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.

To evaluate the predictive ability of mid-upper arm circumference (MUAC) for detecting severe wasting (weight-for-height Z-score (WHZ) <−3) among children aged 6–59 months.

Cross-sectional survey.

Rural Uttar Pradesh, India.

Children (n 18 456) for whom both WHZ (n 18 463) and MUAC were available.

The diagnostic test accuracy of MUAC for severe wasting was excellent (area under receiver-operating characteristic curve = 0·933). Across the lower range of MUAC cut-offs (110–120 mm), specificity was excellent (99·1–99·9 %) but sensitivity was poor (13·4–37·2 %); with higher cut-offs (140–150 mm), sensitivity increased substantially (94·9–98·8 %) but at the expense of specificity (37·6–71·9 %). The optimal MUAC cut-off to detect severe wasting was 135 mm. Although the prevalence of severe wasting was constant at 2·2 %, the burden of severe acute malnutrition, defined as either severe wasting or low MUAC, increased from 2·46 to 17·26 % with cut-offs of <115 and <135 mm, respectively. An MUAC cut-off <115 mm preferentially selected children aged ≤12 months (OR=11·8; 95 % CI 8·4, 16·6) or ≤24 months (OR=23·4; 95 % CI 12·7, 43·4) and girls (OR=2·2; 95 % CI 1·6, 3·2).

Based on important considerations for screening and case detection in the community, modification of the current WHO definition of severe acute malnutrition may not be warranted, especially in the Indian context.

To understand caregivers’ perceptions of children’s linear growth and to identify the cultural meanings and perceptions of risk associated with poor height attainment.

Three investigators from Bangladesh conducted twelve focus group discussions.

The study was conducted in rural and slum settings in Bangladesh.

Participants included mothers and alternative caregivers (n 81) who were recruited by household screening. No eligible, recruited subjects refused participation.

Caregivers reported limited experience with growth monitoring services from the health system. Caregivers mainly use visual cues and developmental milestones to understand if children are growing properly, and recognize that children normally experience both weight gain and linear growth with age. Mothers expressed concern over children’s malnutrition and short stature, but did not discuss children’s failure to attain a ‘growth potential’ or distinguish inherited short stature from stunting. Caregivers interpret the consequences of poor height attainment as primarily social and economic and cite few health risks.

Linear growth interpretation is determined more by community norms than by guidance from nutrition programming or the health system. Interventions to prevent or reduce linear growth failure may be perceived to have limited value where appropriate linear growth in children is determined by comparison to peers and siblings. Such perceptions may be significant barriers to programmes addressing stunting prevention in settings where many children are stunted. Efforts to raise awareness about the risks of linear growth faltering may need to consider delivering messages to caregivers that emphasize the social and economic consequences of stunting.

To estimate the determinants of stunting using rich data from a birth cohort study from urban South Africa and to examine the various mechanisms, both proximate and distal, through which maternal education affects stunting.

Multivariate regression analysis using birth cohort data, where the outcome variable was stunting at age 2 years, and multiple mediator analysis to identify pathways from maternal education to stunting.

South Africa’s largest metropolitan area, Soweto-Johannesburg.

Participants of Birth to Twenty Plus, a longitudinal cohort study of children born in 1990 (n 691).

In multivariate analysis, the birth weight Z-score (−0·084; P<0·001; 95 % CI −0·11, −0·06), the mother’s openness towards modern health care, captured by a vaccination score (−0·05; P=0·04; 95 % CI −0·10, −0·00), and a better-quality care environment (−0·015; P=0·04; 95 % CI −0·03, −0·00) were found to be negatively associated with stunting. Having experienced symptoms of illness related to ears and eyes increased the risk of stunting (0·038; P=0·01; 95 % CI 0·01, 0·07). Results of the mediation analysis showed that maternal education had an indirect effect on stunting largely through socio-economic status and the antenatal environment (measured by the birth weight Z-score).

Overall, many of the factors that were protective against stunting in the final analysis, whether they operated through maternal education or not, were related to the mother’s contribution to the child’s life. This reinforces the idea that to minimise stunting, enhanced antenatal and postnatal services to better support and empower mothers may be important.

To retrospectively investigate the association between short stature and increased sitting height ratio (SHR) – indicators of stunting – and obesity markers in adults.

Cross-sectional evaluation of the EPIPorto cohort. Weight, height, sitting height and waist circumference were measured. Obesity was assessed for men and women through BMI and waist-to-height ratio (WHtR). Short stature (women, <152 cm; men, <164 cm) and high SHR (women, ≥54·05 %; men, ≥53·25 %) were taken as stunting measures. OR with 95 % CI were computed using logistic regression models.

Representative sample of adults from EPIPorto, an adult cohort study from Porto, Portugal.

A sample of 1682 adults, aged 18–86 years, was analysed.

Higher obesity prevalence was found among women (BMI≥30·0 kg/m2: 25·5 v. 13·3 %, P<0·001) and a higher proportion of men presented abdominal obesity (WHtR≥0·5: 80·1 v. 71·1 %, P<0·001). A positive association was found between short stature and obesity measures for women (multivariate-adjusted OR; 95 % CI: 1·75; 1·17, 2·62 for BMI≥30·0 kg/m2; 1·89; 1·24, 2·87 for WHtR≥0·5). Increased SHR was associated with higher likelihood of having BMI≥30·0 kg/m2 in both sexes (multivariate-adjusted OR; 95 % CI: 2·10; 1·40, 3·16 for women; 1·92; 1·07, 3·43 for men) but not with WHtR≥0·5.

Different growth markers are associated with obesity in adults. However, this association depends on the population and anthropometric measures used: short stature is associated with a higher risk of presenting excessive weight in women but not in men; SHR is more sensitive to detect this effect in both sexes.

Dietary energy density (ED) might have influences on body composition. We therefore examined whether ED is associated with body composition among Chinese adults.

We collected dietary data through validated two-day 24 h recalls. ED, defined as the amount of energy per unit weight of food consumed, was calculated based on five methods. Multiple linear regression analyses were performed to explore the associations between ED and body composition parameters, including BMI, fat mass index (FMI), fat-free mass index (FFMI), percentage body fat (%BF) and waist circumference (WC).

Southwest China.

Chinese adults (n 1933) in 2013.

After adjusting the covariates, all ED definitions were positively associated with BMI, FMI, FFMI, %BF and WC among women (P<0·01). In men, however, ED with foods only was positively associated with BMI, FMI, FFMI and %BF (P<0·05), but not with WC (P=0·07); we also found null associations between ED with foods and all beverages and body composition among men. Additionally, ED contributed to higher increases of body composition in women than in men (P<0·01).

The present study supports the positive association between ED and body composition among adults in Southwest China, in which beverages may play an important role.

Excess meat consumption, particularly of red and processed meats, is associated with nutritional and environmental health harms. While only a small portion of the population is vegetarian, surveys suggest many Americans may be reducing their meat consumption. To inform education campaigns, more information is needed about attitudes, perceptions, behaviours and foods eaten in meatless meals.

A web-based survey administered in April 2015 assessed meat reduction behaviours, attitudes, what respondents ate in meatless meals and sociodemographic characteristics.

Nationally representative, web-based survey in the USA.

US adults (n 1112) selected from GfK Knowledgeworks’ 50 000-member online panel. Survey weights were used to assure representativeness.

Two-thirds reported reducing meat consumption in at least one category over three years, with reductions of red and processed meat most frequent. The most common reasons for reduction were cost and health; environment and animal welfare lagged. Non-meat reducers commonly agreed with statements suggesting that meat was healthy and ‘belonged’ in the diet. Vegetables were most often consumed ‘always’ in meatless meals, but cheese/dairy was also common. Reported meat reduction was most common among those aged 45–59 years and among those with lower incomes.

The public and environmental health benefits of reducing meat consumption create a need for campaigns to raise awareness and contribute to motivation for change. These findings provide rich information to guide intervention development, both for the USA and other high-income countries that consume meat in high quantities.

Despite progress, levels of malnutrition among children in Bangladesh are among the highest in the world and this is one of the major causes of death in children. The pace of reduction in the prevalence of undernutrition among children is still relatively low. The present study aimed to examine the association between parental education and childhood undernutrition among Bangladeshi children under 5 years of age when adjusting for potential risk factors.

The data set was extracted from a nationally representative survey based on a cross-sectional study, the Bangladesh Demographic and Health Survey (BDHS) 2014.

The base survey was conducted using a two-stage stratified sample of households. In the first stage, 600 enumeration areas (EA) were selected with probability proportional to EA size (207 EA from urban areas, 393 EA from rural areas).

A total of 7173 children under 5 years from 17 863 households were considered for the analysis. A modified Poisson regression model was implemented to the data for assessing the relationship between parental education and childhood undernutrition when demographic and socio-economic covariates for the child, parents, households and clustering were adjusted.

Higher parental education level was associated with lower levels of stunting and underweight, but not with wasting. Maternal and paternal education were both significantly associated with the reduction in prevalence of childhood undernutrition in Bangladesh.

Paternal education appears equally as important as maternal education in reducing undernutrition prevalence among children under 5 years in Bangladesh.

To identify home environment factors associated with toddler dietary behaviours using ecological momentary assessment (EMA).

Home environment and toddler’s diet were assessed by mothers through EMA (random beeps over ≤8 d and a brief survey). Dietary outcomes were fruit/vegetable consumption, eating episode (‘snack’ v. ‘meal’) and sugar-sweetened beverage (SSB) consumption. Home environment factors included interacting with mother, eating alone/with others, eating in a high chair/chair at the table, watching television and movement/translocation. Multilevel logistic mixed-effects regression models assessed both within- (individual toddlers across time) and between- (toddlers-on-average) subject effects.

Low-income mother–toddler dyads (n 277).

Urban and suburban Maryland, USA.

EMA captured eating/drinking episodes for 249/277 (89·9 %) toddlers (883 eating episodes, 1586 drinking episodes). Toddlers-on-average were more likely (adjusted OR, P value) to eat fruit/vegetables when not moving around (0·43, P=0·043), eat with the television off (0·33, P<0·001) and eat in a high chair/chair (3·38, P<0·001); no within-subject effects were shown. For eating episodes, both toddlers-on-average and individual toddlers were more likely to eat snacks when not in a high chair/chair (0·13, P<0·001 and 0·06, P<0·001, respectively) and when eating alone (0·30, P<0·001 and 0·31, P<0·001, respectively). Also, individual toddlers were more likely to eat snacks when moving around (3·61, P<0·001). Toddlers-on-average were more likely to consume SSB when not in a high chair/chair (0·21, P=0·001), eating alone (0·38, P=0·047) or during a snacking episode (v. a meal: 3·96, P=0·012); no within-subject effects shown.

Factors in the home environment are associated with dietary behaviours among toddlers. Understanding the interplay between the home environment and toddler diet can inform future paediatric dietary recommendations.

The aim of the current meta-analysis was to evaluate the accuracy of using BMI based on self-reported height and weight (BMIsr) to estimate the prevalence of overweight and obesity among children and adolescents.

A systematic literature search was conducted to select studies that compared the prevalence rates of overweight and obesity based on BMIsr and BMIm (BMI based on measured height and weight). A random-effect model was assumed to estimate summary prevalence rates and prevalence ratio (PR).

Thirty-seven studies were included. The aggregated prevalence of overweight and obesity based on BMIsr (0·190, 95 % CI 0·163, 0·221) was significantly lower than that based on BMIm (0·233, 95 % CI 0·203, 0·265). The pooled mean PR was 0·823 (95 % CI 0·775, 0·875). Moderator analyses showed that the underestimation was related to gender, age, weight status screened (overweight v. obesity) and weight status screening tool.

BMIsr may produce less biased results under some conditions than others. Future researchers using BMIsr may consider these findings and avoid the conditions that could lead to more severe underestimation of the prevalence of overweight and obesity among children and adolescents.

To determine which parental health behaviours early in childhood most strongly predict whole-of-childhood dietary trajectories.

Population-based Longitudinal Study of Australian Children (LSAC, waves 1–6; 2004–2014). Exposures were parents’ fruit/vegetable consumption, alcohol, smoking and physical activity at child age 0–1 years (B Cohort) or 4–5 years (K Cohort). Outcomes, from repeated biennial short diet diaries, were group-based trajectories of (i) dietary scores and empirically derived patterns of (ii) healthful and (iii) unhealthful foods consumed, spanning ages 2–3 to 10–11 years (B Cohort) and 4–5 to 14–15 years (K Cohort). We investigated associations of baseline parental health behaviours with child dietary trajectories using multinomial logistic regression.

Australian homes.

Of children, 4443 (87·0 %) from the B Cohort and 4620 (92·7 %) from the K Cohort were included in all trajectories. Multivariable analyses included 2719 to 2905 children and both parents.

Children whose primary caregiver reported the lowest fruit/vegetable consumption had markedly higher odds of belonging to the least healthy score and pattern trajectories (K Cohort: OR=8·7, 95 % CI 5·0, 15·1 and OR=8·4, 95 % CI 4·8, 14·7, respectively); associations were weaker (K Cohort: OR=2·3, 95 % CI 1·0, 5·2) for the unhealthiest pattern trajectory. Secondary caregiver fruit/vegetable associations were smaller and inconsistent. Parental alcohol, smoking and physical activity were not predictive in multivariable analyses. Results were largely replicated for the B Cohort.

Low primary caregiver fruit/vegetable consumption increased nearly ninefold the odds of children being in the lowest intake of healthy, but only weakly predicted unhealthy, food trajectories. Healthy and unhealthy food intake may have different determinants.

The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve diet. The present systematic literature review aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults.

A systematic search was performed in PubMed, Scopus, Web of Science and the Cochrane Library. Titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. Studies were included when focusing on dietary intake as an outcome and on chemosensory, oral, cognitive or physical function as a determinant.

Community.

Older adults at least 65 years old without acute or specific chronic diseases.

From initially 14 585 potentially relevant papers, thirty-six were included. For chemosensory, cognitive and physical function only a few papers were found, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied (n 31). Different surrogates of oral function like dental status, number of teeth, bite force or chewing problems were associated with food as well as nutrient intakes including fibre. As all except six studies had a cross-sectional design, no causal relationships could be derived.

Among functional determinants of dietary intake oral factors are well documented in older adults, whereas the role of other functional determinants remains unclear and needs further systematic research.

To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India.

Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall.

High-altitude region of Nainital District, Uttarakhand State, North India.

Community-dwelling geriatric subjects (n 981) aged 60 years or above.

We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0–29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work.

There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.

To evaluate Ca intake and its association with cardiometabolic risk factors during childhood.

A cross-sectional study with a representative sample. Food consumption was assessed through three 24 h dietary recalls. Anthropometry, body composition and biochemical measurements were also conducted.

Viçosa, Minas Gerais, Brazil.

Children between 8 and 9 years old (n 350) enrolled in public and private schools in the urban area of the municipality of Viçosa.

Almost all children had inadequate intake of Ca (97·4 %), especially those with low income, non-white and who studied in public schools. Foods that contributed most to Ca intake were ‘milk’ and ‘cheeses and yoghurts’ (R2=0·66 and 0·13, respectively), and intake of ‘milk’ was correlated with ‘chocolate milk powder’ intake (r=0·538, P<0·01). Children with lower Ca intake had a higher prevalence of increased C-reactive protein (prevalence ratio=2·93; 95 % CI 1·21, 7·07), increased waist circumference (prevalence ratio=2·86; 95 % CI 1·01, 8·13) and a lower prevalence of high LDL cholesterol (prevalence ratio=0·64; 95 % CI 0·41, 0·99).

Lower Ca intake was associated with excess abdominal adiposity and subclinical inflammation in Brazilian children. Monitoring of adequate Ca intake is important, especially in poorer communities.

To assess the association of fish consumption with risk of dementia and its dose–response relationship, and investigate variations in the association among low-, middle- and high-income countries.

A new community-based cross-sectional study and a systematic literature review.

Urban and rural communities in China; population-based studies systematically searched from worldwide literature.

Chinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis.

In the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose–response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose–response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimer’s disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively.

Greater consumption of fish is associated with a lower risk of dementia. Increasing fish consumption may help prevent dementia worldwide regardless of income level.

Wheat and rye, the most consumed whole grains (WG) in the Nordic countries, contain alkylresorcinols (AR) in their bran. AR concentrations in human adipose tissue might reflect long-term WG rye and wheat intake. We aimed to evaluate AR concentrations in adipose tissue biopsies as a long-term biomarker of WG wheat and rye intake in free-living Swedish men and women.

Cross-sectional study. AR concentrations in adipose tissue biopsies were analysed and compared with long-term WG intake assessed by three FFQ (repeated over a period of 14 years in men, 17 years in women) and with plasma AR concentrations.

The Cohort of Swedish Men between 1997 and 2010 and the Swedish Mammography Cohort between 1987 and 2003, Sweden.

Men (n 149) and women (n 109).

Long-term WG rye intake estimated with repeated FFQ correlated (r=0·31–0·41, P<0·01) with adipose-tissue AR concentrations, while WG wheat intake correlated only weakly (r=0·17–0·33, P<0·05). Total AR concentration in adipose tissue was 61 % lower in women than in men at similar energy-adjusted WG wheat and rye intakes, but plasma concentrations were similar. AR concentrations in adipose tissue correlated well with plasma concentrations (r=0·49–0·81, P<0·001).

AR in adipose tissue reflected long-term WG rye but not WG wheat intake, probably due to poor precision in estimating WG wheat intake by FFQ. AR in adipose tissue appears promising as a biomarker of long-term WG rye intake but should be adjusted for sex.

We aimed to examine the food-seeking experiences of homeless emerging adults (age 18–24 years) in a US urban context.

The study used a qualitative descriptive design, combining semi-structured interviews with a standardized quantitative measure of food insecurity. Interview data were coded using constant comparative methods to identify patterns across and within interviews. Emerging themes were confirmed and refined through member checking.

Buffalo, a mid-sized city in the Northeastern USA.

A sample of thirty participants was recruited through community-based methods. Eligibility criteria specified that participants were aged 18–24 years and did not have a stable place to live. The sample was demographically diverse and included participants who were couch-surfing, staying on the streets and/or using shelters.

Participants’ food access strategies varied across their living circumstances. Common strategies included purchasing food with cash or benefits (reported by 77 %), using free meal programmes (70 %) and eating at friends’ or relatives’ homes (47 %). Although 70 % of participants received Supplemental Nutrition Assistance Program benefits, several reported access barriers, including initial denials of eligibility due to being listed on a parent’s application even when the participant no longer resided in the household. Participants described a stigma associated with using food pantries and free meal programmes and expressed preference for less institutionalized programmes such as Food Not Bombs.

Given endemic levels of food insecurity among homeless youth and young adults, policy modifications and service interventions are needed to improve food access for this population.

The current study aimed to assess Uruguayan consumers’ accounts of their own need to change their dietary patterns, their intended changes and the barriers related to doing so, and to compare the intentions and barriers with the recommendations of the national dietary guidelines.

An online survey with 2381 Uruguayan employed adults, aged between 18 and 65 years, 65 % females, was conducted. Participants had to answer two open-ended questions related to changes they could make in the foods they eat and/or the way in which they eat to improve the quality of their diet and the reasons why they had not implemented those changes yet. Content analysis using inductive coding by two researchers was used to analyse the responses.

Consumers mainly intended to change consumption of types of foods, particularly eating more fruits, vegetables and legumes and consuming less flour, but also intended to alter their eating patterns. Lack of time and the fact that healthy foods are perceived as being more expensive than unhealthy foods were major barriers to behaviour change. Some of the recommendations of the dietary guidelines, particularly those related to enjoying cooking and meals and engaging in it as a social activity, were not represented in consumer accounts.

Accompanying policies to the dietary guidelines need to underline the importance of changes in dietary patterns, including greater enjoyment and sharing food preparation and meals in the company with others, address misconceptions about flour, and provide concrete, consumer-derived recommendations on how to enact the guidelines.

Food insecurity is associated with toxic stress and adverse long-term physical and mental health outcomes. It can be experienced chronically and also triggered or exacerbated by natural and human-made hazards that destabilize the food system. The Baltimore Food System Resilience Advisory Report was created to strengthen the resilience of the city’s food system and improve short- and long-term food security. Recognizing food insecurity as a form of trauma, the report was developed using the principles of trauma-informed social policy. In the present paper, we examine how the report applied trauma-informed principles to policy development, discuss the challenges and benefits of using a trauma-informed approach, and provide recommendations for others seeking to create trauma-informed food policy.

Report recommendations were developed based on: semi-structured interviews with food system stakeholders; input from community members at outreach events; a literature review; Geographic Information System mapping; and other analyses. The present paper explores findings from the stakeholder interviews.

Baltimore, Maryland, USA.

Baltimore food system stakeholders stratified by two informant categories: organizations focused on promoting food access (n 13) and community leaders (n 12).

Stakeholder interviews informed the recommendations included in the report and supported the idea that chronic and acute food insecurity are experienced as trauma in the Baltimore community.

Applying a trauma-informed approach to the development of the Baltimore Food System Resilience Advisory Report contributed to policy recommendations that were community-informed and designed to lessen the traumatic impact of food insecurity.