This study aimed to investigate the association of ultra-processed food consumption at 4 and 7 years of age with appetitive traits at 7 years and BMI at 10 years of age. Participants were 1175 children of the population-based birth cohort Generation XXI, who provided food diaries and complete data on socio-demographic variables, anthropometric measures and the Portuguese Children’s Eating Behaviour Questionnaire (P-CEBQ). Foods were grouped according to NOVA classification into: ‘unprocessed, minimally or moderately processed, and culinary preparations’; ‘processed’ and ‘ultra-processed’. To assess tracking of groups’ consumption, Pearson’s correlation coefficient (r) and the intraclass correlation coefficient (ICC) were calculated. Generalised linear models were fitted to test main associations, mediators and interactions among the variables. Ultra-processed consumption exhibited a fair level of stability between ages 4 and 7 years (r0·34; ICC = 0·32; 95 % CI 0·25, 0·39), corresponding, respectively, to 27·3 % (1881·9 (SD908·8) kJ/d) and 29·3 % (2204·5 (SD961·1) kJ/d) of total energy intake. After adjusting for maternal and child characteristics, higher ultra-processed consumption at 4 years was associated directly with ‘Food Responsiveness’ (β= 0·019; 95 % CI 0·007, 0·037) and indirectly through energy intake with avoidant traits: ‘Food Fussiness’ (β= –0·007; 95 % CI 0·002, 0·012) and ‘Satiety Responsiveness’ (β= –0·007; 95 % CI 0·003, 0·012). Ultra-processed consumption at 4 years old was associated with BMI at 10 years old, but appetitive behaviours were not powerful mediators of this association. The results suggest a path by which ultra-processed products may impact on later appetitive traits and higher BMI in children.

Objective: To examine associations between food insecurity, excess body weight, psychosocial factors and food behaviours among low-income African-American families.Design: Cross-sectional survey of participants in the baseline evaluation of the B’More Healthy Communities for Kids (BHCK) obesity prevention trial. We collected data on socio-economic factors, food source destinations, acquiring food, preparation methods, psychosocial factors, beliefs and attitudes, participation in food assistance programmes, anthropometry and food security. We used principal component analysis to identify patterns of food source destinations and logistic regression to examine associations.Setting: Fourteen low-income, predominantly African-American neighbourhoods in Baltimore City, MD, USA.Subjects: Two hundred and ninety-eight adult caregiver–child (10–14 years old) dyads.Results: Of households, 41·6 % had some level of food insecurity and 12·4 % experienced some level of hunger. Food-insecure participants with hunger were significantly more likely to be unemployed and to have lower incomes. We found high rates of excess body weight (overweight and obesity) among adults and children (82·8 % and 37·9 % among food insecure without hunger, 89·2 % and 45·9 % among food insecure with hunger, respectively), although there were no significant differences by food security status. Food source usage patterns, food acquisition, preparation, knowledge, self-efficacy and intentions did not differ by food security. Food security was associated with perceptions that healthy foods are affordable and convenient. Greater caregiver body satisfaction was associated with food insecurity and excess body weight.Conclusions: In this setting, obesity and food insecurity are major problems. For many food-insecure families, perceptions of healthy foods may serve as additional barriers to their purchase and consumption.

A recent policy in the U.S. authorized monthly benefits from a nutrition assistance program - Supplemental Nutrition Assistance Program (SNAP) - to be used online to increase grocery access and promote healthy eating. This study examined online grocery attitudes and purchasing behaviors among low-income SNAP-eligible households with young children with and without online grocery experience. An explanatory sequential mixed methods design was used, including a survey informed by the theory of planned behavior (TPB) and focus groups conducted between November-March 2021. In the quantitative phase, 310 Maryland residents completed an online survey assessing TPB constructs (attitudes, social norms, perceived control), and food purchase frequency online and in-store. Subsequently, 42 participated in the qualitative phase. Differences in TPB constructs and food purchases were compared between families with and without online grocery experience. Online food selection and fees were a common obstacle to online grocery purchasing. Families who had purchased groceries online (57%) had more positive attitudes and perceived fewer barriers to online shopping than those who had not. Self-reported frequency of buying fresh produce (OR = 0.34, p < 0.001), meat and seafood (OR = 0.29, p < 0.001), and sweets (OR = 0.54, p = 0.005) were lower online than in-store. Families discussed mistrust of online hired shoppers and fewer impulse purchases online as reasons for less frequent purchases of produce and sweets, respectively. Successful scale-up of the U.S. policy must address barriers to healthier purchasing behaviors to effectively promote equitable food access, such as decreasing delivery fees and improving the online food selection.

Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020–March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems.

Objective The work aimed to investigate dietary practices of university students after an action aiming to promote adequate and healthy food. Methods The article reports the experience of the distance education course Comida da República, promoted by the Universidade Federal de São Paulo as an educational space for sharing and exchanging knowledge, experiences, and thoughts on eating in the university context, especially in student homes or fraternities (repúblicas). Online questionnaires assessed the profile of participants and changes in their perception or relationship with food. The Students’ t-test was adopted to compare perceptions before and after the intervention, and content analysis for qualitative data. Results The course had 201 students enrolled and 82 who concluded it, with 35.4% living in repúblicas. Before the course, 89.6% of those who completed the course indicated the need to improve their diets, and 57.3% classified their diets as “regular”. There was a significant change in perception after the course: 58.5% of those who completed it rated their food as “good”. Dietary changes were categorized into two themes: “vision on food production and distribution” and “food and meal consumption”. The emerging codes show a greater awareness and criticism about food systems and a greater appreciation of cooking, commensality, and unprocessed and minimally processed foods. Participants identified environmental, personal, and interpersonal barriers (67.1%) to dietary changes. The course emerged as a facilitator of these changes. Conclusions This intervention proved to be an important educational tool to promote adequate and healthy eating, in addition to contributing to the planning and execution of student affairs and food security policies.