Context Previous reviews have focused on evaluating the efficacy and effectiveness of rice fortification, despite the need to also understand the outcomes of micronutrient retention, organoleptic properties, and acceptability to inform nutrition programs. Objective This systematic review aims to consolidate existing evidence on micronutrient retention, organoleptic properties, and acceptability of fortified rice. Data Sources Eligible articles were identified from 22 electronic databases and personal referrals and reviews. Study Selection Studies on rice fortified via extrusion or coating technologies were included in the review if they reported outcomes in at least 1 of 3 domains: micronutrient retention, organoleptic or physicochemical properties, and acceptability (evaluated by sensory tests and consumer surveys). Any years of publication and study populations were considered for inclusion. A total of 15 391 articles were screened, yielding 49 for inclusion. Data Extraction Study results were summarized descriptively through discussions by intervention conditions, study population, measurement methods, and key findings. The included studies were independently reviewed by 2 of the 3 authors, and all 3 authors reached consensus on the quality and major findings from the included articles. Results Extrusion and coating fortification technologies were found to be comparable across studies that assessed retention, organoleptic properties, and acceptability. Cooking fortified rice in excess water increased micronutrient loss for both technologies. Fortified kernels containing ferric pyrophosphate, zinc oxide, or zinc sulfate showed the most positive results for all outcomes reviewed, while retention rates of vitamin A in multiple-micronutrient-fortified rice were variable. Conclusions The current practice of fortifying rice with ferric pyrophosphate provides high micronutrient stability and results in rice with organoleptic properties and consumer acceptance levels comparable to those of unfortified milled rice, although it presents challenges regarding the effect of vitamin A–fortified rice on vitamin A status.

Improving diet quality of preschool children is challenging in countries undergoing food environment and nutrition transition. However, few studies have sought to understand how mothers in these countries decide what and how to feed their children. This study aims to explore maternal experiences, perspectives and beliefs when making food choice decisions for preschool children in urban, peri-urban and rural areas in northern Vietnam. Two focus group discussions and 24 in-depth interviews were carried out and analysed using thematic analysis. The results showed that mothers across the urban-rural spectrum shared the intention to feed children safe, nutritious food for better health and weight gain while satisfying child food preferences to improve appetite and eating enjoyment. These food choice intentions were embedded within family food traditions, whereby mothers emphasised nutritious food and adopted strict feeding styles during lunch and dinner but were flexible and accommodating of child preferences during breakfast and side meals. These intentions were also embedded within the physical food environment, which provided a mix of healthy and unhealthy food through informal food retailers. Despite these intentions, mothers faced financial constraints and difficulties in managing children's refusal to chew, changes in eating mood and strong eating temperament. These findings support policies to limit the presence of unhealthy food in informal food retail and encourage meal-specific feeding strategies to help children enjoy nutritious food, transition from soft to textured food and become more cooperative during mealtime.

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Objectives High sugar intake has been implicated in hepatic steatosis and metabolic dysfunction. A previous clinical trial among adolescents with non-alcoholic liver disease (NAFLD) demonstrated that replacing household meals and snacks with similar no- or lower-sugar alternatives for 8 weeks resulted in a reduction in sugar intake and hepatic steatosis. This pilot study aimed to assess the feasibility and acceptability of a guided grocery shopping (GGS) intervention, as an alternative to food replacement, to reduce sugar intake among Latino children with NAFLD. Methods After removing foods high in added sugar (>5g of sugars per serving) from the households of nine adolescents with previously diagnosed NAFLD, parent/child dyads were provided dietitian-led personalized nutrition education sessions and assistance with selecting and purchasing weekly groceries low in free sugars (added sugars + those in fruit juice) for the household for four weeks. Children's readiness-to-change was measured at baseline (month 0), upon conclusion of the intervention (month 1), and at long-term follow-up (month 6) using a Likert scale survey based on the Transtheoretical Model, and semi-structured in-depth interview with code-based thematic analysis were used to assess parents and children's perceptions of the intervention. Results Readiness-to-change of participating children (n = 5; age 8 to 15 y) shifted from Contemplation (considering to take actions at a foreseeable future) at baseline to Action (recently achieved behavior change) at both months 1 and 6. A key theme that emerged from the interviews (n = 6, 11 interviews) was the importance of promoting nutrition literacy, particularly by utilizing the nutrition facts label to help identify foods high in free sugars. Changes in the food environment through food removal and low-sugar groceries were also considered acceptable and helpful intervention strategies. Conclusions Dietitian-guided grocery shopping with nutrition counseling following removal of sugary foods from the household was found to be an acceptable intervention strategy to promote a low-sugar diet among adolescents with known NAFLD. Funding Sources The pilot trial was funded by the Center for Cystic Fibrosis and Airways Disease Research of Emory University and Children's Healthcare of Atlanta.