National Nutrition Policy Research Articles

Integration and coherence in food governance—a comprehensive analysis of food security public programs in Chile

This study critically examines Chilean food governance. In particular it focuses on two aspects of inter-ministerial governance: policy “integration” and policy “coherence.” It does so by evaluating the alignment between two key policy objectives within the Chilean government; the Social Determinants of Health (SDH) and National Food and Nutrition Policy (NFNP) objectives. This is accomplished by using publicly available data at the Integrated Bank of Social Programs (BIPS – Banco Integrado de Programas Sociales) collected in 2021. Utilizing mixed methods including content analysis, program review, and financial analysis, 245 public programs were scrutinized. Only 0.042% of the 2021 national budget for public programs was allocated to n = 70 key programs directly addressing food and nutrition security (FNS), highlighting significant resource disparities among ministries. While some inter-ministerial integration was observed, overall coherence with NFNP objectives, particularly in “health integration and intersectorality,” was lacking. Since disparities in resource allocation and neglect of stability and agency within food security across ministries are identified, indicating a variegated approach to food security with differing emphases on availability, utilization, and access, this study calls for a collaborative, multi-sectoral strategy to bridge policy gaps and enhance coherence in addressing food security challenges. Its findings contribute to the discourse on food governance, offering insights into policy implementation gaps and suggesting avenues for enhancing inter-ministerial integration and coherence. This research underscores the importance of a comprehensive approach to policy formulation and execution in achieving NFNP goals and addressing the complex challenges of food security in Chile.

Intermediate and secondary school food environment in New Zealand: Food and drink menu assessment.

Nutrition-related obesity is rising among adolescents in New Zealand with an estimated one in eight children being obese. The school environment is an ideal community setting for encouraging a healthy lifestyle as schools contain a diverse population and involve students and parents. However, the healthiness of food available to intermediate and secondary school students (Years 7-13) is unknown. This study assessed how food and drink menus from schools align with policy guidelines for healthy school food environments. A convenience sample of NZ schools' (years 7-13; ages 10-19) menus was collected in 2020. Menus were classified using traffic light criteria. A toolkit was developed by three nutritionists and one dietitian (with trained staff support) to aid with menu classification. Menu quality was evaluated against school characteristics and policy use. Of the school menus assessed (n = 60), 3.3% met the recommendation for the provision of 75% 'green' items. 'Red' items were the main contributors (mean = 53.6%). Schools with high socio-economic status (deciles 8-10; 14.3%; p < 0.05) and small school size (<749 students; 14.1%; p < 0.025) were associated with a higher proportion of 'green' items. Community (19.3%) and in-house (25.9%) food providers provided a lower percentage of 'amber' items than school providers (39.3%; p < 0.001). In-house providers (64.6%) had a greater percentage of 'red' items than school providers (48.2%; p = 0.017). Food available in schools (Years 7-13) tends to be unhealthy. A national nutrition policy could improve the school food environment, especially in schools with large populations and low socio-economic status. SO WHAT?: School demographics have been associated with menu quality but further research within these schools is needed to identify the gaps to improve equitable outcomes within school food environments.

Changing paradigm of malnutrition among Bangladeshi women of reproductive age and gaps in national Nutrition Policies and Action Plans to tackle the emerging challenge.

The main objective of this paper is to document the changing paradigm of malnutrition in Bangladesh and estimating how this is creating an intergenerational risk. This paper also examines national policy responses to tackle the silent epidemic of double burden of malnutrition. Publicly available datasets of five Bangladesh Demographic and Health Surveys were used to see the changing paradigm of malnutrition among Bangladesh women. In addition to that, four national policies concerning, maternal and child health; and nutrition were reviewed using CDC's 2013 Policy Analytical Framework. In Bangladesh, the share of ever-married women aged 15-49 who were underweight declined sharply between 2007 and 2017-2018, from 30 to 12%. In the same period, the proportion of women who were overweight or obese increased from 12 to 32%. Despite remarkable progress in reducing undernourishment among women, the share of well-nourished remained unchanged: 58% in 2007 and 56% in 2017-2018, mainly due to the shift in the dominant burden from undernutrition to overnutrition. This shift occurred around 2012-2013. Currently, in Bangladesh 0.8 million of births occur to overweight women and 0.5 million births occur to underweight women. If the current trend in malnutrition continues, pregnancies/births among overweight women will increase. Bangladesh's existing relevant policies concerning maternal health and nutrition are inadequate and mostly address the underweight spectrum of malnutrition. Both forms of malnutrition pose a risk for maternal and child health. Underweight mothers are at risk of having anemia, antepartum/postpartum hemorrhage, and premature rupture of membranes. Maternal obesity increases the risk of perinatal complications, such as gestational diabetes, gestational hypertension, and cesarean deliveries. Currently, around 24% of the children are born to overweight/obese mothers and 15% to underweight mothers. Bangladesh should revise its national policies to address the double burden of malnutrition among women of reproductive age across pre-conception, pregnancy, and post-natal stages to ensure optimum maternal and child health.

Responses to the updated Nutri-Score algorithms in Norway: A qualitative study among food system actors in the NewTools-project.

Nutri-Score is a front-of-pack label grading foods and beverages from A to E indicating nutritional quality based on the foods' favorable and unfavorable components, and a contender in the ongoing debate on the possible implementation of a harmonized mandatory front-of-pack nutrition label in the European Union. NewTools is a research project on scoring systems for foods involving 28 partners representing actors involved in the Norwegian food system. This study aimed to explore views reported by Norwegian food system actors on the advantages and disadvantages with the updated Nutri-Score algorithms for food and beverages (2022-2023). This included Nutri-Score's performance in ranking foods according to the national food-based dietary guidelines and to the nutritional challenges in Norway. A total of 28 project partners and 15 other food system stakeholders following the NewTools-project were invited to provide responses on the Nutri-Score algorithms and their application on foods and beverages in the Norwegian food composition table. Thirteen written responses were received and analyzed with qualitative content analysis. The responses to the updated Nutri-Score varied in content, reflecting mainly concerns. Examples of perceived concerns included excessive penalty of salt content; insufficient differentiation based on fat content in meat, sausages, cheese, and milk; and several unreasonable comparisons across food categories. They also expressed a concern that Nutri-Score may stimulate to increased food processing, and some reported inconsistencies between Nutri-Score's classification of foods and national nutrition guidelines and policies. Several concerns with the updated Nutri-Score algorithms were raised, including the weighting of specific nutrients, unfair outcomes when comparing across food categories, and inconsistencies with established Norwegian nutrition guidelines and policies. The results should be interpreted with caution, as some perspectives from the Norwegian food system may be missing.

School health and nutrition services for children and adolescents in Tanzania: A review of policies and programmes.

School health and nutrition programmes are effective strategies to address the health problems among school-going children and adolescents. We examined the policy environments, successesand bottlenecks associated with school health and nutrition programmes in Tanzania. We used the 'policy triangle framework' to examine 22 national and regional school health and nutrition policies and programmes in Tanzania. We also interviewed 16 key informants to gain further insights into school health and nutrition programmes. Several school health and nutrition policies in Tanzania outline the basic elements of school-based health and nutrition services. Yet, these documents neither recognise vulnerable groups, recommend age-appropriate strategies to address children's and adolescents' varied and transient needs, nor provide a framework for implementing and tracking recommended activities. In these documents, underweight and infectious diseases, including humanimmunodeficiency virus/acquired immunodeficiency syndrome, are frequently identified as major concerns of young people, with little or no consideration of social determinants. Diverse strategies including school feeding, water and sanitation services, health and nutrition educationand promotion of healthy behaviours are identified. In doing so, these documents adequately define the roles and responsibilities of all government actors, but young people and their guardians are not actively engaged in design and implementation. Additionally, there are several challenges to implementing these policies including budgetary constraints, limited resources, a lack of inter-sectoral coordinationand insufficient capacity within targeted schools. To improve the health and nutritional status of school-going children and adolescents in Tanzania, adequate budgets, strengthened coordination and implementation efforts, the development of school-based stakeholders' capacity, as well as the involvement of all other stakeholders, including adolescents, are imperative.

Cognitive Interviewing to Improve Infant and Young Child Dietary Assessments in the Nepal Demographic and Health Survey

BackgroundThe Demographic and Health Survey (DHS) is the primary source of nationally representative nutrition data for many countries and is important in shaping national nutrition policy, advocacy, and research. Without careful testing and adaptation to local contexts, findings are at risk of inaccurately representing respondents’ behaviors and key nutritional indicators. ObjectivesThis study used a cognitive interviewing approach to assess mothers’ comprehension, retrieval, judgment, and response to the infant and young child feeding (IYCF) dietary assessment module questions in the Nepal DHS-8 Woman’s Questionnaire. MethodsA cross-sectional qualitative study was conducted in December 2021, using semistructured cognitive interviews, among 54 mothers of children 6–23 mo of age across 3 regions of Nepal. Interviews were analyzed to identify issues in participant understanding of questions, as well as cognitive challenges or benefits of a longer introduction to the IYCF dietary assessment module, as compared with the original shorter introduction and challenges or benefits to using closed-ended compared with open-ended questions. ResultsCognitive challenges were identified, including issues with judgment of certain food categories resulting in misclassification, comprehension of certain concepts, and comprehension of certain instructions for the dietary assessment that resulted in the variability of food and liquids recalled by mothers. ConclusionsThese findings carry substantial implications for the measurement of the diet quality of infants and young children (IYC) in Nepal, and similar cognitive challenges may exist in other contexts. Although this current study is not able to answer the exact extent to which the accuracy and precision of IYCF indicators are affected by these cognitive challenges, these findings indicate that current measurements may be subject to over or underestimation and there is a need for further research in this area to understand the degree of measurement error related to these challenges.

Food insecurity and its severity among adults receiving antiretroviral therapy in health facilities, northcentral Ethiopia: a multi-facility-based cross-sectional study.

Food insecurity plays a crucial role in predicting the spread of HIV due to the adverse effects of coping mechanisms adopted to mitigate it. However, there is a scarcity of context-specific evidence regarding food insecurity among HIV-infected adults. Therefore, this study aimed to assess the context-specific magnitude of food insecurity and associated factors among adults receiving antiretroviral therapy (ART) in health facilities in the North Shewa Zone, Ethiopia, ultimately contributing to the achievement of the 95-95-95 HIV treatment target in the local context. A multi-facility cross-sectional study was conducted among 865 HIV-infected adults receiving ART and being followed up for their treatment. We included health facilities that provide ART, including four hospitals and six health centers. A log-binomial regression model was fitted to identify the association between food insecurity and independent variables. Adjusted prevalence ratios (APRs) with a 95% confidence interval were computed to measure the strength of the association. In this study, 290 (33.7, 95% CI: 30.60, 36.91) of the HIV-infected adults studied had food insecurity during their treatment and follow-up, of which 152 (52.41, 95% CI: 46.64, 58.13) and 110 (37.93%, CI: 32.50, 43.68) of them were found to have severe and moderate forms of food insecurity, respectively. We found that being younger (APR = 2.27, 95% CI: 1.12, 4.60), being female (APR = 1.87, 95% CI: 1.03, 3.39), lacking formal education (APR = 10.79, 95% CI: 14.74, 24.58), having lower educational status (APR = 5.99, 95% CI: 2.65, 13.54), being a daily laborer (APR = 6.90, 95% CI: 2.28, 20.85), having low monthly income (APR = 1.89, 95% CI: 1.11, 3.22), advanced WHO clinical stage (APR = 2.34, 95% CI: 1.08, 5.10), and receiving ART for less than 4 years (AOR = 2.28, 95% CI: 1.09, 4.74) were significantly associated with a high proportion of food insecurity among HIV-infected adults. The magnitude of food insecurity among HIV-infected adults receiving ART was high, with an extremely high magnitude of severe food insecurity. The finding suggests the need for culture- and context-specific nutritional interventions to address the gender dynamics of food insecurity, attention to the early stage of ART, and the integration of strategies to improve educational status and enhance income-generation activities of HIV-infected adults. This requires an emphasis on the link between food insecurity and HIV in Ethiopia's national food and nutrition policy.

Effects of Food Bioactive Compounds on Human Health and Disease Prevention in Botswana

Purpose: The aim of the study was to evaluate effects of food bioactive compounds on human health and disease prevention in Botswana. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study found that bioactive compounds found in a variety of foods, including fruits, vegetables, grains, and herbs, have been extensively studied for their potential health benefits, including antioxidant, anti-inflammatory, and anti-cancer properties. In Botswana, where NCDs such as diabetes, hypertension, and cardiovascular diseases are major public health concerns, integrating bioactive-rich foods into the diet plays a crucial role in reducing the prevalence and impact of these conditions. Unique Contribution to Theory, Practice and Policy: Nutritional Epidemiology Theory, Pharmacological Theory of Food Bioactive Compounds &amp; Health Behavior Theory may be used to anchor future studies on effects of food bioactive compounds on human health and disease prevention in Botswana. Promote public awareness and education campaigns to highlight the importance of incorporating bioactive compounds into daily diets for health maintenance and disease prevention. This can include disseminating accessible information about bioactive-rich foods and their health benefits. Advocate for the inclusion of dietary guidelines that emphasize the consumption of bioactive-rich foods in national nutrition policies. This can involve collaborating with policymakers to integrate evidence-based recommendations into dietary guidelines and public health initiatives.

Developing a national nutrition policy strategy to advance cardiometabolic health and health equity

Developing a national nutrition policy strategy to advance cardiometabolic health and health equity

The contribution of the National Nutrition Policy in addressing Ghana's social determinants of health and nutrition inequalities

One of the major challenges for developing countries is growing economic prosperous while eradicating poverty and lowering social and health inequalities. The National Nutrition Policy of Ghana (NNP) was launched in July 2016 to ensure optimal nutrition for people living in Ghana, promote child survival, and enhance capacity for economic growth and development. A review of the policy was conducted in 2018 where the effectiveness of the policy in meeting its objectives was ranked as poor, impacting negatively on the social determinants of health. This article analyzes the NNP by using the Kingdon Framework to determine how problems, politics, and the policy itself can act as a tool to address the factors that have a significant influence on an individual’s health and well-being, especially the marginalized in society.

Implementation of National Nutrition Policies and Strategies to Reduce Unhealthy Diets: An Ecological Analysis of 194 Countries from 2017 to 2021.

This study investigates the implementation of national policies and strategies to control unhealthy diets, which are pivotal in the global surge of non-communicable diseases. Leveraging data from the World Health Organization's Non-Communicable Diseases Progress Monitors and Country Capacity Surveys, we calculated aggregate implementation scores for 13 diet-related policies across 194 countries from 2017 to 2021. We used descriptive statistics and linear regression to investigate the implementation trends and associations between key national-level factors and implementation scores. The mean score in 2021 was 52% (SD = 24), with no statistical differences in the 5-year period. Stark disparities in implementation efficacy were noted, ranging from comprehensive adoption in some nations to minimal application in others. Our analysis also highlights a shifting focus in policy adoption: notably, an increased commitment to taxing sugar-sweetened beverages juxtaposed with a decline in dietary awareness initiatives. Significant predictors of policy implementation include the Human Development Index, the cost of a healthy diet, and health service coverage. These findings suggest a complex interdependence of socioeconomic factors influencing policy implementation. Our research underscores the need for multifaceted, globally collaborative strategies to effectively combat diet-related diseases, emphasizing the importance of comprehensive policy frameworks in public health interventions.

Ethiopian Street Foods: Working Conditions and Governance Perspectives. A Qualitative Study.

Street foods are foods and beverages as either ready for direct consumption or minimally processed, prepared, and/or sold by vendors and handlers. The objective of this study was to explore the condition and governance of street foods in Ethiopia. A qualitative exploratory study was employed from December 2022 to January 2023 in Addis Ababa, Hawassa, Dire Dawa, and Jimma, cities of Ethiopia. Twelve respondents comprised key informants from selected governmental sectors were interviewed. The purposive sampling method was used to recruit study participants. The number of participants interviewed was determined by the information saturation criterion, and data were collected at the interviewee's offices. Data were collected by using key informant interview technique and audio recorded. An interview guide was used to facilitate interviews and thematic analysis was employed. The Overall data management process was conducted using Atlas-ti V 8 software. The result revealed there were 4 thematic areas these were street food vendors and vending process, policy content and implementation, integration and coordination of sectors, and the way forward. The street food vendors prepared their food in an insanitary manner, absence of common working places for the vendors, lack of due emphasis for the street food vendors in the national food and nutrition policy, lack of formalization and legalization of street food vendors, poor coordination among sectors and institutions work on street food governance, and weakness on the implementation of rules and regulations in controlling street food vendors were the prominent gaps that were identified in the policy. Though Ethiopia has a national food and nutrition policy, the policy doesn't adequately address the street food vending sector. Besides, it is not well communicated to the implementers resulting in poor policy implementation. Quantifying socio-economic benefits of street food vending activities in Ethiopia needs further investigation.

Vitamin K variations in conger eel (Conger myriaster) influenced by harvest time and size

This study analyzed the variation in vitamin K content in conger eel (Conger myriaster) caught off Tongyeong, Gyeongsangnam-do, Korea, focusing on the influence of size (large and small) and harvest period (monthly throughout 2021). We applied enzymatic extraction and HPLC-fluorescence methods for the analysis of vitamin K1 (phylloquinone) and K2 (menaquinone). The vitamin K content in conger eel varied significantly with size and harvest season (p&lt;0.05). In large-sized samples, the phylloquinone content peaked in July (0.80±0.09 μg/100 g), while the highest menaquinone content was in May (0.79±0.11 μg/100 g). Conversely, in small-sized conger eels, the highest phylloquinone was found in December (1.94±0.15 μg/100 g), and the peak menaquinone level was in January (0.66±0.02 μg/100 g). The fat content was highest in July for large samples and in January for smaller ones. There was a positive correlation between fat and total vitamin K contents in conger eel (r=0.631, 0.667). Method validation and quality control measures ensured data reliability for vitamin K1 and K2 analyses. This study provides reliable information on the size and seasonal variations of vitamin K in conger eels, a staple in the Korean diet. This information is valuable for inclusion in Korea’s national food nutrition database and for formulating future national health and nutrition policies.

Emergence of National Nutrition Policy in the Lao People’s Democratic Republic: an analysis of collaborations between governmental and external actors

BackgroundIn most developing countries, addressing malnutrition involves a coalition of stakeholders that includes the government and international development partners. This study explores the evolution of the malnutrition actor coalition landscape before and after the emergence of the National Nutrition Policy in the Lao People’s Democratic Republic (Lao PDR) in 2008.MethodsA qualitative study was conducted based on the theory of coalition structuring. Twenty semi-structured interviews were performed with representatives of national and international organisations involved in addressing malnutrition in Lao PDR. The information obtained from the interviews was complemented by an analysis of relevant documents dating back to 1990. Interviews were recorded and transcribed verbatim. A thematic analysis was performed using NVivo 11 software and the diagrams of collaboration drawn by the participants were turned into a visual collaboration map using SocNetV software. We relied on various types of triangulation to increase the analysis's credibility, reliability, and confirmability.ResultsThe results showed that before the emergence of the National Nutrition Policy, three coalitions representing the health, agriculture, and education sectors coexisted. These colalitions worked largely in silos, although with some interactions when deemed necessary mainly by United Nations agencies. The emergence of the National Nutrition Policy provided the government with an effective political tool for coalescing the three coalitions into a unique coalition involving all major stakeholders in the nutrition field. All three forces that incite actors to collaborate inside a coalition according to the theory of coalition structuring (transactions, control, intangible factors) were mobilised in the creation of the single coalition.ConclusionsCombating malnutrition is a government priority in the Lao PDR. The current study showed that the National Nutrition Policy in Lao PDR has led to a significant evolution in the malnutrition coalition landscape, resulting in improved collaboration among stakeholders. This finding highlights the effectiveness of public policies in facilitating intersectoral activities to tackle complex problems, such as malnutrition.

ASSESSMENT OF RURAL AREA FOOD CONSUMPTION STATUS IN THE NATIONAL NUTRITION POLICY OF MALAYSIA

Food consumption is one of the most important components in ensuring household food security. However, there are practices and beliefs that some foods are detrimental to health among low-income people, which affects food consumption in the household. This situation is directly related to nutrition policy. This study aims to investigate the food consumption households in the rural areas of Kedah State, to fulfill the national nutrition policy of Malaysia. The study centers on rural Kedah State, specifically the municipalities of Kubang Pasu, Baling, Pendang, Alor Setar, and Kuala Muda. The technique of stratified random sampling was used to choose 225 rice growers from the rural regions of the chosen districts. SPSS 25 and food intake results scores were used to analyze the information. The results of the reading revealed that food consumption among farmers was low with a value of less than 29.9. Almost the total food intake for each food category is low except for beverages that have a high value of above 80. The study also found that this group believes that some foods have an impact on health. The study suggests that the government should sensitize the rural population in particular to eat balanced foods. At the same time, the restructuring of the primary school curriculum and syllabus needs to be holistic so that awareness of nourishment and fitness can be raised in early childhood education.

Dietitians as change agents for promoting healthy and sustainable food systems

Dietitians as change agents for promoting healthy and sustainable food systems

The development of the NOURISHING and MOVING benchmarking tools to monitor and evaluate national governments' nutrition and physical activity policies to address obesity in the European region

Despite assurances of government action, the burden of non-communicable diseases (NCDs) and overweight and obesity is continuing to grow at an alarming rate both globally and in Europe. The NOURISHING and MOVING policy frameworks outline a comprehensive set of policy actions across 6 domains and 16 policy areas in which national governments should take action to promote healthy diets and physical activity. Monitoring and benchmarking these policies is important for assessing progress on obesity and NCD prevention. This paper describes the participatory process for developing benchmarking tools structured around the policy areas of the NOURISHING and MOVING policy frameworks. They consist of a set of indicators and policy attributes that assess government support in promoting healthy nutrition and physical activity. They are adolescent relevant as they capture policy actions that target or impact adolescents. The benchmarking tools are designed to monitor progress on national government action on nutrition and physical activity based on aspirational standards. They will be applied in 27 European countries initially and are aimed at policymakers, researchers, and civil society, to track progress, develop the research infrastructure on effectiveness of NCD prevention policies at population level, and support advocacy efforts.

A Qualitative Study Investigating the Current Practices, Obstacles, and Needs of Enteral Nutrition Support among Registered Dietitians Managing Non-Critically Ill Hospitalized Patients in Riyadh, Saudi Arabia

Introduction: Despite the wide availability of international guidelines that direct enteral nutrition practices, no recommendations or guidelines are tailored specifically for the unique healthcare environment in Saudi Arabia. Specifically tailored national guidelines are considered essential evidence that should be developed and followed. However, understanding the current practices, local needs, and gaps is important to facilitate the process of developing a practical national guideline. Methodology: In this qualitative study, focus groups using a structured interview technique were conducted to gain an in-depth understanding of the current enteral nutrition practices and related needs/obstacles from 24 registered dietitians handling non-critically ill patients. The recorded sessions were transcribed, and then themes were identified via coding analysis. In addition, the inter-rater agreement of the data’s themes was evaluated. Results: Five focus group sessions that consisted of 24 participants (3 males and 21 females) working in private and governmental hospitals (18 governmental and 6 private) in Riyadh city were conducted. Ten enteral nutrition practice-related themes for non-critically ill patients were identified via coding analysis, in addition to four obstacle-related themes and four need-related themes. Conclusion: Non-critically ill patients represent the most significant majority of hospitalized patients. Therefore, it is recommended for the relevant regulatory authorities to develop national enteral nutrition guidelines and policies that guarantee consistent and sustainable care, along with improving the health outcomes for this population.

Recommendations to strengthen nutritional care in the primary care setting in BrazilRecomendaciones para el fortalecimiento de la atención nutricional en la atención primaria de salud en Brasil

RESUMOObjetivo.Elaborar recomendações para o fortalecimento da alimentação e nutrição (A&N) na atenção primária à saúde (APS) brasileira a partir de um consenso de especialistas.Métodos.Realizou-se estudo descritivo e exploratório utilizando a técnica Delphi. De 172 especialistas em A&N na APS convidados a participar, 116 aceitaram o convite e 72 participaram da primeira rodada. A segunda rodada teve 56 participantes das cinco macrorregiões brasileiras, entre gestores, profissionais de saúde, representantes da sociedade civil e pesquisadores. As recomendações foram construídas por análise temática das respostas a perguntas abertas sobre obstáculos, estratégias, ações e iniciativas de cinco componentes técnicos da Política Nacional de Alimentação e Nutrição (vigilância alimentar e nutricional, atenção e coordenação do cuidado nutricional, promoção da saúde, intersetorialidade e gestão das ações de A&N). Na segunda rodada, os especialistas classificaram cada item proposto quanto à sua pertinência e relevância para fins de recomendação.Resultados.Os especialistas elaboraram 35 recomendações, organizadas em seis categorias: estrutura; agenda de A&N na APS; organização em rede e organização da APS; processos de trabalho de A&N na APS; planejamento, monitoramento e avaliação das ações de A&N na APS; e sistema de informação. As categorias foram organizadas em dois blocos: “ações estruturantes da APS para o fortalecimento da A&N” e “ações estruturantes da A&N para o fortalecimento da APS”.Conclusões.As recomendações foram produzidas por pessoas experientes que acompanham a trajetória da A&N e da APS por diferentes pontos de vista, sendo úteis para a gestão e proposição de políticas públicas rumo ao fortalecimento da A&N nas APS brasileira.

The relationship between volume of newspaper coverage and policy action for nutrition issues in Australia: a content analysis

ObjectivesUnhealthy diets are a leading risk factor for the global burden of disease. Research suggests that comprehensive, population-level solutions are required to attenuate this problem, though such policies have not been adopted. Increased media attention may lead to government-led policy action through issue definition and agenda setting. The aim of this study was to analyse which nutrition policy issues are covered in print media, and whether media attention correlated with relevant policy actions in Australia. Study design/methodsA content analysis was conducted on newspaper articles published between 1999 and 2019 from 11 major Australian metropolitan newspapers. ResultsOf the policy issues identified, few received meaningful media attention. Of those with peaks in media attention, only fortification and labelling issues coincided with government-led policy actions, while regulating junk-food advertising to children, sugar-sweetened beverage taxation, and the formulation of a National Nutrition Policy did not result in policy outcomes. ConclusionsGiven the limited coverage of nutrition policy issues, the relationship between media attention and policy actions for the captured issues may not be determinable. In addition, factors including social, political, and historical contexts may be stronger influences on policymaking than media attention. Although this study did not demonstrate a relationship between media attention and policy action because of low coverage of nutrition issues, it did identify the media are generally reporting nutrition policy issues with a positive public health framing. Promoting favourable coverage of nutrition policy issues is still an important tool for advocacy globally. Moving forward, increasing the volume of coverage of nutrition issues should be an advocacy priority.