This study aimed to examine how food processing is addressed within indices/tools used to assess healthy and sustainable diets. A scoping review was conducted following the PRISMA-ScR protocol. Peer-reviewed studies developing or applying indices/tools for assessing sustainable diets were included. Two independent reviewers performed the selection, with disagreements resolved by discussion and, when necessary, a third reviewer was consulted to reach a consensus. The review included studies published in English, Portuguese, or Spanish, without time restrictions, and indexed in PubMed, Scopus, Web of Science, and SciELO databases. A total of 57 studies about sustainable diets were analyzed. Most studies showed significant gaps in addressing food processing and other food system components when assessing sustainable diets. The majority of studies were conducted in recent years and primarily in high-income countries, and while environmental and health dimensions of sustainability are widely explored, economic and sociocultural dimensions remain underrepresented. The assessment of diet sustainability remains incomplete without accounting for the role of food processing and the broader food system. There is a need for comprehensive methodologies that integrate all sustainability dimensions while also considering local contexts, particularly in low- and middle-income countries.

Current approaches to measurement of diet quality lack precision, do not translate well beyond academia and may have unintended consequences. A novel metric- 'Unrefined Plantfoods' (UP) is proposed. The UP metric is grounded in established science, precise, easy to measure, consistent with wider nutrition agendas and policies, reduces potential commercial and ideological exploitation of public health nutrition goals, is unbiased, translatable, and inclusive. The concept is value-aware and grounded in a harm minimisation approach.

Across school and community-based contexts, nutritional education interventions are often associated with improvements in a range of food-related and health-related outcomes. The aim of this study was to investigate whether the nutritional education component of the Holiday Activities and Food (HAF) programme, in England, was similarly associated with changes in these outcomes for children who attend. A quasi-experimental, mixed-factorial 3 (School) x 3 (Group) x 2 (Time) design was employed. Outcome variables were liking and frequency of trying new foods, perceived cooking competence and health-related quality of life. Pre-post data were collected at three primary schools in one local authority in the North East of England, at two time points (before and after the summer holidays). A non-probability, purposive sample of 169 children (Mean age = 9.4 years, SD = 0.54), self-selected into groups of children who did not attend HAF over the summer holidays (No HAF; n = 123), attended their school-based HAF club (HAF; n = 29) or attended their school-based HAF club alongside a bespoke nutritional education programme (HAF NEP; n = 17). Kruskal-Wallis and Mann-Whitney U analyses found no significant between-group differences for any outcome, apart from perceived cooking competence. HAF NEP was associated with improved perceived cooking competence. Standard HAF was not associated with improved outcomes related to nutritional education. The HAF NEP group was associated with improved cooking competence only. The lack of significant findings in the intervention groups suggests further research into HAF nutritional education is required.

Food brand marketing is one of the techniques used by the food industry to create positive images and enhance brand recall among children. The objectives of this study were to assess food and beverage brand recall and to examine the sociodemographic characteristics associated with food brand recall, as well as the purchasing and consumption of branded foods among Thai children. Cross-sectional analysis of secondary data from the 2024 Monitoring on Food and Beverage Marketing to Children in Thailand survey. A validated and reliable questionnaire was used for data collection. Descriptive statistics were used to summarise sociodemographic characteristics, food and beverage brand recall, and purchasing behaviours. Associations between brand recall and purchasing behaviours were examined using multivariable logistic regression models. Eleven provinces across Thailand. A total of included 2,113 children aged 10-18 years. Nearly 40% of children recalled sweetened beverage brands, while 35% recalled snack brands. Food and beverage brand recall was statistically associated with purchasing and consumption of branded foods across several product categories after adjustment for sociodemographic characteristics. Food and beverage brand recall was commonly reported among Thai children and showed statistically significant associations with purchasing and consumption behaviours. These findings contribute to the evidence base on food marketing exposure among children in Thailand.

To model the potential value-for-money of implementing proposed unhealthy food advertising restrictions on Western Australian (WA) transport-owned assets to prevent obesity-related diseases. A cost-benefit analysis using a societal perspective was undertaken to model the policy intervention over a 30-year time horizon. The effectiveness of the intervention was based on a similar policy implemented in the United Kingdom by Transport for London, adapted to the WA context. The ACE-Obesity Policy model, a validated multi-state lifetable Markov model, was used to assess the expected health (quantified as health-adjusted life years (HALY)) and economic outcomes of the intervention's impact on unhealthy food consumption. The potential cost of policy development and monitoring and revenue impacts on government and industry (outdoor advertising companies) were included in the modelled analysis. Western Australia. Greater Perth population. The cost of implementing the policy was estimated at A$28 million (95% UI [Uncertainty Intervals]: $23-$35), 71% borne by government and the remaining by outdoor advertisers. A mean population weight reduction of 0.58kg (95%UI: 0.28-0.90) was estimated, which translated to 5,906 HALYs gained (95%UI: 2,750-9,084) with a monetary value of A$1,374 million (95%UI: $642-$2,112). Eight percent of the monetised benefits were attributed to healthcare cost savings, while 92% were associated with monetised health gains. The intervention was estimated to generate a net-present value of $1,346 million (95%UI: $614-$2,082) and benefit-cost ratio of 50 (95%UI: 23-81). Policy to restrict advertising of unhealthy foods on WA transport owned assets is likely to represent excellent value-for-money.

To assess the exposure of Austrian children to TV HFSS food and beverage ads and identify changes in HFSS food advertising after the implementation of self-regulatory measures of marketing restriction. All ads shown on five popular TV channels for Austrian children/teenagers were coded over four days (360 hours) using the WHO TV Monitoring Protocol, to identify food/beverage marketing, marketing strategies, target audience, and presence in peak viewing times. Nutrient analysis was performed using Nutrient Profile Models (NPMs) which classify foods as permitted or not permitted for marketing to children: WHO EURO NPM for international comparability and Austria's NPM for local regulatory compliance. Results were compared with pre-regulatory Austrian TV monitoring data. Austria. None. Of 9099 ads captured, 17.0% were for foods and beverages. Most promoted products not permitted for marketing to children according to WHO EURO NPM (81.8%) and Austria's NPM (83.8%). On all channels, the advertising rate for food ads rose throughout the day, culminating during child/teen peak viewing times in the evening. A mix of marketing strategies and persuasive appeals was used; emotional themes (e.g. friendship, holidays, enjoyment) were more common in not permitted ads, compared to permitted ads. Not permitted ads featured elements appealing to children/teenagers significantly more often than permitted ads. Despite self-regulatory measures of marketing restriction, children and teenagers in Austria are still exposed to a high number of advertisements for HFSS foods using impactful emotional marketing strategies on TV. To protect children from this influence, further regulations are called for.

To assess changes in (1) sodium content of processed foods in the Canadian food supply and (2) the proportion of products meeting Health Canada's voluntary sodium reduction targets (SRTs) between 2010 and 2020. This repeated, cross-sectional study used foods from the 2010 (n=6,929), 2013 (n=9,366), 2017 (n=10,324), and 2020 (n=15,797) collections of the University of Toronto's Food Label Information and Price database, categorized into Health Canada's sodium categories. Quantile regression was used to assess changes in sodium content. Firth's bias-reduced logistic regression was used to evaluate changes in the proportion of foods meeting the SRTs and trends were assessed with Cochran-Armitage tests. Canada. Processed foods. Between 2010-2020, 54% (7/13) of major categories had a left shift (reduction) in their sodium distribution, 15% (2/13) had a right shift (increase), 15% (2/13) had both a left and right shift, and 15% (2/13) did not change. The proportion of products meeting the average targets and maximum levels increased 6% and 4% from 2010-2013 and 4% and 3% from 2013-2017, then decreased 3% and 1% between 2017-2020, with trends for improvement over time (p-trend<0.001). Although many categories decreased in sodium, some did not change or increased in sodium and improvements in the proportion of products meeting the SRTs were modest and occurred early on. Further actions, such as implementing accountability initiatives that promote industry adherence to voluntary SRTs or introducing mandatory measures, alongside frequent and transparent monitoring are needed to reduce sodium in processed foods in Canada.

This commentary responds to the study by Kelly Garton et al., "Monitoring the impacts of international trade and investment agreements on food environments: a Canadian case study," published in Public Health Nutrition, which applies the INFORMAS trade and investment monitoring framework to the Canadian food system.

This study aimed to determine the prevalence of Lebanese adults living with underweight, overweight, or obesity, assess and compare the cost of the Mediterranean Diet (MD) with that of the current dietary consumption pattern, and explore diet cost as a determinant of living with underweight, overweight, or obesity. Data for this nationally-representative cross-sectional study were collected through sociodemographic questionnaires, anthropometric measurements, the Arab Family Food Security Scale, and dietary assessments using a validated food frequency questionnaire and 24-hour recalls. Diet costs were calculated based on 2023 market prices using purchasing power parity. Logistic regression was used to assess associations with BMI. Lebanon, using data representative of the Lebanese adults' population. 444 Lebanese residents aged 18-64 years. Overall, 66.2% of the participants were living with underweight (4.3%), overweight (37.8%), or obesity (24.1%). On average, the cost of following MD ranged from Intl.$ 23.36 to Intl.$ 26.49/person/day, whereas, a Lebanese adult spent Intl.$ 20.46 on consumption. Only 31.1% of participants spent an amount equal to or greater than the minimum MD cost (Intl. $23.36/day). Participants who meet or exceed this threshold were 1.59 times more likely to be living with a healthy weight (aOR=1.59, p=0.043). The high prevalence of Lebanese adults living with underweight, overweight, or obesity is compounded by the unaffordability of a healthy MD. Improving the affordability of nutritious foods is crucial to promoting healthier dietary patterns and achieving better weight outcomes. Public health strategies should include economic, behavioral, and policy-level interventions to enhance diet quality and affordability in crisis-affected populations.