Objective: To determine if a global mid-upper arm circumference (MUAC) cut-off can be established to classify underweight in adults (men and non-pregnant women). Design: We conducted an individual participant data meta-analysis (IPDMA) to explore the sensitivity (SENS) and specificity (SPEC) of various MUAC cut-offs for identifying underweight among adults (defined as BMI < 18·5 kg/m2). Measures of diagnostic accuracy were determined every 0·5 cm across MUAC values from 19·0 to 26·5 cm. A bivariate random effects model was used to jointly estimate SENS and SPEC while accounting for heterogeneity between studies. Various subgroup analyses were performed. Setting: Twenty datasets from Africa, South Asia, Southeast Asia, North America and South America were included. Participants: All eligible participants from the original datasets were included. Results: The total sample size was 13 835. Mean age was 32·6 years and 65 % of participants were female. Mean MUAC was 25·7 cm, and 28 % of all participants had low BMI (<18·5 kg/m2). The area under the receiver operating characteristic curve for the pooled dataset was 0·91 (range across studies 0·61–0·98). Results showed that MUAC cut-offs in the range of ≤23·5 to ≤25·0 cm could serve as an appropriate screening indicator for underweight. Conclusions: MUAC is highly discriminatory in its ability to distinguish adults with BMI above and below 18·5 kg/m2. This IPDMA is the first step towards determining a global MUAC cut-off for adults. Validation studies are needed to determine whether the proposed MUAC cut-off of 24 cm is associated with poor functional outcomes.

Most Africans enter old age after a lifetime of poverty and deprivation, poor access to health care and a diet that is usually inadequate in quantity and quality. However, nutrition interventions in African countries are directed primarily toward infants and young children, as well as pregnant and lactating women. This situational analysis focuses on two key areas to identify priorities for future research and policy development: the nutritional status of older Africans and determinants of undernutrition. Based on the scant evidence available, the prevalence of undernutrition is high in older African men (9.5-36.1%) and women (13.1-27%); however, in some urban areas there is evidence that older adults are experiencing the nutrition transition. Information on micronutrient status is sparse, yet it appears that anemia related to suboptimal folate status is a particular problem. Important determinants of poor nutritional status in the elderly in the African context include inadequate household food security, war and famine, and the indirect impact of HIV infection and AIDS. The rapidly increasing size of the older population, combined with their increased burden of care-giving responsibilities and severe socioeconomic hardship, indicates an urgent need for increased attention to this group, including applied research on nutrition problems and the development and evaluation of nutrition interventions.

Aim: Iodine deficiency, which has adverse effects on health has re-emerged in Australia. The present study aimed to develop and validate a novel iodine-specific food frequency questionnaire for use in older Australians. Methods: A 49-item food frequency questionnaire that included iodine-rich foods was constructed and administered in 84 men and women aged 60-95 years with normal cognitive function. Dietary iodine intake assessed by the food frequency questionnaire was validated against three repeated 24-hour dietary recalls. Urinary spot iodine concentrations were selected as iodine intake biomarker. Agreement between the two dietary methods was determined using a Bland-Altman plot and intra-class coefficients. Correlations between dietary and urinary iodine were assessed. Forty-three participants repeated the questionnaire after 9 months for reproducibility. Results: Mean iodine intake measured by the food frequency questionnaire and 24-hour dietary recalls did not differ significantly (P = 0.870). The two methods were moderately correlated (r = 0.377; P < 0.05) and the Bland-Altman plots demonstrated an acceptable level of agreement (P = 0.870). Despite an association (r = 0.230; P < 0.05) between urinary iodine concentrations and 24-hour dietary recalls, the food frequency questionnaire was not associated with urinary iodine concentration (r = 0.094; P = 0.40). The method of triads showed coefficients of 0.238 (urinary iodine), 0.953(food frequency questionnaire), 0.396 (24-hour dietary recall) with the unknown true value. Conclusion: A short food frequency questionnaire to assess habitual dietary iodine intake in older Australians has been shown to be valid at the group level with regard to categorising individuals according to their habitual iodine intake. Reproducibility of the food frequency questionnaire remains to be demonstrated.

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Purpose of review Food systems at all levels are experiencing various states of dysfunction and crisis, and in turn their governance contributes to other intensifying crises, such as climate change, biodiversity loss and the rapid expansion of dietary-related non-communicable diseases. In many jurisdictions governments at local, state and national levels are taking action to tackle some of the key challenges confronting food systems through a range of regulatory, legislative and fiscal measures. This article comprises a narrative review summarising recent relevant literature with a focus on the intersection between corporate power and public health. The review sought to identify some of the principal barriers for the design and support of healthy food systems and environments, as well as key reforms that can be adopted to address these barriers, with a focus on the role of local governments. Recent findingsThe review found that, where permitted to do so by authorising legislative and regulatory frameworks, and where political and executive leadership prioritises healthy and sustainable food systems, local governments have demonstrated the capacity to exercise legislative and regulatory powers, such as planning powers to constrain the expansion of the fast food industry. In doing so, they have been able to advance broader goals of public health and wellbeing, as well as support the strengthening and expansion of healthy and sustainable food systems. Summary Whilst local governments in various jurisdictions have demonstrated the capacity to take effective action to advance public health and environmental goals, such interventions take place in the context of a food system dominated by the corporate determinants of health. Accordingly, their wider health-promoting impact will remain limited in the absence of substantive reform at all levels of government.

Objective: To analyse local government (LG) policies concerned with creating a healthy, sustainable and equitable food system.Methods: All relevant policies on LG websites were identified and analysed against a framework of 34 recommendations for LG action on food system issues.Results: A total of 13 of 207 (New South Wales 128, Victoria 79) LGs had dedicated food system policies. Most actions on food system issues were in general (non-food specific) policies. MostLGs acted on food safety, sustainable local food production, food waste, drinking water access and food system-related education. Few used economic measures to support the consumption of healthier foods, restricted unhealthy food advertising, developed and implemented dietary guidelines in LG-managed settings or influenced the opening of unhealthy/healthy retail food outlets. Conclusions:LGs undertook a range of actions relevant to creating a healthy, sustainable and equitable food system. Strategic opportunities for LGs include regulating the sale and marketing of unhealthy food and ensuring policy coherence. Implications for public health:LGs can be supported to act further on food system issues, including through 'joined-up' state and federal policies. Further research should address how relevant LG policies can be developed, implemented and monitored effectively to address the complex challenges created by contemporary food systems.