices were found in all studies. In twenty-nine of fifty-nine studies, CF was introduced between 6 and 9 months, with eight studies finding minimum dietary diversity was achieved in 6–33 %, and ten of seventeen studies noting minimum meal frequency in only 25–50 % of the study populations. Influencing factors included cultural influences, poor knowledge on appropriate CF practices and parental educational status.

This is the first systematic review to evaluate CF practices in SA in India. Campaigns to change health and nutrition behaviour and revision of nationwide child health nutrition programmes are needed to meet the substantial unmet needs of these children.

To understand the effects of interviewers on the responses they collect for measures of food security, income and selected survey quality measures (i.e. discrepancy between reported Supplemental Nutrition Assistance Program (SNAP) status and administrative data, length of time between initial and final interview, and missing income data) in the US Department of Agriculture’s National Household Food Acquisition and Purchase Survey (FoodAPS).

Using data from FoodAPS, multilevel models with random interviewer effects were fitted to estimate the variance in each outcome measure arising from effects of the interviewers. Covariates describing each household’s socio-economic status, demographics and experience in taking the survey, and interviewer-level experience were included as fixed effects. The variance components in the outcomes due to interviewers were estimated. Outlier interviewers were profiled.

Non-institutionalized households in the continental USA (April 2012–January 2013).

Individuals (n 14 317) in 4826 households who responded to FoodAPS.

There was a substantial amount of variability in the distributions of the outcomes examined (i.e. time between initial and final interview, reported values for food security, individual income, missing income) among the FoodAPS interviewers, even after accounting for the fixed effects of the household- and interviewer-level covariates and removing extreme outlier interviewers.

Interviewers may introduce error in food acquisition survey data when they are asked to interact with the respondents. Managers of future surveys with similarly complex data collection procedures could consider using multilevel models to adaptively identify and retrain interviewers who have extreme effects on data collection outcomes.

The present study assessed the nutrition information displayed on ready-to-eat packaged foods and the nutritional quality of those food products in Thailand.

In March 2015, the nutrition information panels and nutrition and health claims on ready-to-eat packaged foods were collected from the biggest store of each of the twelve major retailers, using protocols developed by the International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support (INFORMAS). The Thai Nutrient Profile Model was used to classify food products according to their nutritional quality as ‘healthier’ or ‘less healthy’.

In total, information from 7205 food products was collected across five broad food categories. Out of those products, 5707 (79·2 %), 2536 (35·2 %) and 1487 (20·6 %) carried a nutrition facts panel, a Guideline Daily Amount (GDA) label and health-related claims, respectively. Only 4691 (65·1 %) and 2484 (34·5 %) of the products that displayed the nutrition facts or a GDA label, respectively, followed the guidelines of the Thai Food and Drug Administration. In total, 4689 products (65·1 %) could be classified according to the Thai Nutrient Profile Model, of which 432 products (9·2 %) were classified as healthier. Moreover, among the 1487 products carrying health-related claims, 1219 (82·0 %) were classified as less healthy. Allowing less healthy food products to carry claims could mislead consumers and result in overconsumption of ready-to-eat food products.

The findings suggest effective policies should be implemented to increase the relative availability of healthier ready-to-eat packaged foods, as well as to improve the provision of nutrition information on labels in Thailand.

We evaluated the extent to which providing training and technical assistance to early childcare centre (ECC) directors, faculty and staff in the implementation of evidence-based nutrition strategies improved the nutrition contexts, policies and practices of ECC serving racially and ethnically diverse, low-income children in Broward County, Florida, USA. The nutrition strategies targeted snack and beverage policies and practices, consistent with Caring for Our Children National Standards.

We used the nutrition observation and document review portions of the Environment and Policy Assessment and Observation (EPAO) instrument to observe ECC as part of a one-group pre-test/post-test evaluation design.

ECC located within areas of high rates of poverty, diabetes, minority representation and unhealthy food index in Broward County, Florida, USA.

Eighteen ECC enrolled, mean 112·9 (sd 53·4) children aged 2–5 years; 12·3 (sd 7·2) staff members; and 10·2 (sd 4·6) children per staff member at each centre.

We found significant improvements in centres’ overall nutrition contexts, as measured by total EPAO nutrition scores (P=0·01). ECC made specific significant gains within written nutrition policies (P=0·03) and nutrition training and education (P=0·01).

Our findings support training ECC directors, faculty and staff in evidence-based nutrition strategies to improve the nutrition policies and practices of ECC serving racially and ethnically diverse children from low-income families. The intervention resulted in improvements in some nutrition policies and practices, but not others. There remains a need to further develop the evaluation base involving the effectiveness of policy and practice interventions within ECC serving children in high-need areas.