Public Health Nutrition最新文献

Objective: To adapt current iron intake reference values for Brazilian children aged 7-11 and 12-23 months, using the opportunity to apply the principles and rationale of the harmonisation approach.

Design: Nutrient reference values (NRV), including the average requirement (AR) and population reference intake (PRI), were estimated for children aged 7-11 and 12-23 months. We applied and adapted methods from the Institute of Medicine (IOM) and the European Food Safety Authority (EFSA) to estimate the NRV. Body iron losses, iron needs for growth and dietary iron bioavailability were estimated using both local and external data.

Setting: Rio de Janeiro, Brazil.

Participants: Data on dietary intake from a probabilistic sample of children aged 7-23 months in the city of Rio de Janeiro, Brazil, were used to estimate iron consumption and bioavailability.

Results: The mean physiological iron requirements were 0·78 mg/d (7-11 months, male), 0·53 mg/d (7-11 months, female), 0·79 mg/d (12-23 months, male) and 0·54 mg/d (12-23 months, female). Mean dietary iron bioavailability was 7·5 % across all age and sex groups. AR and PRI were 10 mg/d and 19 mg/d for children aged 7-11 months, and 7 mg/d and 13 mg/d for those aged 12-23 months. NRV did not differ by sex.

Conclusion: The AR for children aged 7-11 and 12-23 months were 11 mg/d and 8 mg/d, respectively. The corresponding PRI were 20 mg/d and 14 mg/d. The estimated Brazilian NRV were higher than those of the IOM and EFSA. Iron bioavailability was the most influential factor explaining the differences from other NRV.

Objective: Classroom celebrations and food rewards are substantial sources of unhealthy foods within the school environment in the USA. This study was designed to describe classroom food reward practices and examine the association between food rewards and constructs of the Health Belief Model (HBM).

Design: An online survey using summated scales of food reward frequency and HBM constructs.

Setting: The online survey was distributed to elementary schools throughout seven Midwestern states from November through December 2023.

Subjects: Elementary school teachers (n 256).

Results: Candy was the most frequently used food reward with the majority of teachers (55·9 %) reporting they utilised candy at least 'sometimes'. Bi-variant analysis revealed food reward frequency was positively correlated with perceived barriers to refraining from the use of food rewards (r = 0·47, P < 0·01) and negatively correlated with policy cues to action (r = -0·22, P < 0·01). Multiple regression analysis predicted food reward frequency (R = 0·47, F (3247) 23·62, P < 0·001), but only perceived barriers (β = 0·45; P < 0·001) contributed significantly to the prediction.

Conclusion: Classroom food rewards are common, and perceived barriers (but not perceived threat or policy cues) were associated with food rewards among this sample of teachers. Reducing barriers to refraining from the use of food rewards may begin to reduce the practice of using classroom food rewards.

Objective: Half of people living in the USA do not consume tap water. Surveys have assessed perceptions of water and water utilities, but less is known about how these perceptions relate to the preference for tap or bottled water. The present analysis examined whether beliefs about tap water and the water utility were associated with drinking water preferences.

Design: In a cross-sectional survey, six water beliefs were measured: trust in tap water, the water utility, and the local government; perceived safety and quality of tap water; and awareness that the water utility frequently tests tap water. Regression models adjusted for sociodemographic characteristics were used to estimate the odds of preferring tap over bottled water dependent on respondents' beliefs about their tap water.

Setting: Virginia, USA.

Participants: Adults aged 18 years and older (n 808).

Results: More than two-thirds of respondents had positive beliefs about their tap water, but only 54 % reported tap as their preferred drinking water source. All water beliefs, except for awareness of the frequency of water testing, were associated with higher odds of preferring tap water over bottled (adjusted OR range: 1·56-3·2).

Conclusions: Our findings suggest that favourable tap water beliefs may be necessary, but not sufficient, to motivate people to drink from the tap. There remains a critical need for future research to bridge the gap between tap water perceptions and consumption, which should include enhancing the trustworthiness of tap water and the water utility as well as improving consumers' perceptions of water quality and safety.

Objective: To examine how school food policies and perceived barriers influence food provision in New Zealand primary school canteens, using the 'Healthy Food and Drink Guidance for Schools'.

Design: Cross-sectional analyses of school food menus and school food policy and practices surveys completed by school leaders/principals.

Setting: New Zealand primary schools.

Participants: 239 primary schools completed the school food policies and practices survey, and eighty schools provided canteen menus.

Results: Most schools reported having a healthy food and drink policy in their school (76·2 %) and promoted healthy eating during school hours (87·4 %). Two-thirds (69·5 %) identified barriers to healthy food and drink provision, most commonly the convenience of ready-made foods (39·3 %), and resistance from parents (34·3 %). The number of reported barriers was not a significant predictor for the presence of a school food policy (OR-1·034, P = 0·841). School menus (n 80) consisted of 16·4 % 'green' items, 34·7 % 'amber' items and 36·8 % 'red' items. There was no relationship between the percentage of 'green', 'amber' and 'red' items and the presence of a school food policy or reported barriers. More than a third (38·9 %) of menus from schools that reported they had a 'Plain Milk and Water' only policy still contained sugar-sweetened beverages.

Conclusions: Although most New Zealand primary schools had healthy food policies, this was not consistently reflected in healthy food items on canteen menus. Further research is needed to understand how systemic barriers, such as cost, convenience and parental influence, affect policy implementation and school food provision.

Objective: Traditional diets are culturally accepted and adapted to local environments, but globalisation has shifted towards unhealthy, unsustainable eating habits. This study aims to assess the literature on the effects of traditional, place-based diets on health and sustainability and examines the suitability of common tools used to evaluate them.

Design: A systematic search was conducted using the PRISMA 2020 guidelines across seven databases (CINAHL, Cochrane Library, MEDLINE, Scopus, Web of Science, PubMed and Google Scholar), and the protocol was registered with PROSPERO (CRD42023445750). The inclusion criteria were traditional place-based diets, studies examining the nutritional, health benefits and sustainability impacts of traditional food consumption, published in English, with no date restriction.

Results: Eleven studies from Spain, Romania, Portugal, Mexico, Chile, Japan, Uganda and India met the criteria. Assessment tools included carbon footprints (via LCA), nitrogen footprints, NRF9.3, Nutri-Score and EAT-Lancet; some incorporated qualitative methods. Mediterranean, Atlantic and Japanese diets aligned well with health and sustainability, whereas meat-heavy or nutrient-deficient patterns raised concerns. Most studies relied on standardised tools and secondary datasets, with limited use of region-specific environmental data or qualitative insights. Only one intervention study was identified.

Conclusions: Traditional diets show promise as culturally appropriate models for sustainable and healthy eating. Current tools designed around standardised, reductionist frameworks often fail to capture the complexity of traditional food systems, including local practices, preparation methods and cultural meaning. To better assess traditional diets, future research should develop regionally adapted indicators and integrate quantitative measures with qualitative insights from local communities.

Objective: To co-design a systems approach aimed at promoting the wide-scale adoption of whole-school approaches to food in UK primary schools to improve school food environments, food provision and dietary intake in children.

Design: A systems framework (Action Scales Model) was used to guide the co-design of the systems approach. The process involved identifying leverage points within the UK primary school food system that, if influenced, could alter the way in which the system functions. Actions were then agreed upon to influence those leverage points.

Setting: Co-design workshops were held online between September 2021 and February 2022.

Participants: Members of the co-design team comprised twelve school stakeholders (headteachers, school food improvement officers, catering leads, representatives of UK school food organisations and a dietician) and a team of researchers with expertise in school food, systems thinking and intervention development. Our partnership board included decision-makers and advocates of the whole-school approach to food in England and Northern Ireland.

Results: Identified leverage points included the priorities of headteachers, who are instrumental in instigating whole-school approach to food adoption. Direction from local and national policymakers was also identified. Actions to influence these leverage points included providing direct support to schools (through an online resource) and encouraging policymakers to monitor the adoption of the approach.

Conclusion: The methods described here can be replicated by others to promote the adoption of whole-school approaches to food in other contexts and contribute to the growing literature on developing systems-wide approaches to promote the adoption of public health initiatives.

Objectives: To describe the drivers of dietary behaviours among young South Asian adults (18-35 years) in Australia and examine the influence of acculturation and the host environment in shaping these behaviours.

Design: A cross-sectional qualitative study design was used to collect data through Zoom focus groups. The analysis of the qualitative data followed Vears and Gilliam's inductive content analysis approach. Demographic data were presented descriptively, and the findings were reported in accordance with the standard for reporting qualitative research.

Setting: Sydney, New South Wales, Australia.

Participants: A total of twenty-one young South Asian migrants (aged 18-35 years), mostly from India and Pakistan, participated in four online focus groups.

Results: Six main themes were identified, highlighting the complex interplay of acculturation, cultural identity, family influence and other socio-economic factors in shaping dietary behaviours. (1) Acculturation and exposure to diverse cuisines, (2) interplay between religion and culture during special occasions, (3) influence of social networks and community norms, (4) structural and practical constraints shaping food choices, (5) shifting perceptions around healthy eating and (6) empowerment through knowledge. Participants reported incorporating Western and multicultural cuisines, often balancing convenience and cultural preferences.

Conclusions: Numerous drivers, including but not limited to acculturation and the host environment, influence the dietary behaviours of young South Asian adults in Australia. Despite limitations in representativeness, the study provides valuable insights highlighting the need for inclusive health promotion efforts for Australia's growing South Asian population.

Objective: The complexity and nuance of how social networks shape dietary behaviours and health dynamics remain underexplored, particularly in collectivist societies where family and peer relationships strongly impact health. This study applies social network analysis to examine these dynamics in Singapore.

Design: An online household survey of young adults (age 21-35) and family (21+) assessed the consumption of healthy food groups (fruit, vegetable intake), unhealthy food groups (fast food, snack consumption) and social network characteristics (interaction frequency, emotional closeness, shared meals and perceived health influence). Data were analysed using network analysis, mixed regression models and generalised estimating equations.

Setting: Online Singaporean household survey.

Results: Among 116 participants from thirty-six households, 345 unique individuals and 1145 dyadic relationships were identified, with networks averaging 9·7 nodes (sd: 4·7) and 33·2 edges (sd: 27·3). Mutual health influence was strongest in spousal (β = 0·89, 95 % CI: 0·42, 1·35) and intergenerational ties (older-to-younger: β = 0·62, 95 % CI: 0·29, 0·94; younger-to-older: β = 0·36, 95 % CI: 0·03, 0·68) and associated with emotional closeness (β = 0·38, 95 % CI: 0·30, 0·46) and shared meals (β = 0·43, 95 % CI: 0·36, 0·49). Greater family health effort correlated with lower snack (Adjusted Odds Ratio [AOR]: 0·50, 95 % CI: 0·29, 0·85) and fast-food consumption (AOR: 0·41, 95 % CI: 0·22, 0·77), while higher perceived family health associated with increased snack intake (AOR: 3·21, 95 % CI: 1·58, 6·52). Frequent meals with friends associated with lower fast-food intake (AOR: 0·50, 95 % CI: 0·30, 0·84), but no associations with fruit or vegetable intake were found.

Conclusion: Findings highlight intergenerational and spousal ties as key health influencers, particularly through shared meals, and the complex role of social networks in shaping diet. Analyses suggest network-based interventions may be more useful in reducing unhealthy rather than promoting healthy eating behaviours.

Objective: Restaurant marketing to children may be associated with consumption. We examined whether and to what extent reported frequency of restaurant advertisements exposure was associated with consumption and money spent at all types of restaurants among children living in Canada. We also describe what children and youth report as appealing restaurant marketing techniques.

Design: This study reports findings from a cross-sectional, online survey. The survey covered reported exposure to restaurant marketing, restaurant product consumption, money spent at restaurants and appealing features of restaurant advertisements. Descriptive statistics and adjusted and unadjusted linear and logistic regressions were constructed.

Setting: Canadian provinces.

Participants: 1500 children and youth aged 9-17 years.

Results: A third (32 %) of participants reported restaurant advertisement exposure at least once per day. Overall, 43 % of participants consumed restaurant products more than twice per week, 61 % spent at least some money at a restaurant in the last 7 d, and of those who spent money, the mean expenditure in the last week was $20·70. Frequency of advertisement exposure was significantly associated with all outcomes. Several significant differences in outcomes emerged by region, age and race/ethnicity. Pictures were the most appealing marketing technique among both age groups; however, youth (aged 13-17 years) seemed to prioritise price and price promotions, while children (aged 9-12 years) prioritised toys, humour and winning prizes.

Conclusions: A large proportion of Canadian children and youth consumed restaurant offerings more than twice a week. Reported restaurant advertising exposure was significantly positively associated with restaurant consumption frequency and money spent at restaurants.

Objective: To describe changes in the community food environment between 2010 and 2022 in all municipalities in the state of Rio Grande do Sul (RS), Brazil, and to evaluate the possible associated sociodemographic inequities.

Design: This ecological study was based on an analysis of the distribution and density of food retail establishments between 2010 and 2022 and their associations with the sociodemographic characteristics of the municipalities. Sociodemographic and food retail variables were extracted from secondary government databases. The establishments were classified according to the degree of processing of the foods they predominantly sold. Non-parametric tests and linear and Prais-Winsten regressions were used to analyse data.

Setting: State of RS, Brazil.

Participants: All 497 municipalities.

Results: There was a significant reduction in overall food retail density (Coef.: -2·97; 95 % CI: -3·34, -2·61; P < 0·001). The greatest reduction occurred in establishments that sourced ultra-processed foods (Coef.: -3·34; 95 % CI: -3·65, -3·02; P < 0·001), which, despite the decrease, remained the most widely present. In 2022, the density of these establishments (median: 24·5; min/max: 4·4-124·8) was twice the density of establishments supplying fresh/minimally processed foods and culinary ingredients (median: 13·1; min/max: 0·0-95·8). Cities with greater social vulnerability had lower densities of establishments and greater reductions in the density of establishments over the evaluated period.

Conclusions: The reduction in food retail outlets disproportionately affected the most vulnerable municipalities and negatively impacted the availability of healthy foods. These findings reinforce the need for food and nutrition policies that promote equity in the food environment.