OBJECTIVE:Reliable biomarkers are essential for assessing children's fluoride exposure, yet 24-h urinary fluoride excretion (24 h-UFE), the gold standard, is logistically challenging to collect. The validity of spot urine samples as a proxy across fluoridation modalities has not been evaluated. This study is the first to assess the predictive accuracy of spot urine fluoride concentration (UFC), creatinine-adjusted (UF/CR), and specific gravity-adjusted (UF/SG) for estimating 24 h-UFE across multiple fluoride exposure modalities. METHODS:In this multi-modality observational study, 178 children aged 4-6 years residing in regions with different fluoride modalities were included: water fluoridation (UK, Brazil), salt fluoridation (Colombia), milk fluoridation (Chile), and non-fluoridated areas (UK, Chile). Each child provided one 24-h urine sample and four spot samples during a separate session (post-breakfast, post-lunch, before bedtime, first morning void). Linear regression models assessed the predictive validity of UFC, UF/CR, and UF/SG. RESULTS:Mean urinary fluoride ranged 0.48-1.38 mg/L (UFC), 1.13-2.30 mg/g (UF/CR), and 0.55-1.70 mg/L (UF/SG). UFC showed the strongest association with 24 h-UFE (mean R2 = 77%), particularly in water-fluoridated areas (up to 85%). UF/CR and UF/SG correlations were weaker (mean R2 = 58% and 61%). Accuracy improved when multiple spot samples were used. Timing of peak fluoride excretion varied: post-breakfast (water), post-lunch (salt), first morning void (milk and non-fluoridated areas). CONCLUSION:Spot UFC provides a practical alternative for population-level monitoring of fluoride exposure in children, although accuracy depends on sampling time and fluoridation modality. This multi-modality study demonstrates variability in fluoride excretion across sources and informs optimized sampling strategies for public health surveillance.

OBJECTIVES:Fluoride exposure in children is commonly estimated using questionnaires or urinary biomarkers. However, no study has yet compared these methods for classifying participants into five intake categories ranging from low to high. This study aimed to estimate the extent of agreement and classification consistency between questionnaire- and urinary-based methods for assessing total daily fluoride intake (TDFI) in children aged 4-7 years. METHODS:A total of 104 healthy children across three countries (UK, Brazil, Chile) receiving one of three fluoridation modalities (non-fluoridated-water, fluoridated-water, or fluoridated-milk) provided a 24-h urine sample and completed validated dietary and oral hygiene questionnaires. TDFI was estimated from dietary sources and toothpaste ingestion, adjusted for body weight. Urinary fluoride concentration was measured and 24 h-UFE determined by multiplying urine volume by fluoride concentration. TDFI was predicted from 24 h-UFE using the WHO's recommended method. Method agreement was assessed using paired t-tests and Bland-Altman analysis to evaluate continuous fluoride intake estimates. Cohen's kappa was used to assess agreement between categorical intake classifications, while descriptive statistics reported the percentage of children in each intake group. RESULTS:The questionnaire method estimated a higher mean TDFI (0.072 mg/kgbw/day) than the urine-based method (0.058 mg/kgbw/day, p = 0.01). Bland-Altman analysis showed good agreement for lower mean TDFI values (< 0.10 mg/kgbw/day) but increasing variability at higher fluoride intake levels. The questionnaire classified a larger proportion of children as high exposure (≥ 0.1 mg/kgbw/day) than the urine method (19.2% vs. 11.5%), with the greatest discrepancy observed in the fluoridated milk group (46.2% vs. 7.7%). Despite these classifications, Cohen's kappa revealed minimal agreement between methods (κ = 0.034, p = 0.508), suggesting that classification concordance was likely due to chance. CONCLUSION:This first study comparing questionnaire and urinary methods for assessing TDFI in children found significant discrepancies and minimal agreement, especially in higher exposure groups, highlighting the risk of misclassification and the need for research into combined assessment approaches.

AIM:This study aimed to explore food insecurity prevalence and experiences of adults with severe mental illness living in Northern England. METHODS:This mixed-methods cross-sectional study took place between March and October 2022. Participants were adults with self-reported severe mental illness living in Northern England. The survey included demographic, health, and financial questions. Food insecurity was measured using the US Department of Agriculture Adult Food Security measure. Quantitative data were analysed using descriptive statistics and binary logistic regression; and qualitative data using content analysis. RESULTS:In total, 135 participants completed the survey, with a mean age of 44.7 years (SD: 14.1, range: 18-75 years). Participants were predominantly male (53.3%), white (88%) and from Yorkshire (50.4%). The food insecurity prevalence was 50.4% (n = 68). There was statistical significance in food insecurity status by region (p = 0.001); impacts of severe mental illness on activities of daily living (p = 0.02); and the Covid pandemic on food access (p < 0.001). The North West had the highest prevalence of food insecurity (73.3%); followed by the Humber and North East regions (66.7%); and Yorkshire (33.8%). In multivariable binary logistic regression, severe mental illness' impact on daily living was the only predictive variable for food insecurity (odds ratio = 4.618, 95% confidence interval: 1.071-19.924, p = 0.04). CONCLUSION:The prevalence of food insecurity in this study is higher than is reported in similar studies (41%). Mental health practitioners should routinely assess and monitor food insecurity in people living with severe mental illness. Further research should focus on food insecurity interventions in this population.

Out-of-home eating (takeaway, take-out and fast-foods) is associated with intakes of higher energy and fat, and lower intakes of micronutrients, and is associated with excess weight gain. In 2017, a unique opportunity arose to measure the association between the opening of a new multi-national fast-food restaurant (McDonald's) and consumption of fast-food on young people aged 11-16. This study uses a repeated cross-sectional design to explore group level change over time with respect to out-of-home eating behaviours of young people. Two secondary schools in Redcar and Cleveland agreed to participate and facilitated the completion of a questionnaire on their pupils eating behaviours at three timepoints a) prior to the new restaurant opening, b) three months post-opening and c) nine months post opening. Reported frequency of visits to McDonald's showed a statistically significant increase in visits between 3 and 9 months of the restaurant opening. This research asks and explores the question of whether the introduction of a new multi-national fast-food restaurant influences eating habits of young people attending schools near the new outlet.

BACKGROUND:People living with severe mental illness experience premature mortality from diet-related preventable illnesses. Yet, little research focuses on food insecurity with adults with severe mental illness. This coproduced study aimed to understand the experiences of adults with severe mental illness and food insecurity and strategies to help. METHODS:Following a pragmatism philosophical foundation, we undertook a mixed-methods study involving a survey (online and paper versions) and one-to-one semi-structured interviews (online and telephone) during March 7 to Dec 16, 2022. We recruited participants via existing severe mental illness service user groups and social media in Northern England. Eligible participants were adults (≥18 years) self-reporting a diagnosis of severe mental illness. Ethics approval was obtained from Teesside University and the Health Research Authority (Reference: 22/NR/0010; IRAS ID: 306281), with informed consent given. The target sample size, accounting for a typical survey response rate for people with severe mental illness of 10-20%, was 135. A target sample of 20 interviews was agreed to capture a range of views. Food insecurity was defined as the lack of financial resources needed to ensure someone has reliable access to enough food to meet their dietary, nutritional, and social needs. It is sometimes called food poverty. Quantitative data were analysed using descriptive statistics and binary logistic regression and qualitative data using thematic analysis. FINDINGS:135 participants completed the survey (mean age 44·67 years [SD 14·1]). Participants were predominantly male (53%, n=72), white (87%, n=117), and from the Yorkshire region (50%, n=68). Overall, prevalence of food insecurity was 50·4% (n=68). Discussion across 13 interviews found food insecurity being a long-rooted experience, including familial and intergenerational experiences of food insecurity: "I grew up… with this insecurity around food" (P002). Recommendations for tackling food insecurity centred on food banks, increasing accessibility, and reducing stigma: "I would like to get more information on where the centres are..." (P006) and "I was referred to, erm, a foodbank … but it's still the stigma that's attached to it." (P002). INTERPRETATION:We found a higher prevalence of food insecurity in this study than in the general population (being 15%), yet limited research with adults with severe mental illness perpetuates food insecurity intergenerational injustices. Food insecurity should be eliminated. However, in the meanwhile, there should be widespread easy access to food banks offering nutritional foods. Limitations of this research include not reaching target sample size and a lack of ethnic diversity. FUNDING:National Institute of Health and Care Research (NIHR) Research for Patient Benefit.

Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. Food insecurity can lead to many health problems such as obesity, heart disease, diabetes, and other long term health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Peer-led in-depth interviews were conducted with adults with severe mental illness from Northern England, during which their experiences of food insecurity and strategies to tackle food insecurity were discussed. Interviews took place between March and December 2022, with interviews being transcribed and analysed using deductive and inductive thematic analysis. Thirteen interviews were conducted, finding that food insecurity in adults with severe mental illness was often a long-standing issue. Unemployment, the cost-of-living crisis and fuel poverty impacted on experiences of food insecurity. Difficulties accessing food banks such as transport, stigma, and the limited selection of available food was also discussed. Strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food. Future research should aim to eradicate food insecurity for adults with severe mental illness, as limited research and action focuses on this population group over and above 'mental illness' or 'poor mental health'. Removing barriers to accessing food such as lack of transport, and providing food which is of adequate nutritional quality, should be prioritised, as well as tackling the stigma and accessibility issues surrounding food banks use.

Due to practical difficulties in quantifying fluoride exposure in populations, practical and accurate biomarkers can play a major role in the surveillance of fluoride. Among different fluoride biomarkers, spot urine and nail-clippings have gained more attention due to their ease of acquisition. However, there is no robust consensus about the accuracy of these biomarkers for the estimation of fluoride exposure. This systematic review and meta-analysis aimed to synthesize evidence on the association between fluoride exposure and the fluoride concentration of spot urine and nail-clippings. This review was conducted and reported using the PRISMA Statement. Nine databases (Medline, CINAHL, Web of Science, Scopus, ScienceDirect, Sage Journals Online, Campbell Collaboration, Cochrane Collaboration, and Embase); search engines (Google and Google Scholar); and grey literature were searched up to September 2022. All screening, data extraction, and quality assessments were conducted in duplicate. All experimental and observational research studies that reported the correlation between fluoride exposure and fluoride concentrations of spot urine and/or nail clippings were included. The Mixed-Methods Appraisal tool was used to assess the methodological quality of the included studies. A random effect meta-analysis was carried out to determine the relationship between fluoride exposure and fluoride concentration of biomarkers (i.e., spot urine and nail clippings). Forty-four studies met the inclusion criteria. A total of 694,578 participants were included in this review. Twenty-five studies were included in the meta-analysis. The primary meta-analysis showed a moderate correlation of 0.674 (95%CI: 0.623-0.725, n=25) between fluoride intake and fluoride concentration of spot urine and a strong correlation of 0.938 (95%CI: 0.520-1.355, n=11) between fluoride intake and the fluoride concentration of nail-clippings in all age groups. The findings of secondary meta-analyses showed a strong positive correlation between fluoride intake and fluoride/creatinine ratio of spot urine in children (0.929; 95%CI: 0.502-0.991; n=2). In conclusion, spot urine and nail-clippings have the potential to be employed as non-invasively obtained biomarkers in populations. However, due to the scarcity of high-quality, relevant studies, more research is needed to establish the validity of these biomarkers.

Abstract Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross‐sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high‐income countries. A mixed‐method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random‐effects meta‐analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta‐analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432–1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy‐dense, nutrient‐poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide‐reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.

This novel and mixed-method study investigated food poverty conversations at the beginning of the COVID-19 pandemic and the subsequent national lockdown on the social media platform Twitter. NodeXL Pro software was used to collect tweets using the terms 'food' and 'poverty' in any order somewhere in a tweet sent on selected days between April 5 and May 23, 2020. The data obtained from NodeXL Pro were cleaned. Social network analysis tools were used to analyse and visualise our data. Using this method, sentiment-related words (positive or negative words), the top (the most mentioned) 10 hashtags, top words and top word pairs were identified. The patterns of word pairs communicated in our network were visualised based on each word pair's frequency. This also enabled us to carry out a content analysis to create coding of the word pairs' data. A total of 81 249 tweets were identified that contained the terms 'food' and 'poverty'. Our findings revealed that individuals' tweets overwhelmingly contained views about the increase in hunger, food poverty and food insecurity due to the COVID-19 pandemic. Twitter users perceived that when the pandemic measures began, many food-secure families were pushed into food insecurity due to a rapid rise in unemployment and rising poverty due to the quarantine and stay-at-home instructions in place at the time. They also addressed the sharp rise in food poverty being driven by panic buying, food shortages, food affordability and disruptions in food supply and food systems. Our analysis of this data suggests that to mitigate food poverty or to prevent a 'hunger pandemic' for future pandemic emergencies, comprehensive and longer term policy responses and economic supports are needed to strengthen the resilience of food systems. However, the highlighted limitations of this study must be considered.

Background There is an increased interest in identifying practical and accurate biomarkers for fluoride exposure. Due to the narrow ‘dose-gap’ between the benefit of caries reduction and the risk of dental fluorosis, monitoring of fluoride exposure is vital when introducing any fluoridation programme for the prevention of dental caries. This scoping review aimed to ascertain the nature and extent of the available evidence on how spot urine and nail clippings are used to measure fluoride intake/exposure, by using a unique approach of mapping the studies according to population, setting, type of study design, methodology and analytical approach in community prevention programmes. Methods Multiple relevant databases were searched up to July 2021 for any study designs, including randomised controlled studies, quasi-experimental studies, surveys, retrospective and prospective cohort studies, case studies, phenomenological studies, and expert opinions. Results The search retrieved 9,222 studies of which 155 met the inclusion criteria. A high proportion of the studies (25.2%) originated from Latin America and the Caribbean continent subregion. However, per country, China recorded the highest number, followed by India and Mexico. The majority (62.6%) employed a cross-sectional study design, and 65.8% combined participants from different age groups. Of the included studies, 82.6% used spot urine samples as a biomarker for assessing fluoride intake/exposure. Water fluoride concentration was reported in 66.5% of the studies with 46.6% of all included studies reporting a water fluoride concentration of > 1.2 mg/L. The methods used in assessing oral hygiene and dietary intake were not reported in 72.3% and 71.0% of the included studies, respectively. Only 35.5% of the included studies assessed the relationship between fluoride exposure and excretion. Conclusions This review revealed a large variability in the way in which spot urine samples and/or nail clippings are used to measure fluoride exposure in different settings and situations. Particularly, there are inconsistencies in the methodologies and the analytical approaches used in assessing fluoride exposure. Therefore, there is a need for more rigorous primary research studies using standardised approaches to determine the suitability of spot urine samples and nail clipping as biomarkers for monitoring fluoride exposure.

Background Research indicates that food parcels provided by food banks are nutritionally poor. Food insecurity and the use of food banks are both rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using food banks reduces the food insecurity and improves the dietary intake of their users. Methods A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using eight electronic databases, four grey literature databases and eight relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings reporting the views of food bank users regarding food from food banks underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively. Results Of 2189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using food banks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, and is explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at food banks, including catering for individual needs. Conclusions Food banks are a lifeline for those severely food insecure. However when used alone, food banks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring food banks.

Understanding the social and environmental influencers of eating behaviours has the potential to improve health outcomes for young people. This review aims to explore the effectiveness of school nutrition interventions and the perceptions of young people experiencing a nutrition focused intervention or change in school food policy. A comprehensive systematic search identified studies published between 1 December 2007 to 20 February 2020. Twenty-seven studies were included: 22 quantitative studies of nutrition related outcomes and five qualitative studies reporting views and perceptions of young people (combined sample of 22,138 participants, mean ages 12-18 years). The primary outcome was nutrition knowledge/dietary behaviours, with secondary outcomes exploring body mass index (BMI) and wellbeing. Due to the heterogeneity of studies, a narrative results description is presented. The findings demonstrate that school nutrition programmes can be effective in reducing sugar, sugar sweetened beverages (SSB) and saturated fat and increasing fruit and vegetable (FV) intake. The lived experiences of young people in a school context provide valuable insights that should be considered in the development of effective school food policy and interventions. This review affirms the significant role that schools can play in supporting good nutrition in all young people and provides opportunities to inform the school food agenda.

BackgroundAlthough the UK has not routinely collected national data on household food insecurity, the United Nations estimates that 8·4 million people in the UK experience food insecurity, a point emphasised by UN Special Rapporteur Philip Alston. With the use of novel and mixed methods we explored current topics, communications, and characteristics of social media networks on food poverty posted on Twitter. Our research questions were: what discussions were taking place on Twitter related to food poverty within the specified time? What hashtags, words, and websites were the most mentioned related to food poverty? What word-pair groups emerged by social analysis?MethodsWe used NodeXL Pro software to collect tweets sent between Nov 28 and Nov 30, 2018, using the phrase food poverty. This temporal range controlled for variables associated with food poverty, notably school-aged children and holiday periods, as we used Twitter's free public application programming interface (API) limit of 18 000 tweets and search range of 9 days. We analysed and visualised our data using social and semantic analysis tools such as overall graph metrics, vertex degree, vertex betweenness and closeness centralities, words and word pairs, and Network top items graph metrics. We also explored the spatiotemporal trends associated with this phrase using Google Trends.FindingsWe identified 4843 Twitter users whose recent tweets contained the term food poverty. There was 6039 tweets and connections in our network including 376 unique tweets, 3576 retweets, 1625 mentions, and 462 replies. The users shared information related to the existence of food poverty in the UK. Conversations included the growing numbers of foodbanks, welfare reforms, and Universal Credit as the cause of this problem. Google Trends indicated the highest degree of interest for food poverty search queries was related to New Zealand, followed by the UK and USA. Philip Alston was also the highest search term trend in the UK during this time.InterpretationThis research provides a snapshot of conversations about food poverty on Twitter. The themes we obtained indicate a lack of acknowledgment of food poverty in terms of both social policy and public health in the UK. Capturing and analysing social communications using this approach has highlighted increasing public awareness of food poverty.FundingTeesside University.

Corresponding Author: Hasan Habibi Assistant’s professor of Agriculture and Natural Resources College, Persian Gulf University, Bushehr, Iran. Phone: +98-9173034921 E-mail: h.habibi@pgu.ac.ir Abstract Background: Pulicaria gnaphalodes, Ducrosia anethifolia, Trachyspermum copticum, Foeniculum vulgare Mill and Majorana hortensis Minch are widely used as herbal plants in traditional medicine and they have been reported to have a variety of therapeutic effects. This study was carried out to evaluate the antimicrobial effects of essential oils (EOs) extracted from these medicinal herbs against six species of food-borne microorganisms. Materials and Methods: The EOs were analyzed by gas chromatography mass spectrometry (GC/MS). The detection of inhibitory effect of the EOs on the tested bacteria was carried out by agar disk-diffusion method and then MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) of the EOs against six bacteria were determined. Results: The analysis of the components of the essential oils (EOs) extracted by gas chromatography spectrometry allowed the identification of 63 compounds of the five tested EOs. All of these five tested EOs indicated an antimicrobial effect against strains of Bacillus sp and Listeria Monocytogenes ATCC1297. Essential oils from T. copticum, M. hortensis and F. vulgare possessed a wide spectrum of antibacterial activity against the growth of the six bacteria with zone diameter of inhibition (ZDI) between 14-32 mm, depending on the susceptibility of the tested organism. Conclusion: Antibacterial efficacy shown by these plants provides a scientific basis and thus validates their use as medicinal remedies. Isolation and purification of different phytochemicals may further yield significant antibacterial agents.

Corresponding Author: Hasan Habibi Assistant’s professor of Agriculture and Natural Resources College, Persian Gulf University, Bushehr, Iran. Phone: +98-9173034921 E-mail: h.habibi@pgu.ac.ir Abstract Background: Pulicaria gnaphalodes, Ducrosia anethifolia, Trachyspermum copticum, Foeniculum vulgare Mill and Majorana hortensis Minch are widely used as herbal plants in traditional medicine and they have been reported to have a variety of therapeutic effects. This study was carried out to evaluate the antimicrobial effects of essential oils (EOs) extracted from these medicinal herbs against six species of food-borne microorganisms. Materials and Methods: The EOs were analyzed by gas chromatography mass spectrometry (GC/MS). The detection of inhibitory effect of the EOs on the tested bacteria was carried out by agar disk-diffusion method and then MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) of the EOs against six bacteria were determined. Results: The analysis of the components of the essential oils (EOs) extracted by gas chromatography spectrometry allowed the identification of 63 compounds of the five tested EOs. All of these five tested EOs indicated an antimicrobial effect against strains of Bacillus sp and Listeria Monocytogenes ATCC1297. Essential oils from T. copticum, M. hortensis and F. vulgare possessed a wide spectrum of antibacterial activity against the growth of the six bacteria with zone diameter of inhibition (ZDI) between 14-32 mm, depending on the susceptibility of the tested organism. Conclusion: Antibacterial efficacy shown by these plants provides a scientific basis and thus validates their use as medicinal remedies. Isolation and purification of different phytochemicals may further yield significant antibacterial agents.

Recently the role of adipocytokines in relationship to incidence of diabetes has been demonstrated. One of the medicinal plants that are used in the treatment of diabetes is stevia. This study investigates the effect of stevia on serum omentin and visfatin levels as novel adipocytokines in diabetic induced rats to find potential mechanisms for the anti hyperglycemic effect of stevia. Forty male wistar rats weighing 180-250 g were induced with diabetes by intraperitoneal injection of streptozotocin (STZ). The animals were divided into 5 groups of 8. Rats in group 1 (non-diabetic control) and group 2 (diabetic control) were treated with distilled water, and the rats in the treated groups, group 3 (T250), group 4 (T500), and group 5 (T750) were treated with stevia, gavaged every day at 9 a.m. in doses of 250, 500, and 750 mg/kg, respectively. At the end of the study significant reductions in fasting blood sugar (FBS), the homeostasis model assessment insulin resistance (HOMA-IR), triglyceride (TG), alkaline phosphatase (ALP), and Omentin level were found in groups 3 and 4 in comparison with group 2. Pancreatic histopathology slides demonstrated that stevia extract did not induce any increase in the number of β-cells. The conclusion is that prescription of stevia in the doses of 250 and 500 mg/kg/d decreases the omentin level indirectly via activating insulin sensitivity and lowering blood glucose in STZ-induced diabetic rats.