Background: The current means-tested Free School Meals (FSM) policy aims to provide nutritious meals to children from disadvantaged backgrounds. This study evaluated the effectiveness of the UK secondary school FSM policy on fruit and vegetable (FV) intake, diet quality, nutrient intake, and food insecurity. Methods: A cross-sectional study was conducted in 34 UK secondary schools, (England (n=17), Northern Ireland (NI) (n=17)), with varying FSM uptake in those eligible and registered. Dietary intake was assessed using Intake24 dietary recalls; diet quality (Diet Quality Index for Adolescents (DQI-A)) and food security (Child Food Security Survey Module). Multilevel linear regression examined associations between school-level FSM uptake and the primary outcome, FV intake. Secondary outcomes included diet quality, school FV intake, meeting ‘5-a-day’ FV recommendations, energy and nutrient intakes, and food security. Model covariates included school-level (rurality, gender mix, location) and individual-level factors (gender, relative age, deprivation, ethnicity, English as an Additional Language, Special Educational Needs, FSM status). Findings: A total of 1,678 students aged 11-12 and 14-15 years (NI n=823; England n=855) participated. Mean FSM registration and uptake were 39% and 73% respectively. After adjustment for covariates, a 10% increase in FSM uptake was associated with a 0.11 portion/d mean increase in FV intake (95% CI 0.01, 0.20; p=0.02); a 22% increased odds of meeting FV recommendations (OR=1.22 95% CI 1.05, 1.42) and a 0.8 unit mean increase in DQI-A score (95% CI 0.13, 1.47). FSM uptake was not significantly associated with food security .Interpretation: Increased school-level FSM uptake was associated with marginal improvements in FV intake and diet quality, but not food security in UK secondary school students. Strengthening FSM participation and the nutritional quality and attractiveness of school food could enhance uptake, broaden access to healthier options, and support better diet quality among secondary school students.

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.

OBJECTIVE:Food environments can influence dietary behaviours. Promotion of foods high in fats, salt and sugars is a barrier to healthy eating. We explore advertising by deprivation in an English city. DESIGN:Using a cross-sectional design, we describe the prevalence of outdoor advertising, the types of products advertised and the UK Nutrient Profile Modelling scores for advertised foods and non-alcoholic beverages. Differences in outdoor advertising prevalence by area deprivation were assessed using χ2 tests. SETTING:Six areas in each of five deprivation strata were randomly selected from all 482 Leeds neighbourhoods (England) (n 30 neighbourhoods). PARTICIPANTS:Eligible outdoor advertisement assets (intentionally placed permanent/semi-permanent advertisements visible from the street) were photographed in May-June 2023. RESULTS:A total of 295 outdoor advertising assets were recorded. The most deprived quintile had the highest number of advertising assets (n 74). Bus shelters were the most prevalent asset (n 68). The number of food adverts differed significantly by deprivation level. The two most deprived areas had higher than expected exposure, while the two least deprived areas had lower than expected exposure (P < 0·01). Data were insufficient to compare compliance against a hypothetical Healthier Food Advertising Policy; however, bus shelters were most likely to display high in fats, salt and sugars food adverts. CONCLUSIONS:Food advertising in Leeds is unequally distributed, with more food adverts in more deprived areas. Similar inequalities may exist in other cities, but data are scarce. Unhealthy adverts are most prevalent on bus shelters, highlighting an important asset for policy focus.

OBJECTIVE:We evaluated the impact of an established nutrition education intervention, 'PhunkyFoods' on food literacy, cooking skills and fruit and vegetable intake in primary school aged children. DESIGN:A pre-registered cluster randomised controlled trial was used; the intervention group received the 'PhunkyFoods' programme and the wait-list control group received the usual school curriculum. Primary outcomes measured were differences in food literacy and cooking skills scores between the intervention and control arms after 12 months adjusted for baseline values. SETTING:The trial was undertaken in twenty-six primary schools in North Yorkshire, UK. PARTICIPANTS:631 children aged 6-9 years participated (intervention n 307, control n 324) through assemblies, classroom activities and after-school clubs. RESULTS:There were no significant effects of the intervention compared with control on food literacy, cooking skills, vegetable intake or fruit intake. Adjusting for baseline, the Food Literacy Total Score was 1·13 points lower in the intervention group than the control (95 % CI -2·87, 0·62, P = 0·2). The Cooking Skills Total Score was 0·86 lower in the intervention group compared with the control (95 % CI = -5·17, 3·45, P = 0·69). Girls scored 2·8 points higher than boys in cooking skills across the sample (95 % CI = 0·88, 4·82, P < 0·01). CONCLUSION:The intervention did not result in improved food literacy or cooking skills, though sex effects on these outcomes were observed. More practical food preparation hours are needed in primary schools to improve the likelihood of an effect on outcomes.

A school food service, which is the way children access food during the school day, is one of the many aspects in creating a health-promoting school environment. School-provided meal services differ greatly, depending on the country, region and school contexts, however, there is limited understanding of the diverse meal delivery within these settings. Therefore, the aim of this study was to understand different school-provided meal systems across different countries and contexts. This study used a qualitative, naturalistic observation, using an interpretative epistemology and a multiple-case design to explore food service across seven schools, mapped against a school meal food service framework. This included three schools with an established school-provided meal system (England, France and Sweden) and four schools with emerging school-provided meal systems (Australia). Mapping captured findings across the domains of Menu offering, Food service system, Administration, Eating environment, Mealtime experience and Post-meal. Results demonstrate the need for tailored school food programmes, designed appropriate to the country, region and school context, including considering cultural underpinnings and available resources. Furthermore, a positive eating environment and elements of student choice and responsibility were all noted as principles important in a school food service. This knowledge can be used to inform planning of future systems, particularly for regions transitioning into a school-provided meal model, and those looking to implement improvements to existing systems.

OBJECTIVE:To use the validated Online Quality Assessment Tool (OQAT) to assess the quality of online nutrition information. SETTING:The social networking platform was formerly known as Twitter (now X). DESIGN:Utilising the Twitter search application programming interface (API; v1·1), all tweets that included the word 'nutrition', along with associated metadata, were collected on seven randomly selected days in 2021. Tweets were screened, those without a URL were removed and the remainder were grouped on retweet status. Articles (shared via URL) were assessed using the OQAT, and quality levels were assigned (low, satisfactory, high). Mean differences between retweeted and non-retweeted data were assessed by the Mann-Whitney U test. The Cochran-Mantel-Haenszel test was used to compare information quality by source. RESULTS:In total, 10 573 URL were collected from 18 230 tweets. After screening for relevance, 1005 articles were assessed (9568 were out of scope) sourced from professional blogs (n 354), news outlets (n 213), companies (n 166), personal blogs (n 120), NGO (n 60), magazines (n 55), universities (n 19) and government (n 18). Rasch measures indicated the quality levels: 0-3·48, poor, 3·49-6·3, satisfactory and 6·4-10, high quality. Personal and company-authored blogs were more likely to rank as poor quality. There was a significant difference in the quality of retweeted (n 267, sum of rank, 461·6) and non-retweeted articles (n 738, sum of rank, 518·0), U = 87 475, P= 0·006 but no significant effect of information source on quality. CONCLUSIONS:Lower-quality nutrition articles were more likely to be retweeted. Caution is required when using or sharing articles, particularly from companies and personal blogs, which tend to be lower-quality sources of nutritional information.

Perceptions of science, industry and related careers are not well-understood in children below age 11, with many potentially influential factors needing research. The Centre for Industry Education Collaboration at the University of York has run the Children Challenging Industry programme (CCI) since 1996. The CCI consists of components designed to place curriculum science in a real-world context, aiming to improve knowledge about and attitudes towards STEM-focused industry, pupils' STEM career aspirations and attitudes towards science. Professional development for teachers and training for industry partners are also important elements of the CCI, but they are not the focus here. In this evaluative study, 508 children aged 9-11 from 23 English primary schools in two UK areas, completed pre- and post-intervention online questionnaires in the academic year 2019-2020 to gather quantitative and qualitative data on their perceptions. The quantitative data were compared across different groups and time points, and qualitative data was explored thematically. The data suggest that the CCI generally positively increased children's experiences of science learning, particularly where baseline awareness of industry was low. The outcomes showed that the positive impact of the CCI on attitudes towards science, and knowledge of industry, including STEM careers in industry, was statistically significant.

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Background: Many children consume a poor quality diet with only a third of children aged 6-9 years eating vegetables daily. A high quality diet is important for good health in childhood; however, the prevalence of children living with obesity has doubled from 10% to 23% during primary school in the UK. Cooking lessons have the potential to improve diet quality and reduce obesity prevalence in childhood, both of which are associated with improved cardiometabolic outcomes in adulthood. The aim of this systematic review is to investigate the impact of school-based cooking classes on cooking skills, food literacy and vegetable intake of children aged 4-12 years. Methods: We conducted a systematic review of OVID Medline, OVID Embase, EBSCO CINHAL and EBSCO ERIC for comparative studies that evaluated outcomes of children receiving cooking classes compared to a control group. Interventions included contained food preparation or a cooking activities and took place on school premises. Risk of bias was assessed using ROB2 and Robins-I. Outcomes were pooled in a meta-analysis using a random-effects model using standardised mean differences or reviewed using narrative synthesis. Certainty of evidence was assessed using GRADE. Results: We included 21 studies, (6 randomised). Meta-analysis showed a small positive effect on cooking selfefficacy of 0.39 units (95% CI 0.05 to 0.54), and a small positive effect on vegetable intake of 0.25 units (95% CI 0.05 to 0.45). Programmes with more than 6 h of cooking showed the greatest effects. Conclusions: Children's cooking programmes result in small improvements in cooking efficacy and vegetable intake, particularly those with more than 6 h of classes. It is recommended that future interventions use consistent measurement for children's food literacy and cooking confidence.

Social media platforms allow people to share information, connect, and build networks at an unprecedented scale with positive and negative consequences. Social network analysis (SNA) applies mathematical network and graph theory to visualise information transfer as relational networks of connected nodes. Measuring node connectivity (centrality) permits the identification of ‘influencers’. SNA has been applied to analyse the spread of misinformation on Twitter (1), but to date, no research has examined nutrition networks. Therefore, this study examined the #Nutrition conversations on Twitter utilising SNA and linguistic analyses. English language tweets including ‘#Nutrition’ on 1–21 March 2023 were collected using the SNA tool, NodeXL Pro (Network Overview for Discovery and Exploration in Excel) (2). SNA is a multistep process that calculates graph metrics and develops a network graph to measure the relationships between users. SNA also identifies semantically related words, hashtags, and word pairs and identifies the sentiment of words used, as measured against the Opinion Lexicon (2). The #Nutrition network included 17,129 vertices (users) with 26,809 unique edges (connections); edges with duplicates were merged. The network density was low, suggesting that most users communicate heavily with a small number of users. The average geodesic distance between any two users was 5.26, revealing a dispersed online discussion. SNA identified the top 10 influencers in this network, measured by high betweenness centrality (23,375,543–5,207,998). Influential users were from a mix of accounts including personal, online blogs, and government organisations. High betweenness centrality identified the users with the greatest influence, acting as bridges between network groups and therefore amplifying #Nutrition messages. Sentiment analysis found the discourse was more positive (0.047, 22,218 words) than negative (0.015, 6795 words). Semantic analysis calculated the total words, 468,191, and identified the most frequently used words in the tweets: #nutrition, #health, food, more, nutrition, health, #diet, #healthylifestlye, #fitness, and #food. Social network analysis shows the discourse on Twitter relating to #Nutrition is dispersed without clear polarising views. Semantic analysis showed that ‘health’ was the main topic discussed in relation to nutrition in this network and was most frequently associated with #Nutrition. The narrative was positively framed, as identified through sentiment analysis.

Social network analysis (SNA) of social media content allows information transfer to be visualised, identifies influential actors, and reveals public opinion. However, to date no research has investigated content related to nutrition on X. This study examined the #nutrition conversations on X (formerly Twitter) utilising SNA and linguistic methods. NodeXL Pro was used for network, semantic and sentiment analyses on English language posts including ‘#nutrition’ collected between 1 and 21 March 2023. The #nutrition network included 17,129 vertices (users) with 26,809 edges (relationships). NodeXL Pro was used to assess the structure of the network and the actors involved by calculating the network metrics. The results show a low density, dispersed network (graph density = 0.001) with most users communicating heavily with a small number of other users. These subgroup community cluster structures restrict information flow outside of the subgroups (modularity = 0.79). These network structures rely on influential users to share information (betweenness centrality range, 0 to 23,375,544). Notably, influential users were typically from both personal and not-for-profit accounts. Semantic analysis identified 97,000 word-pair edges with the most frequently discussed topics related to health, healthy lifestyle and diet, with a positive sentiment found across the network. By using SNA, semantic, and sentiment analyses, this study found a dispersed X network with a high proportion of unconnected users who did not have relationship with other users in the network. The findings reveal a publicly driven debate focused on healthy diets and lifestyle, with information primarily propagated through reposting.

Many children would benefit from a diet richer in vegetables and fruit. Reluctance to taste new foods is widely recognized as a barrier to healthy dietary variety in children. 'Flavour School' is a programme of 'sensory food education', aiming to increase children's confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. We report a pre-registered, cluster-randomised controlled trial to assess the outcomes of the Flavour School programme, in n = 160 children aged 4-7 years from 5 UK schools in London and Leeds. Children either received the Flavour School programme (experimental group n = 84) or no intervention (control group n = 76), in a two-level design with children clustered within school classes. Data collection consisted of video recorded behavioural observation during a tasting activity designed to resemble a Flavour School activity, conducted before and after the intervention. Linear regression models were used to fit relationships between independent variables and outcomes; Willingness-to-taste, Enjoyment (positive/negative facial expression), and Expressiveness (change in facial expression). Most children engaged readily in the tasting activity at baseline. At follow-up children engaged with the tasting activity even more readily (on average biting one more food sample), with no significant effect of the intervention. We interpret these findings to indicate that intra-individual tasting behavior in children is context-dependent. Our results suggest that the context of sensory food education activities facilitates openness to tasting across the normal range of individual traits. However, we find no evidence that receiving sensory food education makes a reluctant taster into a less reluctant taster; no 'curative' effect of the intervention was observed. Rather, even usually fussy/reluctant children were often willing to have a go at tasting in the conducive context of an exploratory activity. TRIAL REGISTRATION: ISRCTN: 40249947 Date assigned 17/03/2020 Last edited 24/10/2022 Version 1.2 Trial Acronym OASES (Outcomes Assessment of Sensory Education in Schools).

Setting:The internet is an important source of health information but is unregulated. Little research has focused on the assessment of digital information related to nutrition.Aim:To develop and validate a novel online quality assessment tool (OQAT) for quality assessment of online nutrition information.Method:The OQAT was developed and validated in six distinct stages. After reviewing the literature, a framework and criteria were developed and formalised. Next, the quality assessment criteria were piloted on a subset of data and criteria refined. The established criteria were then validated against a previously validated assessment tool, and reliability was tested. Finally, the validated OQAT was used to assess the quality of articles from a 24-h collection period, 19 April 2021.Results:The final OQAT consisted of 10 key questions. Twenty-six news articles were assessed independently by two raters. Comparison of scores found moderate internal consistency (α = 0.382). Cohen's Kappa coefficient demonstrated high interrater agreement (k = 0.653, p < 0.001). The OQAT was tested on 291 relevant Uniform Resource Locators (URLs), which were determined to be either poor 3% (n = 9), satisfactory 49% (n = 144), or high-quality 48% (n = 139) articles. There was a statistically significant difference in OQAT scores between blogs, news articles, and press releases, χ2(2) = 23.22, p < 0.001, with a mean rank OQAT score of 138.2 for blogs, 216.6 for news articles, and 188.7 for press releases.Conclusion:This novel tool provides a reliable and objective method for assessing the quality of nutrition content online. It could potentially be used by researchers to assess the quality of online information in different settings and by organisations to inform readers of the quality of information being accessed.

Background The NCRI FLAIR trial confirmed ibrutinib + rituximab (IR) improved progression free survival (PFS) over FCR in untreated CLL. Durable responses are achieved on continuous Bruton's tyrosine kinase inhibitor (BTKi) therapy, but acquired resistance mutations in BTK, and PLCG2 are reported in up to 80% of relapsed/refractory patients (pts) failing BTKi often detected at low variant allele frequencies (VAF) several months before relapse. Their frequency, evolutionary dynamics, and relevance to progression in the upfront-treatment setting are poorly characterised. We present the observed clonal evolution in standard risk pts with disease progression (DP) on IR, integrating next generation sequencing (NGS) with serial measurable disease monitoring by flow cytometry, and tracking individual BTK mutations ( BTKmt) by digital droplet PCR (ddPCR) from initial detection to DP. Methods 771 randomised pts to FCR (n=385) or IR (n=386). Pts treated with IR received rituximab at 375 mg/m 2 on D1/C1 and 500 mg/m 2 on D1/C 2-6 of every 28-days. I was given orally at 420 mg/day for up to 72 mo. All 61 DP pts on IR were included in the analysis. DNA from baseline and progression peripheral blood (PB) samples were processed for sequencing of 33 genes recurrently mutated in lymphoid malignancies including BTK (exon 15) and PLCG2 (exons 19-20) with an Illumina MiSeq. Variants were reported down to minimum VAF of 3-5% and coverage of 100X. Low VAF (3-6%) BTKmt were validated by ddPCR using the QX200 ddPCR protocol (sensitivity 1-0.1%). ddPCR was used for the individual serial analysis at baseline and 6 monthly in pts with confirmed BTKhot spot mutations (p.C481S (c.1441T>A, c.1442G>C)), p.C481R (c.1441T>C), p.T474I (c.1421C>T) and presented with concurrent PB MRD monitoring using highly sensitive flow cytometry with a detection limit of one CLL cell in 100,000leukocytes (0·001%). Results 61/386 pts progressed after a median follow up of 44 mo. on I with 50/61 pts progressing after >24 mo. No deaths were recorded before DP. 47/61 IR DP samples were sequenced by MiSeq, 10 further samples with low disease burden were only analysed by ddPCR for hotspot BTKmt. 7/47 sequenced at baseline and DP, developed new isolated mutations in ATM, SF3B1, NOTCH1, BIRC3, BRAF, KLF2, CDKNB1 or TRAF2. The most frequently mutated gene at DP was BTK. From 57/61 sequenced samples at DP, 7 were found to have hotspot BTKmt most with multiple mutations (Fig/Table). No BTKmt detected at DP were detected at baseline by NGS or ddPCR. One pt had a PLCG2 mutation at DP (VAF 33.3%). The 8 BTKmt/ PLCG2 mt IR progressions were mostly in late DP pts (median 60.3 mo.) compared to a median time to DP of 54.3 mo in BTKwt/ PLCG2wt pts. The majority of BTKmt IR DP (5/7) were reported after stopping therapy at 72 mo. 6 monthly samples during I were studied for BTKmt. Evolution of BTKmt in the context of increasing disease burden on I, shows a steady rise in the VAF preceding frank DP (Fig). 148/386 (38.3%) IR pts were 100% homologous to germline IGHV unmutated and 31/148 (20.9%) progressed. 12/15 pts, who acquired additional mutations at DP were IGHV unmutated and 9/12 were 100% homologous to germline including 6/8 with acquired BTK/PLCG2 mutations. Conclusion In upfront IR treated standard risk CLL pts 15.8% progressed (61/386), the majority late. Only 13% of the IR DP cohort (8/61) had a BTK/PLCG2 mutation, suggesting other non- BTK/PLCG2 mutations or disease related factors as contributors to DP after initial response in the upfront setting. Interestingly, the background mutation profile did not change from baseline in those who acquired BTK/PLCG2 mutations at DP, but 7/15 acquired non- BTK/ PLCG2mutations at DP. The majority of IR DP with BTK/PLCG2 mutations (6/8), were 100% homologous to germline IGHV unmutated, suggesting an inherent higher risk disease profile as a risk factor for acquiring BTKmt with prolonged BTKi therapy. BTK/PLCG2 mutations were enriched amongst very late progressors with 6/8 pts progressing shortly after stopping therapy at 72 mo., which is later than previously reported for relapsed/refractory CLL pts.

Abstract Optimum nutrition plays a major role in the achievement and maintenance of good health. The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a charity based in Türkiye and focused on improving public health, combined forces to highlight this important subject. A hybrid conference was held in Istanbul, with over 4000 delegates from sixty-two countries joining the proceedings live online in addition to those attending in person. The primary purpose was to inspire healthcare professionals and nutrition policy makers to better consider the role of nutrition in their interactions with patients and the public at large to reduce the prevalence of non-communicable diseases such as obesity and type 2 diabetes. The event provided an opportunity to share and learn from different approaches in the UK, Türkiye and Finland, highlighting initiatives to strengthen research in the nutritional sciences and translation of that research into nutrition policy. The presenters provided evidence of the links between nutrition and disease risk and emphasised the importance of minimising risk and implementing early treatment of diet-related disease. Suggestions were made including improving health literacy and strengthening policies to improve the quality of food production and dietary behaviour. A multidisciplinary approach is needed whereby Governments, the food industry, non-governmental groups and consumer groups collaborate to develop evidence-based recommendations and appropriate joined-up policies that do not widen inequalities. This summary of the proceedings will serve as a gateway for those seeking to access additional information on nutrition and health across the globe.

Background Schools provide opportunities to improve the quality of children's diet, whilst reducing inequalities in childhood diet and health. Evidence supports whole school approaches, including consistency in food quality, eating culture and food education. However, such approaches are often poorly implemented due to the highly complex environments in which schools operate. We aimed to develop a school food systems map using a systems thinking approach to help identify the key factors influencing primary school children’s dietary choice. Methods Eight workshops were conducted with 80 children (from schools from varying locations (region of England/UK; urban/rural), deprivation levels and prioritisation of school food policies)) and 11 workshops were held with 82 adult stakeholders across the UK (principals, teachers, caterers, school governors, parents, and local and voluntary sector organisations) to identify factors that influence food choice in children across a school day and their inter-relationships. Initial exploratory workshops started with a ‘blank canvas’ using a group model building approach. Later workshops consolidated findings and supported a wider discussion of factors, relationships and influences within the systems map. Strengths of the relationship between factors/nodes were agreed by stakeholders and individually depicted on the map. We facilitated an additional eight interactive, in-person workshops with children to map their activities across a whole school day to enable the production of a journey map which was shared with stakeholders in workshops to facilitate discussion. Results The final ‘CONNECTS-Food’ systems map included 202 factors that were grouped into 27 nodes. Thematic analysis identified four key themes: leadership and curriculum; child food preference; home environment; and school food environment. Network analysis highlighted key factors that influence child diet across a school day, which were largely in keeping with the thematic analysis; including: 'available funds/resources', 'awareness of initiatives and resources', 'child food preference and intake', 'eligibility of free school meals', 'family circumstances and eating behaviours', 'peer/social norms', 'priorities of head teachers and senior leaders'. Conclusions Our systems map demonstrates the need to consider factors external to schools and their food environments. The map supports the identification of potential actions, interventions and policies to facilitate a systems-wide positive impact on children’s diets.

OBJECTIVE:To evaluate the impact of increased availability of healthier options on purchasing of different types of vending snack products sold in English leisure (sports) centres. DESIGN:An evaluation of an intervention using pre-post methods and interrupted time series analysis. Products within the vending machines were altered over three phases to increase the availability of healthier options, using agreed nutrition criteria - Government Buying Standards for Food and Catering Services (GBSF) for England - as a guide, as well as product availability. The primary outcome was the change in mean weekly purchased energy between the first and third phase. Secondary outcomes included changes by phase and by week in weekly number of purchases, fats, sugars and salt for all products combined and by individual product categories. SETTING:Fifteen sports centres in the city of Leeds, West Yorkshire, UK. PARTICIPANTS:Snack products sold in eighteen vending machines. RESULTS:Energy purchased reduced from baseline to phase 2, for all product categories combined, by 47·25 MJ (95 % CI (-61·22, -33·27)) per machine and by 279 kJ, (95 % CI (-325, -266)) per product unit. There were reductions in most nutrients purchased in all individual product categories except chocolate confectionery. Nutrients per product unit decreased for all product categories except saturated fat in chocolate confectionery. Minimal underlying trends in the baseline phase were identified, indicating changes in outcomes were likely to be due to the intervention. CONCLUSIONS:Introducing standards to increase availability of healthier snack products in vending machines is feasible without substantially affecting sales.

Nutrition messages are a central part of policy making as well as communication via product information, advertising, healthcare advice and lifestyle campaigns. However, with amplified information (and misinformation) from a growing number of sources, inconsistent and conflicting food landscapes, and limited engagement from the public, nutrition messaging tensions have become more accentuated than previously. In this review, we focus on the challenges facing those wishing to effect dietary change through communication; and identify opportunities and future research questions . Beginning with a new working definition and taxonomy for the term ‘nutrition message’, we consider the evolution of public health nutrition messages from the past century and discuss which types of messages may be more effective. We then turn to the challenges of implementation and highlight specific barriers to recipients' understanding and change. While the evidence has many gaps and there is a need for systematic evaluation of nutrition messages, research indicates that recipients are more likely to act on fewer messages that provide clear benefits and which resonate with their perceived health needs, and which are relatively straightforward to implement. Effectiveness may be improved through consideration of how nutrition messages can be designed to complement key non-health drivers of food choice (taste, cost) and societal/cultural norms. Consistency can be achieved by aligning the wider food and messaging environment to desired public health actions; that is by ensuring that retail settings provide and signpost healthier choices, and that mass media nutrition messages work with, not against, public health advice.

Objectives: Previous research has shown that food insecurity disproportionately affects households with children and households of minority races/ethnicities.The objective of this study is to describe the association between sociodemographic factors such as age, race, household size, Supplemental Nutrition Assistance Program (SNAP) participation, and language spoken and fruit and vegetable intake of Bronx families with young children who report being food insecure.Methods: A cross-sectional study was administered online via Qualtrics from July to October 2022.Inclusion criteria included adults (main grocery purchasers), living in the Bronx, with children aged <11 years, and living <130% of the federal poverty line.Families were recruited from Head Start programs and 91 completed the survey.The survey assessed sociodemographic characteristics and included two validated questionnaires: the USDA's US Household Six-Item Food Security Scale and the National Cancer Institute's Fruit and Vegetable Intake screener (FVI).Fruit and vegetable intake was aggregated and scored into meeting or not meeting the USDA's daily recommendations for FVI (3.5 servings).Multivariate logistic regression models were used to analyze the relationship between FVI and age, race, household size, SNAP participation, and language spoken.Results: The majority of participants (91%) were women, identified as Hispanic (79%), were < 40 years old (78%), participated in SNAP (74%), and were Spanish-speaking (58%).English speakers had a 10 fold greater ids of meeting daily FVI (OR: 10.37; 95% CI[10.65,40.51]versus Spanish speakers, after controlling other sociodemographic covariants.English language was significantly associated with increased FVI with an increase of 1.6 additional servings per day compared to Spanish speakers ( p = 0.001, X2).Conclusions: This study indicates that for food insecure households with young children, English language was a predictor of meeting the USDA's daily FVI recommendation.Language may be a proxy for immigration status, acculturation, and literacy, and should be further considered in programs and services promoting access to heathy food and nutrition.Dietitians should focus their efforts on reaching food insecure families whose English is not their primary language, as they are at risk for poor diet quality.