There is an urgent need to identify and develop cross-sectoral policies which promote and support a healthy, safe and sustainable food system. To help shape the political agenda, a critical first step is a shared definition of such a system among policy makers across relevant sectors. The aim of the present study was to determine how Australian policy actors define, and contribute to, a healthy, safe and sustainable food system.

A Delphi survey, consisting of two rounds, was conducted. Participants were asked how they define, and contribute to, a healthy, safe and sustainable food system (Round 1) and indicate their level of agreement with summary statements (Round 2).

This was an online Delphi survey conducted in Australia.

Twenty-nine and fourteen multisectoral and multilevel policy makers completed Round 1 and Round 2, respectively.

The definition included food processing regulation, environmentally friendly food production and access to nutritious food. All agreed that it was important for them to improve access and supply of healthy food and ensure healthy planning principles are applied.

There were cross-sectoral differences in definitions and contributions; however, critical consensus was achieved. The study contributes to the definition of key elements of a cross-sectoral food and nutrition policy to meet today’s environmental, health, social and economic challenges; however, further research using a more representative multisectoral sample is warranted.

To identify differences in dietary quality, dietary greenhouse gas (GHG) emissions and food consumption over 20 years in a Dutch cohort.

Participants (n 8932) filled out an FFQ in 1993–1997 and in 2015. The Dutch Healthy Diet index 2015 (DHD15-index) score, GHG emissions and consumption of food groups (g/4184 kJ (1000 kcal)) were compared between the time points with paired t tests.

The Netherlands.

European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) cohort, aged 18–65 years at baseline.

Total energy intake decreased by –678 (95 % CI –4908, 3377) kJ/d (–162 (95 % CI –1173, 807) kcal/d) for men and –372 (95 % CI –3820, 3130) kJ/d (–89 (95 % CI –913, 748) kcal/d) for women. DHD15-index scores increased by 11 % (from 64·8 to 71·9 points) and 13 % (from 65·2 to 73·6 points) in men and women, respectively (P < 0·0001), mainly due to an increased (shell)fish and nuts/seeds/nut paste consumption. After energy intake adjustment, dietary-related GHG emissions increased by 5 % in men (2·48–2·61 kg CO2-eq/4184 kJ (1000 kcal), P < 0·0001) and were similar in women (0·4 %, 2·70–2·71 kg CO2-eq/4184 kJ (1000 kcal), P = 0·3930) due to the increased consumption of (shell)fish, nuts/seeds/nut paste, poultry and higher GHG-intensive red meats such as beef.

This Dutch cohort analyses showed more healthy diets without mitigated GHG emissions over a 20-year period, at similar energy intakes. Higher consumption of (shell)fish and poultry was not yet at the expense of red and processed meat. Lower consumption of animal-based foods is needed to achieve healthier as well as environmentally friendly diets.

Aquaculture is one of the fastest-growing food production sectors in many low-income and food-deficit countries with aquatic ecozones. Yet its specific impact on nutrition and livelihood in local communities, where commercial and/or export-orientated aquaculture activities are developed, is largely unknown.

The present narrative and argumentative review aims to provide an overview of our current understanding of the connections between aquaculture agroecosystems, local and national fish production, fish consumption patterns and nutrition and health outcomes.

The agroecological dynamic in a coastal-estuarine zone, where the aquatic environment ranges from fully saline to freshwater, is complex, with seasonal and annual fluctuations in freshwater supply creating a variable salinity gradient which impacts on aquatic food production and on food production more generally. The local communities living in these dynamic aquatic ecozones are vulnerable to poverty, poor diet and health, while these ecosystems produce highly valuable and nutritious aquatic foods. Policies addressing the specific challenges of risk management of these communities are limited by the sectoral separation of aquatic food production – the fisheries and aquaculture sector, the broader food sector – and public health institutions.

Here we provide an argument for the integration of these factors to improve aquaculture value chains to better address the nutritional challenges in Bangladesh.

To examine mothers’ and young children’s consumption of indigenous and traditional foods (ITF), assess mothers’ perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption.

Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels.

Seme sub-County, Kenya.

Mothers with young children.

Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children’s ITF consumption levels.

A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

To evaluate the dietary diversity and the nutrient contribution of traditional foods (locally cultivated and wild) by conducting a food intake study in rural Ecuador.

Repeated 24 h recalls over a 14 d interval and frequency of consumption served to simulate the usual diet by the Multiple Source Method. Data on missing visits (n 11) were imputed using multivariate imputation by chained equations. The intakes of three macro- and six micronutrients were reported. Nutrient Adequacy Ratios, Mean Adequacy Ratio (MAR), Dietary Species Richness (DSR) and Minimum Dietary Diversity for Women were used as measures of dietary quality. A linear quantile mixed model was used to investigate the association between DSR, local species, MAR, age, education and occupation.

Guasaganda, Cotopaxi (Ecuador).

Rural, indigenous adult women, non-pregnant and not breast-feeding.

The studied diet had MAR of 0·78. Consumption of traditional foods contributed 38·6 % of total energy intake. Daily requirements for protein, carbohydrates, Fe and vitamin C were reached. An extra level of consumption of local species was associated with an increase in median MAR for macronutrients of 0·033 (P < 0·001). On the other hand, an extra level of consumption of local species was associated with an increase in median MAR for micronutrients of 0·052 (P < 0·001).

We found statistical evidence that traditional foods contribute to adequate intakes of macro- and micronutrients and dietary diversification in the studied population. Future public health interventions should promote the cultivation and consumption of traditional foods to increase the quality of the local diet.

Consumption of cow’s milk, which is associated with diet and health benefits, has decreased in the USA. The simultaneous increase in demand for more costly organic milk suggests consumer concern about exposure to production-related contaminants may be contributing to this decline. We sought to determine if contaminant levels differ by the production method used.

Half-gallon containers of organic and conventional milk (four each) were collected by volunteers in each of nine US regions and shipped on ice for analysis. Pesticide, antibiotic and hormone (bovine growth hormone (bGH), bGH-associated insulin-like growth factor 1 (IGF-1)) residues were measured using liquid or gas chromatography coupled to mass or tandem mass spectrometry. Levels were compared against established federal limits and by production method.

Laboratory analysis of retail milk samples.

Current-use pesticides (5/15 tested) and antibiotics (5/13 tested) were detected in several conventional (26–60 %; n 35) but not in organic (n 34) samples. Among the conventional samples, residue levels exceeded federal limits for amoxicillin in one sample (3 %) and in multiple samples for sulfamethazine (37 %) and sulfathiazole (26 %). Median bGH and IGF-1 concentrations in conventional milk were 9·8 and 3·5 ng/ml, respectively, twenty and three times that in organic samples (P < 0·0001).

Current-use antibiotics and pesticides were undetectable in organic but prevalent in conventionally produced milk samples, with multiple samples exceeding federal limits. Higher bGH and IGF-1 levels in conventional milk suggest the presence of synthetic growth hormone. Further research is needed to understand the impact of these differences, if any, on consumers.

A quarter of Australian children are overweight or obese. Research conducted in 2010 found that fast-food children’s meals were energy-dense and nutrient-poor. Since then, menu labelling and self-regulation of marketing have been introduced in Australia. The present study aimed to: (i) investigate the nutrient composition of children’s meals offered at fast-food chains; (ii) compare these with children’s daily requirements and recommendations and the food industry’s own criteria for healthier children’s meals; and (iii) determine whether results have changed since last investigated in 2010.

An audit of nutrition information for fast-food children’s meals was conducted. Meals were compared with 30 % (recommended contribution for a meal) and 100 % of children’s daily recommendations and requirements. A comparative analysis was conducted to determine if the proportion of meals that exceeded meal requirements and recommendations, and compliance with the food industry’s own criteria, changed between 2010 and 2016.

Large Australian fast-food chains.

All possible children’s meal combinations.

Overall, 289 children’s meals were included. Most exceeded 30 % of daily recommendations and requirements for a 4-year-old’s energy, saturated fat, sugars and Na. Results were also substantial for 8- and 13-year-olds, particularly for Na. When compared with mean energy and nutrient contents from 2010, there were minimal changes overall.

Children’s meals can provide excess energy, saturated fat, sugar and Na to children’s diets. Systematic reformulation of energy, saturated fat, sugars and Na would improve the nutrient composition of the meals.

The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status.

Pre/post analysis.

Boston, MA, USA.

Data were from the longitudinal Boston Puerto Rican Health Study (2007–2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA.

Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants.

Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

To estimate the consumption of ultra-processed foods and determine its association with dietary quality among middle-aged Japanese adults.

Cross-sectional study using data from the Saitama Prefecture Health and Nutrition Survey 2011. Dietary intake was assessed using one- or two-day dietary records. Sociodemographic and lifestyle factors were obtained via self-administered questionnaire. Food items were classified according to the NOVA system into four groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. The dietary share of each NOVA food group and their subgroups was calculated in relation to total energy intake, and the average dietary content of key nutrients was determined across tertiles of the dietary energy share of ultra-processed foods (low, middle and high intake).

Saitama Prefecture in Japan.

Community-dwelling adults aged 30–59 years (256 men, 361 women).

Consumption of unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods contributed 44·9 (se 0·8) %, 5·5 (se 0·2) %, 11·3 (se 0·4) % and 38·2 (se 0·9) % of total daily energy intake, respectively. A positive and statistically significant linear trend was found between the dietary share of ultra-processed foods (tertiles) and the dietary content of total and saturated fat, while an inverse relationship was observed for protein, vitamin K, vitamin B6, dietary fibre, magnesium, phosphorus and iron.

Our findings show that higher consumption of ultra-processed foods was associated with decreased dietary quality among Japanese adults.

Processed foods and fatty, sugary snacking products, such as fizzy drinks and desserts, have become more popular, causing a desire to replace meals with snacks worldwide. High-sugar and fat-rich food components have been reported to be associated with increased level of dental caries as well as underweight and overweight. The aim of the present cross-sectional population-based study was to analyse the eating behaviours of young, healthy Finnish males in association with oral health and BMI, considering self-reported and residential background factors.

Cross-sectional study.

Finnish Defence Forces, Finland.

The used clinical data were gathered from 13 564 Finnish conscripts born in the beginning of the 1990s through clinical check-ups. In addition, about 8700 of the conscripts answered a computer-assisted questionnaire (‘Oral Health of the Conscripts 2011’ data) about their background information and health habits.

There was distinct variation in dietary patterns. Eating breakfast, regular physical exercise and daily tooth brushing all decreased the odds for restorative dental treatment need (decayed teeth), whereas smoking and drinking fizzy drinks for quenching thirst increased it. Eating breakfast and dinner were each associated with lower BMI, but smoking increased the odds for higher BMI (≥25 kg/m2).

Regular, proper meals and especially eating breakfast decreased the odds for both dental caries and high BMI (≥25 kg/m2).

Consensus guidelines recommend that children consume reduced-fat (0·1–2 %) cow’s milk at age 2 years to reduce the risk of obesity. Behaviours and perspectives of parents and physicians about cow’s milk fat for children are unknown. Objectives were to: (i) understand what cow’s milk fat recommendations physicians provide to 2-year-old children; (ii) assess the acceptability of reduced-fat v. whole cow’s milk in children’s diets by parents and physicians; and (iii) explore attitudes and perceptions about cow’s milk fat for children.

Online questionnaires and individual interviews were conducted. Questionnaire data were analysed using descriptive statistics. Interview transcripts were analysed using a general inductive approach and thematic analysis.

The TARGet Kids! practice-based research network in Toronto, Canada.

Questionnaire respondents included fifty parents and fifteen physicians; individual interviews were conducted with with fourteen parents and twelve physicians.

Physicians provided various milk fat recommendations for 2-year-old children. Parents also provided different cow’s milks: eighteen (36 %) provided whole milk and twenty-nine (58 %) provided reduced-fat milk. Analysis of qualitative interviews revealed three themes: (i) healthy eating behaviours, (ii) trustworthy nutrition information and (iii) importance of dietary fat for children.

Parents provide, and physicians recommend, a variety of cow’s milks for children and hold mixed interpretations of the role of cow’s milk fat in children’s diets. Clarity about its effect on child adiposity is needed to help make informed decisions about cow’s milk fat for children.

To evaluate the impact of message framing on attitudes towards messages aimed at promoting the use of nutritional warnings, behavioural intention and actual behaviour, evaluated through visual attention to nutritional warnings and the choice of a snack product during a real choice task.

Following a between-subjects design, participants were exposed to loss-framed nutrition messages, gain-framed nutrition messages or non-nutrition-related messages (control group). After evaluating the messages, participants were asked to select a snack product as a compensation for their participation. The experiment was conducted using an eye tracker.

Montevideo (Uruguay).

Convenience sample of 201 people (18–51 years old, 58 % female).

The average percentage of participants who fixated their gaze on the nutritional warnings during the choice task was slightly but significantly higher for participants who attended to nutrition messages (regardless of their framing) compared with the control group. Participants who attended to loss-framed messages fixated their gaze on the warnings for the longest period of time. In addition, the healthfulness of the snack choices was higher for participants exposed to nutrition-related messages compared with the control group.

Results from the present work suggest that nutrition messages aimed at increasing awareness of nutritional warnings may increase consumers’ visual attention and encourage more heathful choices. The framing of the messages only had a minor effect on their efficacy.

To examine the relationship between knowledge and beverage consumption habits among children.

Cross-sectional analysis. Linear regression was used to identify sociodemographic, dietary and behavioural determinants of beverage consumption and knowledge, and to describe the relationships between children’s knowledge and water and sugar-sweetened beverage (SSB) consumption.

Seventeen elementary schools in London, Ontario, Canada.

A total of 1049 children aged 8–14 years.

Knowledge scores were low overall. Children with higher knowledge scores consumed significantly fewer SSB (β = −0·33; 95 % CI −0·49, −0·18; P < 0·0001) and significantly more water (β = 0·34; 95 % CI 0·16, 0·52; P = 0·0002). More frequent refillable water bottle use, lower junk food consumption, lower fruit and vegetable consumption, female sex, higher parental education, two-parent households and not participating in a milk programme were associated with a higher water consumption. Male sex, higher junk food consumption, single-parent households, lower parental education, participating in a milk programme, less frequent refillable water bottle use and permission to leave school grounds at lunchtime were associated with a higher SSB consumption. Water was the most frequently consumed beverage; however, 79 % of respondents reported consuming an SSB at least once daily and 50 % reported consuming an SSB three or more times daily.

Elementary-school children have relatively low nutrition and water knowledge and consume high proportions of SSB. Higher knowledge is associated with increased water consumption and reduced SSB consumption. Interventions to increase knowledge may be effective at improving children’s beverage consumption habits.

The present study aimed to: (i) evaluate changes in Canadian children’s dietary quality during school hours and on school days between 2004 and 2015; and (ii) explore whether changes in dietary quality over time were moderated by sociodemographic characteristics.

Nationally representative 24 h dietary recall data were obtained from the 2004 (n 4827) and 2015 (n 2447) Canadian Community Health Surveys. Dietary quality was measured using the Canadian Healthy Eating Index (C-HEI) which evaluates respondents’ compliance with 2007 national dietary recommendations, and the school-HEI which assesses respondents’ dietary quality during school hours. Multivariable regression models compared differences in dietary quality between 2004 and 2015. Interaction effects were used to test whether changes over time were moderated by sociodemographic characteristics (sex, age group, ethnicity, residential location, province of residence, parental education, food security status).

Canada.

Children aged 6–17 years.

Mean school-HEI score rose from 51.3 to 58.0 points (maximum = 100) from 2004 to 2015 (P < 0.001). School-HEI sub-scores for total vegetables and fruit, whole fruit, dark green and orange vegetables, milk and alternatives, and meat and alternatives improved over time, but remained well below recommendations. Decreased energy from minimally nutritious foods accounted for 39 % of the improvement in mean school-HEI scores. Mean whole day C-HEI scores also improved (60.8 to 66.4 points, P < 0.001). There was no evidence of a moderating effect for any of the sociodemographic variables examined.

Mean dietary quality of Canadian children during school hours and on school days improved modestly for all age and sex groups but remained below 2007 national dietary recommendations.

The present study aimed to evaluate the effect of mandatory iodine fortification of bread on the iodine status of South Australian populations using newborn thyroid-stimulating hormone (TSH) concentration as a marker.

The study used an interrupted time-series design.

TSH data collected between 2005 and 2016 (n 211 033) were extracted from the routine newborn screening programme in South Australia for analysis. Iodine deficiency is indicated when more than 3 % of newborns have TSH > 5 mIU/l.

Newborns were classified into three groups: the pre-fortification group (those born before October 2009); the transition group (born between October 2009 and June 2010); and the post-fortification group (born after June 2010).

The percentage of newborns with TSH > 5 mIU/l was 5·1, 6·2 and 4·6 % in the pre-fortification, transition and post-fortification groups, respectively. Based on a segmented regression model, newborns in the post-fortification period had a 10 % lower risk of having TSH > 5 mIU/l than newborns in the pre-fortification group (incidence rate ratio (IRR) = 0·90; 95 % CI 0·87, 0·94), while newborns in the transitional period had a 22 % higher risk of having TSH > 5 mIU/l compared with newborns in the pre-fortification period (IRR = 1·22; 95 % CI 1·13, 1·31).

Using TSH as a marker, South Australia would be classified as mild iodine deficiency post-fortification in contrast to iodine sufficiency using median urinary iodine concentration as a population marker. Re-evaluation of the current TSH criteria to define iodine status in populations is warranted in this context.

The current study assessed changes in children and mothers’ nutritional status before and after raising Bangladeshi households out of extreme poverty through an income-generating activities (IGA) programme.

Extreme poor households took part in the IGA programme for 2 years and recruitment took place over four waves in annual cycles. Children and mothers were measured with regarding their nutritional status before and after the IGA programme commenced.

Rural Bangladesh.

Three-hundred and eighty-two children under 5 years of age at recruitment, and their mothers.

After 2 years of the IGA programme, the prevalence of stunting significantly declined from 40·3 % to 33·0 % (P = 0·003), anaemia declined from 51·6 % to 44·0 % (P = 0·020) while mothers’ CED (Chronic Energy Deficiency) declined from 52·0 % to 42·7 % (P < 0·001), but no significant changes were found in children’s wasting, declining from 25·4 % to 21·5 %, underweight which remained the same at 43·2 %, while mothers’ anaemia rose from 39·3 % to 42·7 %. There were also highly significant improvements in household socio-economic status. Increases in socio-economic security (especially in relation to cash savings and net income) and improvements in food quantity and quality (indicated by greater food diversity and animal food intake) were associated with normal nutritional status, and cessation of open defecation was associated with reduction in mothers’ and child anaemia.

The IGA programme was associated with increased household socio-economic security, such as asset accumulation, food security and sanitation, and with improvements in the nutritional status of children and their mothers in extreme poor households.

To explore the formal and informal ways in which different actors involved in shaping trade agreements pursue their interests and understand the interactions with nutrition, in order to improve coherence between trade and nutrition policy goals.

The paper draws on empirical evidence from Australian key informant interviews that explore the underlying political dimensions of trade agreements that act as barriers or facilitators to getting nutrition objectives on trade agendas.

Countries experiencing greater availability and access to diets full of energy-dense and nutrient-poor foods through increased imports, greater foreign direct investment and increasing constraints on national health policy space as a result of trade agreements.

Interviews took place with Australian government officials, industry, public-interest non-government organizations and academics.

The analysis reveals the formal and informal mechanisms and structures that different policy actors use both inside and outside trade negotiations to pursue their interests. The analysis also identifies the discourses used by the different actors, as they attempt to influence trade agreements in ways that support or undermine nutrition-related goals.

Moving forward requires policy makers, researchers and health advocates to use various strategies including: reframing the role of trade agreements to include health outcomes; reforming the process to allow greater access and voice to health arguments and stakeholders; establishing cross-government partners through accountable committees; and building circles of consensus and coalitions of sympathetic public-interest actors.