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.

The present study aimed to develop and validate a questionnaire assessing social support for healthy eating in a French-Canadian population.

A twenty-one-item questionnaire was developed. For each item, participants were asked to rate the frequency, in the past month, with which the actions described had been done by family and friends in two different environments: (i) at home and (ii) outside of home. The content was evaluated by an expert panel. A validation study sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on items to assess the number of subscales. Internal consistency reliability was assessed using Cronbach’s ɑ. Test–retest reliability was evaluated with intraclass correlations between scores of the two completions.

Online survey.

Men and women from the Québec City area (n 150).

The content validity assessment led to a few changes, resulting in a twenty-two-item questionnaire. Exploratory factor analysis revealed a two-factor structure for both environments, resulting in four subscales: supportive actions at home; non-supportive actions at home; supportive actions outside of home; and non-supportive actions outside of home. Two items were removed from the questionnaire due to low loadings. The four subscales were found to be reliable (Cronbach’s ɑ=0·82–0·94; test–retest intraclass correlation=0·51–0·70).

The Social Support for Healthy Eating Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. This questionnaire will be useful to explore the role of social support and its interactions with other factors in predicting eating behaviours.

To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes.

Participants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes.

Rural AI reservations and AN villages.

AI/AN (n 2484) with type 2 diabetes.

Both males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β=0·078, P=0·0007; males: β=0·139, P<0·0001).

Health professionals working with AI/AN diagnosed with type 2 diabetes should offer food choice strategies during difficult times and recognize that males may be more likely than females to select unhealthy foods when distressed.

Adolescence is a critical period for development of depression and understanding of behavioural risk factors is needed to support appropriate preventive strategies. We examined associations between adolescent diet quality and depressive symptoms, cross-sectionally and prospectively, in a large community cohort, adjusting for behavioural and psychosocial covariates.

Prospective community-based cohort study (ROOTS).

Secondary schools in Cambridgeshire and Suffolk, UK.

Study participants (n 603) who completed 4 d diet diaries at age 14 years and reported depressive symptoms (Moods and Feelings Questionnaire (MFQ)) at 14 and 17 years of age.

Diet data were processed to derive a Mediterranean diet score (MDS) and daily servings of fruit and vegetables, and fish. At age 14 years, a negative association between fruit and vegetable intake and MFQ score was seen in the unadjusted cross-sectional regression model (β=−0·40; 95 % CI −0·71,−0·10), but adjustment for behavioural covariates, including smoking and alcohol consumption, attenuated this association. Fish intake and MDS were not cross-sectionally associated with MFQ score. No prospective associations were found between MDS, fruit and vegetable intake or fish intake and later MFQ score.

Diet quality was not associated with depressive symptoms in mid-adolescence. Previously reported associations in this age range may be due to confounding. Further longitudinal studies are needed that investigate associations between adolescent diet and depression across different time frames and populations, ensuring appropriate adjustment for covariates.

To examine the relationships between objectively measured sleep patterns(sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage(SSB) consumption (regular soft drinks, energy drinks, sports drinks andfruit juice) among children from all inhabited continents of the world.

Multinational, cross-sectional study.

The International Study of Childhood Obesity, Lifestyle and the Environment(ISCOLE).

Children (n 5873) 9–11 years of age.

Sleep duration was 12 min per night shorter in children who reportedconsuming regular soft drinks ‘at least once a day’compared with those who reported consuming ‘never’ or‘less than once a week’. Children were more likely tosleep the recommended 9–11 h/night if they reportedlower regular soft drink consumption or higher sports drinks consumption.Children who reported consuming energy drinks ‘once a week ormore’ reported a 25-min earlier bedtime than those who reportednever consuming energy drinks. Children who reported consuming sports drinks‘2–4 d a week or more’ also reported a25-min earlier bedtime compared with those who reported never consumingsports drinks. The associations between sleep efficiency and SSB consumptionwere not significant. Similar associations between sleep patterns and SSBconsumption were observed across all twelve study sites.

Shorter sleep duration was associated with higher intake of regular softdrinks, while earlier bedtimes were associated with lower intake of regularsoft drinks and higher intake of energy drinks and sports drinks in thisinternational study of children. Future work is needed to establishcausality and to investigate underlying mechanisms.

The present study investigates whether the reversal of the social gradient in obesity, defined as a cross-over to higher obesity prevalence among groups with lower education level, has occurred among men and women in urban and rural areas of Mexico.

Cross-sectional series of nationally representative surveys (1988, 1999, 2006, 2012 and 2016). The association between education and obesity was investigated over the period 1988–2016. Effect modification of the education–obesity association by household wealth was tested.

Mexico.

Women (n 54 816) and men (n 20 589) aged 20–49 years.

In both urban and rural areas, the association between education and obesity in women varied by level of household wealth in the earlier surveys (1988, 1999 and 2006; interaction P<0·001). In urban areas in 1988, one level lower education was associated (prevalence ratio; 95 % CI) with 45 % higher obesity prevalence among the richest women (1·45; 1·24, 1·69), whereas among the poorest the same education difference was protective (0·84; 0·72, 0·99). In the latest surveys (2012, 2016), higher education was protective across all wealth groups. Among men, education level was not associated with obesity in urban areas; there was a direct association in rural areas. Wealth did not modify the association between education and obesity.

The reversal of the educational gradient in obesity among women occurred once a threshold level of household wealth was reached. Among men, there was no evidence of a reversal of the gradient. Policies must not lose sight of the populations most vulnerable to the obesogenic environment.

To verify the association between changes in socio-economic level (SEL) and nutritional status of Chilean adults over a 10-year period.

Concurrent cohort study.

Individuals born from 1974 to 1978 in the Valparaíso Region of Chile were evaluated between 2000 and 2002 (n 1232) and again between 2010 and 2012 (n 796). SEL was characterized according to the occupation and educational level of the head of household. Nutritional status was based on measurement of BMI and waist circumference (WC).

Between the first and second evaluation there was a 13 % reduction in the number of individuals classified as poor and a 12 % increase in those classified in the medium high SEL. Increases in BMI were found among women who remained in the low SEL (β=2·2, 95 % CI 0·16, 2·87) compared with women who maintained the same SEL (and whose SEL was above low over the 10-year period). Women who remained in the low SEL increased their WC (β=4·10, 95 % CI 0·27, 7·93). There were no associations between nutritional status and SEL among males.

In the period studied, the SEL of the study population improved between the third and fourth decade of life, but BMI and WC also increased among women, with the lowest socio-economic group experiencing the greatest changes. Meanwhile, among males we found no association between anthropometric measurements and changes in SEL.

Data on dietary patterns in relation to the risk of metabolic syndrome (MetS) in a middle-aged Chinese population are sparse. The present study was performed to determine the major dietary patterns among a population aged 45–59 years and to evaluate their associations with MetS risk in China.

Cross-sectional examination of the association between dietary patterns and MetS. Face-to-face interviews were used to assess dietary intake using a validated semi-quantitative FFQ. OR and 95 % CI for MetS were calculated across quartiles of dietary pattern scores using multivariate logistic regression analysis models.

City of Linyi, Shandong Province, China.

Adults (n 1918) aged 45–59 years.

Three major dietary patterns were identified: traditional Chinese, animal food and high-energy. After adjustment for potential confounders, individuals in the highest quartile of the traditional Chinese pattern had a reduced risk of MetS relative to the lowest quartile (OR=0·72, 95 % CI 0·596, 0·952; P<0·05). Compared with those in the lowest quartile, individuals in the highest quartile of the animal food pattern had a greater risk of MetS (OR=1·28; 95 % CI 1·103, 1·697; P<0·05). No significant association was observed between the high-energy pattern and risk of MetS.

These findings indicate that the traditional Chinese pattern was associated with a reduced risk, while the animal food pattern was associated with increased risk of MetS. Given the cross-sectional nature of our study, further prospective studies are warranted to confirm these findings.

In a representative sample of US adults, we investigated the associations of nutrient patterns (NP) with bone mineral density (BMD) and fractures.

Cross-sectional.

US community-based National Health and Nutrition Examination Survey (NHANES).

Participants with measured data on dietary intake and BMD from 2005 to 2010 were included. Principal components analysis was used to identify NP. BMD was measured using dual-energy X-ray absorptiometry. ANCOVA, adjusted logistic and linear regression models were employed, accounting for the complex survey design and sample weights.

We included a total of 18 318 participants, with 47·0 % (n 8607) being men. The mean age was 45·8 years with no sex difference. Three NP emerged, explaining 55·9 % of the variance in nutrient consumption. Multivariable-adjusted linear regressions revealed significant inverse associations between the ‘high-energy’ NP (rich in carbohydrates and sugar, total fat and saturated fat) and total femur, femoral neck, trochanter and intertrochanter BMD (β coefficient: −0·029, −0·025, −0·034 and −0·021, respectively, all P<0·001), while there were significant associations between the ‘nutrient-dense’ NP (rich in vitamins, minerals and fibre) and ‘healthy fat’ NP (high dietary PUFA and MUFA) and BMD at total femur, femoral neck, trochanter and intertrochanter (all P<0·001). In adjusted logistic regression models, the odds of hip, wrist or spine fractures did not vary significantly across NP quartiles.

Nutrient-dense and healthy fat NP are associated with higher BMD at various bone sites, while the high-energy NP is inversely associated with BMD measures.

Anaemia is a major contributor to the global disease burden and half of pregnant women in India were anaemic in 2016. The aetiology of anaemia is complex, yet anaemia determinants are frequently examined in isolation. We sought to explore how shifts in sociodemographic (wealth, age at pregnancy, education, open defecation, cooking fuel type, household size), programmatic (iron–folic acid tablet consumption, antenatal care visits) and dietary factors (intake of Fe, folic acid, vitamin B12, phytate) predicted changes in anaemia prevalence.

Nutrient levels for eighty-eight food items were multiplied by household consumption of these foods to estimate household-level nutrient supply. A synthetic panel data set was created from two rounds of the District Level Household and Facility Survey (2002–04 and 2012–13) and Household Consumer Expenditures Survey (2004–05 and 2011–12). Ordinary least-squares multivariate regression models were used.

Districts (n 446) spanning north, north-east, central and south India.

Pregnant women aged 15–49 years (n 17 138).

In the model accounting for both non-dietary and dietary factors, increased age at pregnancy (P<0·001), reduced village-level open defecation (P=0·001), consuming more Fe (P<0·001) and folic acid (P=0·018) and less phytate (P=0·002), and urbanization (P=0·015) were associated with anaemia reductions. A 10 mg increase in daily household Fe supply from 2012 levels was associated with a 10 % reduction in anaemia.

Public health interventions to combat anaemia in pregnant women should use a holistic approach, including promotion of delayed marriage, construction and use of toilets, and measures that facilitate adoption of nutrient-rich diets.

To assess whether parent-reported time and cost for provision of food is associated with consumption of fruits, vegetables and non-core foods in pre-schoolers.

Cross-sectional analysis of baseline data from the Healthy Habits randomised controlled trial. Two subscales of the Children’s Dietary Questionnaire (CDQ) were used to assess fruit and vegetable, and non-core food consumption.

Thirty pre-schools in the Hunter Region of New South Wales, Australia.

Parents (n 396) with a child aged 3–5 years attending a participating pre-school were recruited. Parents needed to reside with that child for at least four days per week and have primary responsibility for providing meals and snacks to their child.

Sixty-three per cent of children had a parent-reported subscale score indicating adherence to dietary guidelines for fruit and vegetable intake, while 64% of children had a subscale score indicating they were exceeding dietary guidelines for non-core foods. Regression models revealed significant positive associations between higher CDQ scores for non-core foods (indicating higher consumption levels) and minutes that parents spent preparing food (P=0·032 and 0·025) and amount spent on purchasing food (P=0·043 and 0·020). The magnitude of the effects was small (estimate=0·003 and 0·001).

Time and cost spent by parents on provision of food was not significantly associated with child fruit and vegetable consumption. Further explorations into time spent on food preparation and cost of food procurement are warranted to help address the increased consumption of non-core foods by pre-school children.

To investigate the association between sensory-based food education implemented in early childhood education and care (ECEC) centres and children’s willingness to choose and eat vegetables, berries and fruit, and whether the mother’s education level and children’s food neophobia moderate the linkage.

The cross-sectional study involved six ECEC centres that provide sensory-based food education and three reference centres. A snack buffet containing eleven different vegetables, berries and fruit was used to assess children’s willingness to choose and eat the food items. The children’s parents completed the Food Neophobia Scale questionnaire to assess their children’s food neophobia.

ECEC centres that provide sensory-based food education and reference ECEC centres in Finland.

Children aged 3–5 years in ECEC (n 130) and their parents.

Sensory-based food education was associated with children’s willingness to choose and eat vegetables, berries and fruit. This association was stronger among the children of mothers with a low education level. A high average level of neophobia in the child group reduced the children’s willingness to choose vegetables, berries and fruit. No similar tendency was observed in the group that had received sensory-based food education. Children’s individual food neophobia had a negative association with their willingness to choose and eat the vegetables, berries and fruit.

Child-oriented sensory-based food education seems to provide a promising method for promoting children’s adoption of vegetables, berries and fruit in their diets. In future sensory food education research, more focus should be placed on the effects of the education at the group level.

Food practices in the early years of life are important to form healthy eating habits; therefore, it is essential for the caregivers of infants to receive appropriate guidance. The present study aimed to investigate the effectiveness of different nutritional interventions on complementary feeding practices in municipal nurseries.

Non-randomized controlled intervention study with education professionals and parents of infants (<2 years). Participants were divided into: control group (CG), standard food and nutrition education in writing; and intervention group (IG), the same information as the CG and face-to-face meetings (professionals, 8 h; parents, 5 h). Changes in professionals’ knowledge on the subject and alterations in parents’ beliefs, attitudes and intentions were assessed using questionnaires before and after the educational activities.

Ten public nurseries in Nova Lima, Belo Horizonte, Minas Gerais, Brazil, 2015.

Ninety professionals (fifty in CG; forty in IG) and 169 parents (ninety-seven in CG; seventy-two in IG).

After the intervention, there was a significant increase in the mean number of correct responses given by professionals in the IG (12·2 v. 10·7; P=0·001). In addition, there were improvements among the parents of the IG in relation to beliefs (soups and broths do not nourish my child: P=0·012), attitudes (offer meat from the sixth month: P=0·032) and intentions (do not offer soups and broths: P=0·003; offer vegetables: P=0·018; offer meat: P<0·001).

Face-to-face nutritional intervention had a significantly greater effect on the parameters evaluated, indicating the importance of adequate guidance in childcare services to support the introduction of complementary feeding.

The present study aimed to describe breast-feeding, complementary feeding and determining factors for early complementary feeding from birth to 8 months of age in a typical Brazilian low-income urban community.

A birth cohort was conducted (n 233), with data collection twice weekly, allowing close observation of breast-feeding, complementary feeding introduction and description of the WHO core indicators on infant and young child feeding. Infant feeding practices were related to socio-economic status (SES), assessed by Water/sanitation, wealth measured by a set of eight Assets, Maternal education and monthly household Income (WAMI index). Two logistic regression models were constructed to evaluate risk factors associated with early complementary feeding.

Based on twice weekly follow-up, 65 % of the children received exclusive breast-feeding in the first month of life and 5 % in the sixth month. Complementary feeding was offered in the first month: 29 % of the children received water, 15 % infant formulas, 13 % other milks and 9·4 % grain-derived foods. At 6 months, dietary diversity and minimum acceptable diet were both 47 % and these increased to 69 % at 8 months. No breast-feeding within the first hour of birth was a risk factor for the early introduction of water (adjusted OR=4·68; 95 % CI 1·33, 16·47) and low WAMI index a risk factor for the early introduction of other milks (adjusted OR=0·00; 95 % CI 0·00, 0·02).

Data suggest local policies should promote: (i) early breast-feeding initiation; (ii) SES, considering maternal education, income and household conditions; (iii) timely introduction of complementary feeding; and (iv) dietary diversity.

To investigate the sociodemographic and geographical variation in under- and overnutrition prevalence among children and mothers.

Data from the 2014 Bangladesh Demographic and Health Survey were analysed. Stunting and wasting for children and BMI<18·5 kg/m2 for mothers were considered as undernutrition; overweight was considered as overnutrition for both children and mothers. We estimated the prevalence and performed simple logistic regression analyses to assess the associations between outcome variables and predictors. Bayesian spatial models were applied to estimate region-level prevalence to identify the regions (districts) prone to under- and overnutrition.

Children aged<5 years and their mothers aged 15–49 years in Bangladesh.

A significant difference (P<0·001) was observed in both under- and overnutrition prevalence between poor and rich. A notable regional variation was also observed in under- and overnutrition prevalence. Stunting prevalence ranged from 20·3 % in Jessore to 56·2 % in Sunamgonj, wasting from 10·6 % in Dhaka to 19·2 % in Bhola, and overweight from 0·8 % in Shariatpur to 2·6 % in Dhaka. Of the sixty-four districts, twelve had prevalence of stunting and thirty-two districts had prevalence of wasting higher than the WHO critical threshold levels. Similarly, fifty-three districts had prevalence of maternal underweight higher than the national level. In contrast, the prevalence of overweight was comparatively high in the industrially equipped metropolitan districts.

Observed sociodemographic and geographical inequalities imply slow progress in the overall improvement of both under- and overnutrition. Therefore, effective intervention programmes and policies need to be designed urgently targeting the grass-roots level of such regions.

Iodine-deficiency disorders, due to insufficiency of iodine in the diet, are a global public health problem. The Kenyan Food, Drugs and Chemical Substances Act stipulates that processed retail-available edible salts contain 50–84 mg of potassium iodate (KIO3) per kilogram of salt. The present study determined the status of KIO3 levels in commercial salts, for public health action.

As part of the Kenya Demographic and Health Survey 2013, field workers collected salt samples from seven different local manufacturers/packers across eight regions of the country and sent them to the National Public Health Laboratory (NPHL) for KIO3 titration analysis.

A total of 539 samples were collected and analysed at NPHL. The samples had a mean KIO3 of 62 mg/kg. Thirty-three (6 %) samples had KIO3 of <25 mg/kg; ninety-eight (18 %) had 25–49 mg/kg; 335 (62 %) had 50–84 mg/kg; and seventy-three (13 %) had KIO3 of >84 mg/kg.

The study found that 62 % of salts sampled met the Kenyan standards, 24 % were below the required limits and 13 % were above the recommended range. Continuous monitoring of edible salts at the retail level is important to detect brands not adhering to standards and trace them for remedy. However, governmental efforts should be directed to the quality control and quality assurance of the salt-manufacturing industries.

To evaluate the effectiveness of a pilot study of a parental school-based intervention to promote healthy eating behaviours in young children.

A quasi-experimental longitudinal design with three conditions (complete intervention (CIG), minimal intervention (MIG), control (CG)), with repeated measures at baseline, immediately after the intervention, 6 months and 1 year after intervention.

Fourteen public and state-funded kindergartens near Lisbon, Portugal.

Parents (n 349) of 3- to 6-year-old children assigned to the three conditions completed the baseline protocol. The ‘Red Apple’ intervention included four parental group sessions about young children’s growth, nutritional guidelines and positive parental feeding strategies, which was combined with adult–child activities at home and in the classroom, and newsletters (CIG). MIG included only a single nutritional counselling session, whereas the CG had no intervention. At the end, thirty-eight, twenty-six and fifty-four parents in the CIG, MIG and CG, respectively, had completed all evaluation components. Data regarding parental perception of children’s weight, self-efficacy, nutritional knowledge, feeding strategies, eating behaviours and BMI were collected at the four assessment moments.

The CIG showed improvements in children’s healthy food intake, compared with the MIG and CG. Parental self-efficacy regarding the regulation of children’s eating behaviours decreased in the CG but not in both intervention groups.

Considering the low dosage of the intervention, the results obtained were positive. Future studies should offer additional solutions to overcome barriers to parents’ participation.

The physical and social environments that surround children should support good health. However, challenges with food security and access prevent many children from consuming a healthy diet, which is critical to proper growth and development. The present study sought to gain a better understanding of primary care initiatives to address these issues in a low-income setting.

Following the relocation of a paediatric clinic to a farmers’ market building and the implementation of a fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers elicited caregivers’ perceptions of clinic co-location with the farmers’ market; experiences with the prescription programme; opinions of the farmers’ market; and perceived impact on child consumption of fresh produce. Interview recordings were transcribed for textual analysis. Using thematic analysis, researchers examined qualitative data to identify patterns across transcripts and formulate emerging themes. Researchers concluded when data saturation was reached.

Flint, Michigan, USA.

The majority of participants were female (91 %) and African American (53 %).

Four recurrent themes emerged during interviews: (i) convenience of relocation; (ii) attitude towards prescription programme; (iii) challenges with implementation; and (iv) perceived impact of combined interventions. Caregivers indicated that the co-location and prescription programme increased family shopping at the farmers’ market, improved access to high-quality produce and improved food security.

A fruit and vegetable prescription programme involving a partnership between a farmers’ market and paediatric clinic was perceived as effective in improving food security, food access and child consumption of fresh fruits and vegetables.

To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries.

Cross-sectional analysis. Multivariate regression analysis and χ2 comparisons were used to detect differences between countries.

Supermarkets in New Zealand (NZ), Australia, Canada and the UK.

Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks.

A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (9 %, P<0·001). Differences in energy, carbohydrate and sugar content were observed between countries and within categories, with UK products generally having the lowest energy and sugar content. Up to half of all products across categories/countries exceeded the US Food and Drug Administration’s reference single serving sizes, with fruit juices contributing the greatest number. Between 47 and 83 % of beverages in the different countries were eligible for sugar taxation, the UK having the lowest proportion of products in both the low tax (5–8 % sugar) and high tax (>8 % sugar) categories.

There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars.