IntroductionFood environments, the physical, economic, political, and sociocultural contexts shaping food availability, affordability, marketing, and social norms, strongly influence dietary behaviors and population health. The Big Food Map (De Grote Voedselkaart) was developed as a large scale citizen science initiative to engage citizens across Flanders, Belgium, in documenting and reflecting on their local food environments, aiming to raise awareness and support local action for healthy and sustainable food environments.MethodsThe Big Food Map smartphone application was co-created with citizens, particularly adolescents and adults on lower incomes, as well as with actors, such as local governments, retailers, and short-chain initiatives. Co-creation involved Photovoice workshops with adolescents and adults on lower incomes and Group Model Building sessions with actors to explore how they understand food environments and identify key food environment dimensions and settings. Citizens and actors also tested and refined the app. The app was launched in May 2025 until August 2025 to crowdsource and provide feedback on citizen perceptions and behaviors related to neighborhood food environments. A brief evaluation questionnaire assessed the app’s usefulness and potential behavioral impact among citizens, while a more detailed survey explored stakeholder perspectives on the co-creation process and policy relevance.ResultsIn total 4,707 citizens contributed data across 1,320 neighborhoods (48% of all Flemish neighborhoods) and evaluated 11,313 food outlets. Participants appreciated the opportunity to visualize and discuss their local food environments. Approximately half liked the app’s design, 24% reported increased awareness of their food environment, and 56% said they would participate again. Both citizens and stakeholders highlighted challenges around long-term engagement, technical usability, and inclusion of vulnerable groups. The co-creation process strengthened partnerships between research, policy, and practice and underscored the value of tailoring citizen science tools to local contexts and communication channels.DiscussionThe Big Food Map demonstrates the feasibility and potential of citizen science to enrich food environment monitoring and stimulate local dialog and action. To sustain engagement and policy relevance, future efforts should strengthen collaboration with local governments and media, diversify participation strategies, and embed citizen science tools into municipal food policy strategies or frameworks.

Despite the public health importance of active travel, there is limited qualitative research on how people with a lower socioeconomic status (SES)perceive and engage with it in their daily lives. This qualitative study, conducted among 26 adults with a lower SES in two peri-urban municipalities in Flanders, Belgium, explores the decision-making factors on active travel.Semi-structured interviews were conducted and thematically analyzed using Panter's framework on active travel. Findings reveal that active travel was less a voluntary choice than a constrained necessity shaped by financial limitations, lack of a driver's license, or medical conditions. Conversely, some participants cited manageable distances and the wish to be a role model for their children as motivations. Key environmental facilitators included the presence of physically separated walking and cycling paths, even surfaces, low traffic, good visibility, and adherence to traffic regulations. The study highlights how unsafe or poorly maintained environments disproportionately disadvantage people with fewer transport alternatives. These results underline the importance of mobility and urban planning policies that address both the infrastructural factors and the social determinants affecting transport choices among socioeconomically disadvantaged groups.

BACKGROUND:Marketing of nutrient-poor foods is a recognized driver of unhealthy dietary behaviors and childhood obesity. In Senegal, the triple burden of malnutrition persists, while regulations restricting unhealthy food marketing to children remain limited. OBJECTIVE:To assess the extent and nature of food advertising around schools and on television in Senegal and to explore children's and parents' perceptions of food marketing. METHODS:A cross-sectional mixed-methods study was conducted across four regions in Senegal (Dakar, Kaolack, Saint-Louis, Ziguinchor). Food advertising was mapped within a 250-m radius of 40 selected urban/peri-urban schools, and inventoried on four national television channels. Advertised foods were evaluated using the WHO-NPM AFRO and Nutri-Score systems and classified as 'permitted' or 'non-permitted' foods. Focus group discussions with children and in-depth interviews with parents were conducted to explore food marketing perceptions. Quantitative data were analyzed using descriptive and inferential statistical analysis, and qualitative data were analyzed using thematic analysis. RESULTS:Overall, 79% (n = 438) of food advertisements around schools and 75% (n = 366) on television were for 'non-permitted' foods. Non-permitted food advertisements were more frequent during peak viewing times and used persuasive marketing techniques. Children demonstrated brand recall and reported requesting advertised products following exposure. Parents expressed concerns about poor nutritional quality of foods advertised to children and supported stricter regulatory measures. CONCLUSIONS:Children were exposed to 'non-permitted' food advertising across physical and virtual environments in Senegal. The predominance of nutrient-poor food promotion underscores the urgent need for mandatory policies to restrict unhealthy food marketing to children.

Food environments influence dietary behaviors and nutritional health outcomes. Food deserts, areas characterized by limited spatial access to healthy foods, and food swamps, areas where unhealthy outlets predominate, present challenges to the adoption and maintenance of a healthy diet. This study analyzed trends in access to healthy and unhealthy food environments in neighborhoods and around schools in Wallonia, Belgium, over the period 2008–2024. The region remains understudied and offers a particularly insightful case due to its mix of urban and rural areas. We combined data on geocoded food outlets (Locatus database), short chain initiatives (LogCiCa), schools, road networks, residential addresses and area socio-demographic characteristics to identify and quantify food deserts, food swamps and the food environment within 1000m around schools across the study region. Potential food deserts were defined as areas lacking a supermarket within 1000 m road distance and a bus stop within 500 m, while actual food deserts additionally required high proportions of low-income households or elderly (65 years and older). Food swamps were quantified using the modified Retail Food Environment Index (mRFEI). Food environments around 4,696 schools were assessed using 1000 m road-network buffers. Temporal trends were evaluated using linear regression. Between 2008 and 2024, approximately 11

No mandatory policies currently exist to address food environments in Belgium. Monitoring commitments and practices by food industry actors is essential for increasing accountability. The aim of this study was to evaluate and benchmark the transparency, specificity, and comprehensiveness of nutrition-related commitments and associated practices of leading food companies in Belgium, as well as changes over time. The Business Impact Assessment on Obesity and population-level nutrition (BIA-Obesity) was applied to assess commitments related to product formulation, labelling, promotion, accessibility, relationships with other organizations and corporate nutrition strategy among major packaged food and non-alcoholic beverage manufacturers (n = 21), supermarkets (n = 5), and quick-service restaurants (QSR) (n = 6) in Belgium. Publicly available data on commitments in 2023/2024 were collected and company representatives invited to verify and supplement the information. A standardized scoring framework comprising around 60 indicators was used to assess the commitments. Company product portfolios were evaluated using Nutri-Score, the NOVA classification, and the WHO Europe Nutrient Profile Model. In addition, supermarket shelf-space allocation, and QSR density near schools were assessed. Results were compared to the 2019 BIA-Obesity Belgium to evaluate progress. 63

Childhood overweight and obesity represent major public health concerns globally, influenced by food and physical activity environments. In the absence of strong national or regional policies, there has been an increasing interest from local government jurisdictions to address obesity. This study aimed to apply three distinct participatory methods to engage different community groups in a medium size, socio-economically deprived municipality in Flanders (Belgium), to identify context-specific barriers and facilitators to healthy eating and physical activity from the perspective of these groups, and to propose locally relevant strategies. We used group model building with actors (local government officials, health representatives, school representatives and youth workers), Photovoice with children and interviews with parents and teachers. An inductive–deductive approach was used to analyse the different outputs and combine the barriers and facilitators across groups in different themes. In total, 15 actors participated in three group model building sessions, 66 children participated in five group Photovoice sessions, 14 children in one-on-one Photovoice sessions and 10 parents/teachers consented to an interview. Barriers and facilitators were identified across three themes: the obesogenic food environment (e.g. relative presence of healthy food outlets, supermarket proximity), the physical activity environment (e.g. an unsafe road environment discouraging active transportation, poorly designed play spaces) and the socio-economic environment (e.g. time and financial constraints for vulnerable groups, knowledge on poverty). By including the perspective of children and parents, actors could better understand the lived experience of their community and propose context-specific actions to tackle the identified barriers and facilitators. Proposed actions included offering healthy hot meals at school, attracting local markets to food deserts, designing car-free school streets, (re)designing playgrounds and increasing exchanges between community members and the local government. This study demonstrates a promising approach to meaningfully engage different community groups in identifying barriers and facilitators for healthy eating and physical activity at the local level. By addressing the barriers and facilitators across multiple settings, local governments can take concrete steps towards creating healthier and context-adapted environments for future generations.

Abstract Introduction The prevalence of diabetes in Belgium has steadily increased since 2001, reaching 6.9% in 2024, with type 2 diabetes (T2D) accounting for approximately 90% of cases. Diabetes-related healthcare expenditures were estimated at €2 billion in 2022. The European Care4Diabetes Joint Action aimed to transfer and adapt the evidence-based Dutch lifestyle program Reverse Diabetes2 Now to 12 European countries. This study evaluated the transferability and potential effectiveness of the Care4Diabetes lifestyle intervention on metabolic, behavioral, and subjective health outcomes among Belgian adults with T2D in primary care. Research design This quasi-experimental implementation study was conducted in two primary care centers in Wallonia. Forty-three participants initiated the program and 37 completed the 12-month follow-up. The intervention included a 6-month intensive phase with five thematic group sessions and one individual check-up, followed by an additional check-up and a refresher session at Month 12. Primary outcomes were changes in HbA1c and T2D medication use. Secondary outcomes included anthropometric measures, lipid profile, behavioral outcomes, and subjective health indicators. Linear mixed models were used to assess changes over time, accounting for repeated measures. Results At Month 12, 46% of participants had no change in T2D medication, 43% underwent medication deintensification, and 11% required intensification. After adjustment for T2D medication changes, HbA1c decreased significantly from baseline to Month 6 by 5.4 mmol/mol (0.49%; p = 0.002), but the reduction was attenuated at Month 12 to 2.8 mmol/mol (0.26%; p = 0.06). Sensitivity analyses restricted to participants without T2D medication changes showed significant decreases in HbA1c at Month 6 and Month 12. Body weight decreased significantly (− 3.6 kg at Month 12, p < 0.001). Improvements were also observed in dietary behaviors and perceived general health, and satisfaction among participants and healthcare providers was high. Conclusions The Care4Diabetes program demonstrated good transferability and promising effectiveness in primary care in Wallonia. Larger studies across Belgium are needed to further assess clinical effectiveness and potential economic benefits.

Background West Africa is faced with all forms of malnutrition and there is an urgent need to address this public health issue through strengthening food environment policies. Objective This study conducted a regional comparison on the level of implementation of policies aimed at creating healthy food environments in five countries in West Africa Method The INFORMAS healthy food environment policy index (Food-EPI) was adapted to take into account the double burden of malnutrition (12 indicators added), and used to assess the level of food environment policy and infrastructure support implementation in Senegal (2017–2019), and in Togo, Burkina Faso, Benin and Ivory Coast (2020–2023). Evidence on the implementation of 47 or 59 good practice indicators of Food-EPI was compiled in each country and validated by government actors. Subsequently, in each country, a series of workshops with a panel of national experts were conducted to evaluate public policies, identify and prioritize actions recommended to governments to create healthy and sustainable food environments. Based on this process, our study compared the process and results. Results Countries obtained a higher level of implementation of food environment policies linked to the 12 new indicators of double burden unlike the indicators of the original Food-EPI (n = 47) which were focused mostly on obesity and NCD prevention. Burkina Faso and Ivory Coast obtained the highest number of indicators at a "medium" level of implementation; 42.8% (n = 24/56) and 38.9% (n = 23/59) respectively, while Senegal, Togo and Benin obtained the highest proportion of indicators judged at “low or very low” level of implementation. Policies relating to food promotion, food retail and health in all policies were identified as the main gaps in all five countries. Across the five countries, stakeholders recommended common actions, such as the implementation of an integrated school feeding policy and regulating of the marketing of unhealthy foods to children and adolescents. Conclusions In addition to mobilizing national stakeholders and strengthening their capacities, the study demonstrated that countries political priorities focused more on undernutrition, while overnutrition continued to increase in these countries. In this way, it’s crucial to establish a regional agenda of priority actions focus on strengthening existing policies and addressing gaps to reduce malnutrition in all its form in West Africa.

There is a dearth of information on the extent of marketing of ultra-processed foods on traditional media such as radio in low- and middle-income countries (LMICs). Consumption of ultra-processed foods is associated with nutrition-related noncommunicable diseases such as overweight/obesity, type 2 diabetes, and cardiovascular diseases. This study aimed to examine the marketing of ultra-processed foods on the most widely accessed radio stations across three counties in Kenya. This was a cross-sectional quantitative study conducted in three counties: Nairobi, Mombasa, and Baringo counties in the period between December 2021 to February 2022. We purposively selected 5 radio stations based on their popularity in different counties according to the Communications Authority of Kenya ratings. Using stratified sampling, we selected 8 recording days: 4 weekdays and 4 weekend days for three months. The recorded data were coded using a structured questionnaire. The key variables included the food and non-food and beverage products advertised on the radio stations, categorization of the food, non-food beverage products, time slots of the advertisements, promotional strategies, and premium offers. Of the 1499 advertisements on the radio, 15.7

To reduce two key modifiable risk factors for Noncommunicable diseases (NCD)—unhealthy diets and physical inactivity—among adolescents (aged 10-19 years) in various socio-economic urban communities in Nairobi, Kenya, and Accra, Ghana. The study also aims to assess young people in disadvantaged communities mainly driven by rural-urban migration. The project will design, deploy, and evaluate interventions based on the evidence-based “WHO Best Buys” to improve physical activity and nutrition among urban youth. The study will involve approximately 5,300 adolescents from Kibera slum and Buruburu (non-slum) in Nairobi, and Ga-East (low SES) and Ayawaso-West (high SES) in Accra. Guided by MRC’s Intervention Mapping framework, we will engage stakeholders (adolescents, parents, and those in education, health, and community leadership positions) through formative and participatory work. Using qualitative approaches, we aim to adapt, optimize, and co-create the Generation-H multicomponent intervention, focusing on enhanced implementation strategies. The intervention will be delivered in selected sites through schools and faith-based organizations. Repeated cross-sectional surveys at baseline, 6 and 18 months will assess implementation outcomes (primary, e.g. REACH of the intervention) and secondary outcomes (e.g. health literacy, self-efficacy, health behaviors), and analyse outcomes using mixed-effects models. Cost-effectiveness will be assessed over a short-term and long-term life horizon and a mixed-methods process evaluation will evaluate acceptability, feasibility, and adoption within different socio-economic contexts. By involving adolescents, parents and other stakeholders in the design and delivery of interventions, leveraging diverse delivery platforms, and evaluating the (cost-)effectiveness and sustainability of these strategies, this five-year project seeks to provide a model for NCD prevention that can be adapted across Sub-Saharan Africa and other low- and middle-income countries. This aligns with the GSMERH-congress theme by promoting health equity and fostering a multi-ethnic, racism-free world.

BACKGROUND:South Africa faces a double burden of malnutrition (DBM), the coexistence and interaction of multiple forms of malnutrition (undernutrition, micronutrient deficiencies, and overweight/obesity) within individuals and households and across the life course. A healthy food environment is necessary to reduce this DBM. The Healthy Food Environment Policy Index (Food-EPI) can be used to evaluate the implementation of public nutrition and food environment policies in comparison with international best practices. The aim of this study was to assess the extent of implementation of healthy food environment policies in South Africa using an expanded DBM Food-EPI framework, benchmark policies against international best practices, develop priority policy recommendations, and compare implementation progress since the 2016 South African Food-EPI assessment. METHODS:From October 2023 to March 2024, a panel of 23 national experts from different tiers of government (Department of Health), academia, and civil society was invited to participate in the Food-EPI assessment. Through two workshops and online feedback, experts evaluated the implementation of food environment policies across 60 indicators, compared these policies to international best practices, and proposed and prioritized a list of policy actions based on perceived implementation gaps. RESULTS:Of the 23 invited experts, 13 participated in the benchmarking workshop in which about 70% of indicators were rated at very low to low levels of implementation. Overall, of the 48 original indicators, the mean level of implementation improved from 2016 to 2024. Of the 12 indicators that addressed the DBM, eight were rated at very low to low levels of implementation. The experts (original panel plus four additional participants) then proposed ten priority actions, mainly across the domains of Food Promotion, Food Prices, Funding, and Platforms for Interaction. CONCLUSIONS:Application of the expanded Food-EPI in South Africa showed improvements for the original indicators compared with 2016 and highlights the need for additional policy efforts to improve public nutrition policy and address the DBM.

BACKGROUND:Current dietary patterns contribute to health issues and pose high demands on the food production system, leading to environmental degradation. This paper aims to analyze the cost and affordability of current diets in Argentina, compared to one diet based on National Dietary Guidelines and 3 variants of diets based on EAT-Lancet Recommendations. METHODS:The methodology proposed by INFORMAS (International Network for Food and Obesity/Non-communicable Diseases Research, Monitoring and Action Support) was used to design six model diets for a reference household, considering the most consumed food products by the Argentinean population and similar healthier and/or more environmentally sustainable options. Nutritional information and prices of food products were obtained from official sources. Monte Carlo Simulations were performed to estimate the average cost of the diets (and variability). Affordability was measured as the percentage of average monthly household income each model diet represents. RESULTS:On average the diet based on National Dietary Guidelines was the most expensive (274.95 USD; 95% CI: 274.85-275.05), followed by the current diet (261.84 USD; 95% CI: 261.62-262.06), the flexitarian diet that includes higher amount of animal protein sources (design to be more similar to the current consumption pattern in Argentina) (259.43 USD; 95% CI: 259.30-259.55), and then the vegan diet (256.96 USD; 95% CI: 256.90-257.03). The lowest costs were found for the current isocaloric diet (248.29 USD; 95% CI: 248.06-248.52) and the flexitarian diet with less animal proteins (248.37 USD; 95% CI: 248.26-248.48). Between 53% and 59% of the average income is needed to cover the cost of diets. CONCLUSIONS:Diets based on National Dietary Guidelines are on average the most expensive (least affordable), while the least expensive (most affordable) are the current isocaloric diet and the flexitarian diet with fewer animal protein sources, suggesting that there are dietary options that can reduce greenhouse gas emissions and provide health benefits without increasing food expenses.

OBJECTIVE:The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators. DESIGN:This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context. SETTING:Burkina Faso. PARTICIPANTS:Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors. RESULTS:Among the fifty-six indicators, it was assessed the level of implementation as 'high' for six indicators, 'medium' for twenty-four indicators, 'low' for twenty-two indicators and 'very low' for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a 'very low' level of implementation in Burkina Faso. CONCLUSIONS:The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

Exposure of children and adolescents to unhealthy food through marketing and advertising on television (TV) is associated with increased consumption of unhealthy foods and subsequently, overweight/obesity and diet-related non-communicable diseases (NCDs). This study assessed the nature, frequency, and exposure of children to food and beverage advertisements on TV and the perspectives of children/adolescents and parents on food marketing on TV. Mixed methods, nationally representative study, guided by the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol for monitoring food promotion. This entailed simultaneous recording of the three most popular national TV channels in Kenya for eight randomly selected days, 18 h/day, over a 3-month period in 2021–2022. The NOVA classification was used to categorize food based on level of processing. Differences in advertisements by food groups, recording days (weekday/weekend) and seasons (holiday/non-holiday) were assessed. Focus group discussions (n = 14) and in-depth interviews (n = 29) were conducted with school children/adolescents ( 9–18 years) and parents respectively in three counties, to explore their experiences and perspectives of food advertisements. Data were coded in NVIVO and analyzed thematically. Of the 3700 advertisements recorded, about a third (36

Introduction: Consumption of ultra-processed food (UPF) is associated with poor diet quality and a risk for non-communicable diseases (NCDs). This study explores the energy contribution of NOVA foods and the nutrient gaps. Methods: The study sourced data from the previous Ethiopian National Food Consumption Survey (NFCS). It covered 8254 households, 8254 women of reproductive age (15–45 years old), and 7272 children (6–45 months old). Results: The most consumed UPF in children were biscuits, cookies, soft drinks, and semi-solid palm oil; while cow and human milk, whole wheat bread, a range of legumes, tubers, and cereal-based foods were among NOVA1. In both children and women, the largest dietary energy intake was from NOVA1 (74.6% and 79.0%), processed culinary ingredients (18.3% and 14.0%), processed foods (1.9% and 3.5%), and UPF (5.1% and 3.5%), respectively. Higher intake of energy from UPF was found in urban residences, wealthier households, and women with higher education. However, NOVA1 was more dominantly consumed in rural than in urban areas. Micronutrient and macronutrient gaps were observed compared to the recommended nutrient intake (RNI). The intake of fruits and vegetables was also considerably low compared to the WHO recommendation (≥400 g/day for adults, and ≥250 g/day for children). Conclusions: Adequate intake of micronutrients, fruits, and vegetables is essential to meet the RNI and could have reduced existing body micronutrient deficiencies, such as vitamin A, zinc, iodine, calcium, vitamin D, and selenium prevalence. Whether UPF intake in urban areas is associated with insufficient availability and access to NOVA1 foods or just due to the higher provision of UPF and gained popularity needs additional investigation. Further study is recommended to simulate the impact of increased fruits and vegetables and/or reduced intake of selected UPF, salts, and oils on NCD markers or mortality in the country.

BACKGROUND:Many low- and middle-income countries face a double burden of malnutrition, i.e., a co-occurrence of undernutrition with overweight, obesity, or other diet-related noncommunicable diseases. In an increasingly connected global food system, multinational and domestic food industry actors - through their commercial practices and corporate political activity - both contribute to the double burden of malnutrition and hold potential to address it. Systematic monitoring of relevant industry commitments and practices may help to hold industry accountable and foster constructive engagement. The Business Impact Assessment - Obesity and population-level nutrition (BIA-Obesity) tool has been developed to assess and benchmark food companies' commitments and practices related to obesity and support for healthy diets at a national level. METHODS:To enable the application of BIA-Obesity for countries facing a double burden of malnutrition, this study aimed to identify and select relevant best practice indicators for assessing food company commitments and practices regarding the double burden of malnutrition, with a focus on indicators not currently captured by the BIA-Obesity tool. A three-round Delphi study was conducted between April and October 2024, involving an international panel of experts. RESULTS:From 52 invited experts, 30 contributed to our expert panel (response rate 58%). Based on a systematic review, 16 best practice indicators addressing the double burden of malnutrition were proposed. Consensus (i.e., group agreement of 75% or higher) for inclusion was reached for 8 indicators covering the production, distribution and marketing of (i) breastmilk substitutes and (ii) complementary foods, (iii) breastfeeding support and (iv) parental leave for employees, (v) food fortification, (vi) use of traditional foods, (vii) use of discounts and donations, and (viii) healthy diets at work. One additional indicator on corporate strategy was included as an overarching indicator. CONCLUSIONS:Food industry action may complement other efforts to address the double burden of malnutrition, such as public policies and investments. Tools like the extended BIA-Obesity framework can be used for a systematic monitoring of relevant industry commitments and practices and may help to disseminate and establish favourable industry practices as part of broader efforts to address the double burden of malnutrition in low- and middle-income countries. CLINICAL TRIAL NUMBER:Not applicable.

Dietary health impact assessments are valuable decision-support tools for action on population-wide dietary shifts. These assessments rely on epidemiological evidence to estimate associations between dietary risk factors and health outcomes. However, the review and selection of evidence poses several challenges including a lack of systematic approaches to risk-outcome pair selection and ability to extract harmonized dose-response data from scientific papers. To address these challenges, this work aimed to 1) develop a database of dietary risk factor dose-response curves by updating the Nordic Nutrition Recommendations 2023 (NNR2023) evidence base and 2) propose a novel and efficient extraction method for dose-response curves. The NNR2023 scoping review methodology was replicated and risk-outcome pairs were selected according to modified NNR 2023 criteria. Non-linear relationships were estimated by extracting data points with an open-source graph reader and fitting piecewise constant functions to the extracted points. From the selected updated studies and original NNR2023 evidence, 101 risk-outcome associations were included, of which 44 were non-linear, and one quarter included beverages. Around half of the associations reported levels of at least mid-range evidence certainty. The provided database and methodology contribute to increased transparency and provide a standard approach to evidence selection and use in health impact assessments. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was partly funded by the Danish Ministry of Food, Agriculture and Fisheries (AEJ). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the study are available online at Zenodo.

BACKGROUND:Sugar-sweetened beverages (SSBs) are recognized contributors to the global rise in non-communicable diseases. While the link between SSB intake and adverse health outcomes is well established, long-term data from African countries are limited. OBJECTIVE:To assess trends in SSB sales and their associations with type 2 diabetes (T2D) burden across nine African countries from 2010 to 2024. METHODS:We conducted an ecological time-series analysis using national-level data from Cameroon, Côte d'Ivoire, Ethiopia, Ghana, Kenya, Morocco, Nigeria, South Africa, and Uganda. Annual changes in per capita and total SSB sales, national T2D prevalence, and the number of adults with T2D were analyzed. Country-specific multivariate Vector Autoregressive (MVAR) models estimated associations between SSB sales and T2D outcomes. RESULTS:SSB sales rose across all countries, with the sharpest per capita increases in Cameroon (+173.8%), Nigeria (+119.1%), and Côte d'Ivoire (+88.5%). T2D trends varied: Ethiopia, Morocco, and South Africa showed rising prevalence and case numbers, while Ghana and Nigeria showed declines. Per capita SSB sales were significantly associated with adult T2D burden in Ghana (β = 0.41, p = 0.005) and Ethiopia (β = 0.37, p = 0.039. Total SSB volume was associated with T2D burden in Kenya (β = 0.49, p = 0.046) and with T2D prevalence in Nigeria, Morocco, and Côte d'Ivoire. CONCLUSIONS:Rising SSB sales may be contributing to the T2D burden in African countries. This calls for context-specific regulatory measures, such as fiscal taxes and front-of-pack labels.

Background and methods High body mass index (BMI) is a major risk factor for several non-communicable diseases. The increasing concern about the health and economic burden of BMI makes it essential for countries to track their progress on major modifiable risk exposures. The aim of the study is to estimate the burden attributable to high BMI in Belgium, in terms of years of life lost due to disability (YLD), years of life lost due to premature mortality (YLL) and disease costs, using comparative risk assessment. We followed the general framework established in the Global Burden of Diseases, Injuries and Risk Factors study. Population attributable fractions were calculated for the year 2018 for selected health outcomes using local estimates of BMI and burden of disease estimates from the Belgian Burden of Disease study.Results According to our figures, around 37 800 YLD, 56 000 YLL and €1.85 billion in healthcare costs can be attributed to a high BMI. Diabetes had the highest number of YLD attributable to high BMI followed by musculoskeletal disorders. Cardiovascular diseases accounted for the highest burden in terms of YLL attributable to high BMI, followed by diabetes and different forms of cancers (i.e., breast, colon and rectum and oesophageal cancer).Conclusion A substantial proportion of the burden of disease could be prevented when reducing BMI in Belgium. This evidence on the impact of risk factors is important for monitoring disease burdens and setting priorities for health prevention policies.