Public Health Nutrition最新文献

Objective: Vegetables are a key aspect of a healthy diet, but they are under-consumed throughout West Africa, where there is a lack of evidence on food environments. This study aimed to understand the physical availability of vegetables around schools in urban areas of Benin and Mali, as well as describe other aspects of the food environment.

Design: The study used neighbourhood surveys of food outlets around schools in marginalised areas in five cities of Benin and Mali.

Setting: Food outlets within a 1 km radius of the main public primary schools.

Participants: Owners/managers/vendors of food outlets.

Results: Vegetables are in general highly available around schools in representative urban areas of both Mali and Benin, with more outlets and more outlet diversity in general in the Benin contexts but a greater proportion of outlets selling vegetables in the Mali contexts. There is nuance, however, in which vegetables are sold (global or traditional vegetables) and what they are sold alongside that provides healthier or unhealthier options for consumers. Quality, convenience, source, cost and promotion were variable across sites.

Conclusion: The detailed findings in this study on outlet types, vegetable characteristics and the characteristics of vending are a significant contribution to understanding physical food environments in urban neighbourhoods that can inform policy responses in West Africa and beyond.

Objective: Schools are key environments for promoting healthy eating habits, food knowledge and skills, but the systematic implementation of food education is usually lacking. This study aimed to examine the perceptions of primary school headteachers and municipal education directors regarding the key factors influencing the implementation of food education in Finnish primary schools.

Design: In this qualitative study, the participants took part in research interviews. The interviews were transcribed verbatim and analysed using theory-driven content analysis to identify common categories.

Setting: Semi-structured one-on-one interviews were conducted.

Participants: The interviews involved twelve headteachers and five education directors, all of whom had prior experience in implementing food education through the Tasty School project, which supported primary schools in delivering food education.

Results: In the analysis, the key factors influencing implementation of food education were categorised according to an ecological framework into two levels: the macro level and the school community level, which represents the micro-level interactions within the school’s physical and social environment. The results indicate that successful food education requires a school culture that prioritises it − incorporating curriculum integration, dedicating adequate planning time and ensuring sufficient resources.

Conclusions: Primary schools would benefit from a school culture that prioritises food education. This includes setting objectives in the curriculum, allocating sufficient time for planning, ensuring resources and creating supportive learning environments. While headteachers play a central role, support from municipal officials is essential for sustained implementation. These findings provide insights to support the implementation of food education at both school and municipal levels.

Objective: To assess anthropometric failure prevalence using a composite index of anthropometric failure and evaluate the concordance of mid-upper arm circumference (MUAC) with weight for length z score (WLZ) in identifying acute malnutrition in children.

Design: We used data from a pre-proof-of-concept (pre-POC) study conducted in 2022-2023.

Setting: The study was conducted in the Vellore district in Tamil Nadu, South India.

Participants: We included all children aged 5-19 months who were pre-screened for the pre-POC study and had available data on weight, length, MUAC, date of birth and child sex.

Results: A total of 663 children were available for analysis, with a mean age of 11·4 months. The prevalence of underweight, stunting and wasting was 23·8 %, 24·3 % and 16·6 %, respectively. 36·7 % of the children had at least one form of anthropometric deficit, and 8·2 % showed severe deficits. We found a fair agreement between MUAC and WLZ values (kappa = 0·32) and a poor agreement of kappa = 0·19 and 0·10 with weight for age z score (WAZ) and length for age z score (LAZ), respectively.

Conclusions: The prevalence of malnutrition remains a significant public health concern in South India, with rates consistent with previous literature. MUAC and WLZ cutoffs by the WHO identify different groups with acute malnutrition. Community-based studies using WLZ criteria can adopt screening with higher MUAC cutoffs, followed by WLZ or, alternatively, WAZ alone, as low WAZ covers most participants with low MUAC and WLZ, providing better feasibility. However, the optimal measurement for risk identification requires further exploration.

Objective: Canadian front-of-package (FOP) labelling regulations aim to improve dietary patterns by identifying foods high in sodium, sugars and/or saturated fat with a 'high in' FOP nutrition symbol. However, child-appealing marketing on product packaging may undermine these efforts. Therefore, this study (1) compared the prevalence of FOP symbols between products with child-appealing and non-child appealing packaging in the Canadian food supply and (2) identified the number and types of FOP symbols on products with child-appealing packaging (CAP).

Design: Using the University of Toronto's Food Label Information and Price 2017 database, 5850 packaged foods were analysed, 746 of which had CAP. Products were assessed against FOP labelling regulations.

Setting: Large grocery retailers by market share in Canada.

Participants: Foods and beverages available in 2017. Results: 74·4 % of products with CAP would require a 'high in' FOP symbol, significantly higher than the 65·7 % of products with non-CAP. Notably, 54·4 % of products with CAP exceeded FOP labelling thresholds for sugars compared with 37·8 % of products with non-CAP.

Conclusions: Findings highlight a policy gap in Canadian nutrition regulations, as CAP remains a major source of marketing of unhealthy foods to children, undermining the impact of FOP labelling. To address this, food packaging should be included in Canada's marketing restrictions, and products displaying a 'high in' FOP symbol should be automatically restricted from marketing to children. This study underscores the urgent need to harmonise Canadian nutrition regulations to synergistically promote healthier food choices among children and improve their health.

Objective: Despite growing front-of-pack labelling (FOPL) policy implementation in low-and middle-income countries (LMIC), research approaches for evaluating these policies remain poorly characterized, hindering evidence-based policy development and methodological gaps. This study explored research approaches, frameworks, and methods used in assessing FOPL policy implementation and response in LMIC.

Design: Systematic search of five databases, including Medline, Web of Science, Scopus, Global Health, and CINAHL, for peer-reviewed articles published between 2014-2025. Studies on FOPL policy implementation or response in LMIC were included. Data on study characteristics, methods, and findings were extracted and synthesized.

Setting: LMIC.

Participants: All populations.

Results: Thirty-one studies revealed significant research imbalances. Implementation studies (n 3) used qualitative approaches with policy theories, while response studies (n 28) predominantly employed quantitative methods including surveys, experiments, and modeling. Pronounced geographical bias emerged, with 24 studies conducted in Latin America while other LMIC regions remained underrepresented. Common limitations included non-representative sampling, self-reported data, and short timeframes. Mandatory FOPL policies achieved higher compliance than voluntary schemes, though implementation faced challenges including inadequate monitoring, limited resources, and industry resistance. Consumer awareness was generally high but varied significantly across population groups, revealing substantial equity gaps.

Conclusions: This review reveals critical gaps in FOPL implementation research in LMIC, with evidence heavily skewed toward consumer responses and geographically concentrated in Latin America. Future research should prioritize implementation science approaches, geographical diversity, and understanding policy processes in resource-constrained settings to develop effective, context-appropriate FOPL policies.

Objective: This study aimed to assess the prevalence of non-sugar sweeteners (NSS) in Brazilian food products before the implementation of new nutritional labeling legislation. Specifically, we aimed to determine the eligibility of these products to contain NSS according to RDC no. 18/2008, which governed the use of NSS in Brazil during the study period.

Design: Data were collected from 3335 packaged foods and beverages available in one of Brazil's top 10 supermarket chains, six months following the publication of front-of-package nutrition labeling (FoPNL) and 19 months before the legislation came into force.

Setting: The study was conducted in Brazil.

Results: Our analysis revealed that NSS were present in 12.5% of the sampled products. Notably, high frequencies of NSS were observed in powder dessert mixes and soy drinks (100%), gelatin preparations (88.1%), chewing gum (87.1%), tea (84.6%), and carbonated beverages (71.4%). Furthermore, we found that 82% of products containing NSS made claims regarding sugar and calorie reduction, with 16.6% of these claims being inconspicuous. Additionally, 14% of products targeted controlled sugar intake diets, 0.5% aimed at sugar-restricted diets, and 4% were ineligible for NSS use. Importantly, the declared NSS content adhered to Brazilian regulatory limits.

Conclusions: While most products complied with regulatory standards, our findings highlight the presence of ineligible products and less prominent claims, which may complicate NSS identification for consumers. Continuous monitoring of NSS prevalence, especially following the implementation of FoPNL, is essential for ensuring compliance with regulations and promoting informed consumer choices in Brazil.

Objective: To co-develop a systems map of the UK secondary school food system and to understand what factors contribute to food choice within it.

Design: Participatory methods were used with a range of UK school stakeholders to co-produce a systems map of factors contributing to food choice in the secondary school food system. An online survey with stakeholders (n 26) was used to gather an initial list of factors, and a group model-building workshop was conducted with stakeholders (n 13) to establish relationships between these factors. Two school workshops captured the views of students (n 17). The map then underwent final refinement by the research team, and all stakeholders were provided the opportunity to provide feedback on the final version.

Setting: United Kingdom.

Participants: UK school stakeholders.

Results: The systems map contained twenty-four factors with forty-three direct causal relationships between them, each factor falling into one of six themes: catering and procurement; school leadership and governance; the priority of food within schools; social experience, behaviours and attitudes; the food space and experience in school and financial. The map demonstrates how each of the factors interacts with each other, including the direction of influence. It also reveals feedback loops that shape and sustain food choice patterns in secondary schools.

Conclusions: The systems map provides a visualisation of the complex secondary school food system and can be used by stakeholders in the design and evaluation of whole-school, multi-component interventions and programmes targeting food choice in secondary schools.

Objective: Explore adolescents' recall of food and beverage advertisements in digital media, while evaluating associations between socio-demographic characteristics and advertisement recall.

Design: Recruitment took place using a two-stage cluster probability-based sampling approach. Thirty-nine high schools stratified by type (public v. private) were included, with one class within each grade randomly selected, wherein attending students (n 1542; age range: 11-19 years) received a paper-and-pencil questionnaire for completion in their homes. Participants indicated their spontaneous recall of food and beverage advertisements on social media and provided socio-demographic information. Individual responses to an open-ended question were graphically represented using a world cloud, after which the data were analysed through content analysis based on inductive coding.

Setting: The study was conducted in Montevideo, the capital city of Uruguay, which is a high-income South American country with a high prevalence of overweight and obesity among adolescents.

Participants: A total of 1542 adolescents attending public and private high schools participated.

Results: Almost nine of ten adolescents (87·6 %) reported having seen a food or beverage advertisement on digital media and more than three of four (76·1 %) could spontaneously recall at least one such advertisement. The three most frequently used words for spontaneous recall were 'McDonalds', 'Coke' and 'burgers', whereas the three most frequently mentioned product categories were 'Fast-food and fast-food restaurants', 'soft drinks' and 'savoury snacks'. Some socio-demographic differences emerged.

Conclusions: The findings stress the need to implement mandatory regulatory approaches to reduce adolescent exposure to digital marketing of unhealthy foods and beverages.

Creatine is a vital bioenergetic compound that remains largely overlooked within food systems despite its well-established role in human health and performance. Unlike creatinine - a downstream breakdown product of creatine metabolism commonly measured as a biomarker of kidney function - creatine functions as an energy buffer, facilitating the rapid regeneration of ATP in tissues with high metabolic demands such as skeletal muscle, brain and heart. Although a portion of daily creatine requirements is met through endogenous synthesis, dietary intake - primarily from animal-source foods - remains essential to maintain optimal physiological levels. Emerging evidence indicates that suboptimal creatine status, or creatine insufficiency, may be widespread, particularly among vegetarians, vegans, older adults, individuals with chronic illness and those with increased energy needs. This paper examines the evolving role of creatine across four domains: its natural occurrence in foods, incorporation into fortified food products, use as a dietary supplement and potential future classification as a pharmaceutical agent. Special emphasis is placed on differences in regulatory status, intended use, dosage, labelling and public health implications. In light of mounting evidence that creatine insufficiency may contribute to adverse outcomes - including impaired cognition, reduced muscular performance and vulnerability to stressors - integrating creatine into food policy and nutrition strategies represents a promising, scalable and preventive approach to improve population health.