Individuals with CHD are at increased risk of poor mental well-being. Dietary intake of EPA and DHA, the main n-3 fatty acids from fish, may be beneficial to mental well-being. We examined the association of EPA+DHA and fish intake with mental well-being in 644 participants, aged 60–80 years, with a history of myocardial infarction. Habitual food intake was assessed with a 203-item FFQ. Depressive symptoms were assessed with the self-report geriatric depression scale, and dispositional optimism was assessed with the revised life orientation test (LOT-R) and a four-item questionnaire (4Q). In Cox-regression models modified for cross-sectional analyses, we adjusted for sex, age, energy intake, BMI, family history of depression, education, marital status, smoking, physical activity and intake of saturated fat, alcohol and fibre. Compared with the lower tertile, subjects in the higher tertile of EPA+DHA intake had a lower prevalence of depressive symptoms, but this association was not statistically significant (prevalence ratio (PR) 0·78; 95 % CI 0·50, 1·22, P-trend 0·27). The higher tertile of EPA+DHA intake was positively associated with dispositional optimism measured with the 4Q (PR 0·69; 95 % CI 0·46, 1·03, P-trend 0·05), but not according to the LOT-R. Fish intake was not related to either depressive symptoms or dispositional optimism. In conclusion, intake of EPA+DHA was positively associated with dispositional optimism assessed with the 4Q, but not with optimism assessed with the LOT-R or with depressive symptoms.

Type 2 diabetes is associated with a higher cardiovascular risk and there has been a growing interest in using dietary intervention to improve lipid profile and glucose control. The present work aims at analysing the effects of the enrichment of a normal diet with β-glucan (3·5 g/d) in free-living type 2 diabetic subjects for 2 months, using a palatable soup. This trial was a parallel, placebo-controlled, double-blinded randomised study performed in fifty-three type 2 diabetic subjects. During a 3-week run-in period, subjects daily consumed a ready meal control soup (without β-glucan). For the following 8 weeks, subjects were randomly assigned to consume daily either a control soup or a β-glucan soup. Changes in lipid profile (total cholesterol (TC), HDL- and LDL-cholesterol (HDLc and LDLc), apo B and TAG) and in glucose control (HbA1c and fasting glucose) were measured. There was no significant alteration in lipid profile in the two groups (TC, HDLc, LDLc and apo B). TAG decreased significantly in the β-glucan group compared with the control group ( − 0·12 (sd 0·38) v. 0·12 (sd 0·44) mmol/l, P = 0·03). HbA1c and fasting glucose were not reduced in any group. A single daily ingestion of 3·5 g β-glucan, as required by official dietary recommendations, for 8 weeks did not change the lipid profile and HbA1c in type 2 diabetic subjects. To improve the metabolic profile of type 2 diabetic subjects in the long term, the quantity, the food vectors and the tolerability of β-glucan products may be re-evaluated.

In the context of epidemic obesity, satiety is an important target for nutritional interventions. Using a multidimensional approach, we compared the effect on satiety of two food products frequently consumed in France by young adults as a small mid-afternoon meal called the ‘goûter’. Participants were eighteen healthy young males (aged 20·8 (sd 1·8) years) of normal body weight (BMI 21·7 (sd 1·7) kg/m2) used to eating four times per d including a ‘goûter’. On two occasions, under laboratory conditions, the time-blinded participants consumed a fixed energy lunch (2·8 MJ) and, 240 min later, either a liquid yogurt or chocolate bars matched for energy (1·2 MJ) and weight (366 g). Then, satiety was assessed by: (1) ratings of hunger, appetite, desire to eat and fullness at 20 min intervals (perception), (2) the delay until the subject requested his dinner meal (duration) and (3) energy intake at this meal (consumption). Results showed that satiety was perceived higher after liquid yogurt than chocolate bars over the 60 min preceding the next meal, as evidenced by hunger (P < 0·005), appetite, (P < 0·005), desire to eat (P < 0·04) and fullness (P < 0·05) ratings. However, its duration was similar between liquid yogurt and chocolate bars (165 (se 8) and 174 (se 7) min respectively) and this difference was not followed by reduced intake at dinner. In conclusion, this approach of satiety revealed that a liquid yogurt induced a lower subjective motivation to eat than chocolate bars during the hour preceding the spontaneous onset of a meal, without affecting subsequent food intake.

The aim of the present study was to assess reproducibility and relative validity of a self-administered FFQ used in the PREDIMED Study, a clinical trial for primary prevention of CVD by Mediterranean diet in a population at high cardiovascular risk. The FFQ was administered twice (FFQ1 and FFQ2) to explore reproducibility at 1 year. Four 3 d dietary records (DR) were used as reference to explore validity; participants therefore recorded their food intake over 12 d in the course of 1 year. The degree of misclassification in the FFQ was also evaluated by a contingency table of quintiles comparing the information from the FFQ2 and the DR. A total of 158 men and women (aged 55–80 years) were asked not to modify their dietary habits during the study period. Reproducibility for food groups, energy and nutrient intake, explored by the Pearson correlation coefficient (r) ranged 0·50–0·82, and the intraclass correlation coefficient (ICC) ranged from 0·63 to 0·90. The FFQ2 tended to report higher energy and nutrient intake than the DR. The validity indices of the FFQ in relation to the DR for food groups and energy and nutrient intake ranged (r) from 0·24 to 0·72, while the range of the ICC was between 0·40 and 0·84. With regard to food groups, 68–83 % of individuals were in the same or adjacent quintile in both methods, a figure which decreased to 55–75 % for energy and nutrient intake. We concluded that FFQ measurements had good reproducibility and a relative validity similar to those of FFQ used in other prospective studies.

The aim of the present study was to compare body fat percent (BF %) using single-site near-IR reactance (NIR) and dual-energy X-ray absorptiometry (DXA) in a cohort of normal-weight (BMI < 25 kg/m2) black (n 102) and white (n 71); and obese (BMI ≥ 30 kg/m2) black (n 117) and white (n 41) South African women (18–45 years). NIR-derived BF % was significantly correlated with DXA-derived BF % in all groups: normal-weight black (r 0·55, 95 % CI: 0·40, 0·67, P < 0·001) and white (r 0·69, 95 % CI: 0·53, 0·79, P < 0·001) women; obese black (r 0·59, 95 % CI: 0·46, 0·70, P < 0·001) and white (r 0·56, 95 % CI: 0·30, 0·74, P < 0·001) women. NIR under-predicted BF% compared to DXA in black women (normal-weight, − 4·36 (sd 4·13) % and obese, − 3·41 (sd 3·72) %), while smaller mean differences were observed in white women (normal-weight, − 0·29 (sd 4·19) % and obese, − 0·81 (sd 3·09) %), irrespective of normal-weight or obese status (P < 0·001). In obese subjects, NIR-derived BF % did not measure values greater than approximately 45 %, while the maximum DXA-derived measure was 58 %. In conclusion, although there was a significant relationship between NIR- and DXA-derived BF %, NIR under-predicted BF % in normal-weight and obese black South African women compared to DXA, but to a greater extent in subjects with very high levels of adiposity (>45 %). The results of single-site NIR as a measure of BF % should therefore be interpreted with caution, particularly in women of African descent and in those with very high levels of adiposity.

The aim of the present work was to assess the prevalence of the Mediterranean dietary pattern (MDP) in Balearic Islands adolescents, and socio-demographic and lifestyle factors that might determine adherence to the MDP. A cross-sectional nutritional survey was carried out in the Balearic Islands between 2007 and 2008. A random sample (n 1231) of the adolescent population (12–17 years old) was interviewed. Dietary questionnaires and a general questionnaire incorporating questions related to socio-economic status, parental education level and lifestyle factors were used. Dietary habits were assessed by means of two 24 h recalls and a quantitative FFQ. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high MUFA:SFA ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables and fish consumption, and low consumption of meat and milk. Then, socio-demographic, lifestyle and health status variables that could determine a higher or ower adherence were assessed. The mean adherence was 57·9 (sd 8·9) % and the median adherence was 57·3 %. Half of the Balearic Islands adolescents (50·5 %) showed an adherence to the MDP comprised between 52·7 and 62·8 %. By multivariate analyses, a high maternal level of education, increased physical activity, reduced alcohol intake and abstinence from smoking were independent associations of better adherence to the MDP. The promotion of not only the MDP but also the Mediterranean lifestyle, including greater physical activity, should be reinforced among the Balearic younger generations.

The present study explored the association between dietary vitamin D and non-Hodgkin's lymphoma (NHL) risk. The multiethnic cohort (MEC) includes more than 215 000 Caucasians, African Americans, Native Hawaiians, Japanese Americans and Latinos, aged 45–75. After 10 years of follow-up, 939 incident NHL cases were identified. Risk was estimated using proportional hazards' models adjusted for possible confounders. Vitamin D intake was not associated with NHL risk in the entire cohort (Ptrend = 0·72 for men and Ptrend = 0·83 for women), but significantly lowered disease risk in African American women (hazard ratio (HR) = 0·50, 95 % CI: 0·28, 0·90, Ptrend = 0·03) and was borderline protective in African American men (HR = 0·68; 95 % CI: 0·39, 1·19; Ptrend = 0·31) when the highest to the lowest tertile was compared. In NHL subtype analyses, a 19, 36 and 32 % lowered risk, although not significant, was observed for diffuse large B-cell lymphoma, follicular lymphoma and small lymphocytic lymphoma/chronic lymphocytic leukemia in women, respectively. High dietary intake of vitamin D did not show a protective effect against NHL within the MEC except among African Americans, possibly because vitamin D production due to sun exposure is limited in this population.

Discordances exist in epidemiological studies regarding the association between the intake of nutrients and death and disease. We evaluated the social and health profile of persons who consumed olive oil in a prospective population cohort investigation (Pizarra study) with a 6-year follow-up. A food frequency questionnaire and a 7 d quantitative questionnaire were administered to 538 persons. The type of oil used in food preparation was determined by direct measurement of the fatty acids in samples obtained from the kitchens of the participants at baseline and after follow-up for 6 years. The fatty acid composition of the serum phospholipids was used as an endogenous marker of the type of oil consumed. Total fat intake accounted for a mean 40 % of the energy (at baseline and after follow-up). The concordance in intake of MUFA over the study period was high. The fatty acid composition of the serum phospholipids was significantly associated with the type of oil consumed and with fish intake. The concentration of polar compounds and polymers, indicative of degradation, was greater in oils from the kitchens where sunflower oil or refined olive oil was used, in oils used for deep frying and in oils that had been reused for frying five times or more. Consumption of olive oil was directly associated with educational level. Part of the discordance found in epidemiological studies between diet and health may be due to the handling of oils during food preparation. The intake of olive oil is associated with other healthy habits.

Frequent consumption of nuts lowers the risk of CHD. While lowering blood lipids is one of the mechanisms for cardioprotection, the present study sought to determine whether monounsaturated fat-rich almonds also influence other CHD risk factors such as inflammation and haemostasis. This was a randomised, controlled, crossover feeding study with twenty-five healthy adults (eleven men; fourteen women), age 22–53 years. Following a 2 week run-in phase (34 % energy from fat), subjects were assigned in random order to three diets for 4 weeks each: a heart-healthy control diet with no nuts ( < 30 % energy from fat), low-almond diet and high-almond diet (10 % or 20 % isoenergetic replacement of control diet with almonds, respectively). Serum E-selectin was significantly lower on the high-almond diet compared with the control diet. E-selectin decreased as the percentage of energy from almonds increased (P < 0·0001). C-reactive protein (CRP) was lower in both the almond diets compared with the control diet. A clear dose response was not observed for either E-selectin or CRP. There was no effect of diet on IL-6 or fibrinogen. Tissue plasminogen activator antigen was significantly lower on the control and high-almond diets compared with the low-almond diet, although the values were within normal range. In conclusion, consumption of almonds influenced a few but not all of the markers of inflammation and haemostasis. A clear dose response was not observed for any of the markers studied.

Epidemiological evidence shows an inverse relationship between dietary fibre intake and body weight gain. Oat β-glucan, a soluble fibre alters appetite hormones and subjective satiety in acute meal test studies, but its effects have not been demonstrated with chronic consumption. The present study aimed to test the effects in women of two different doses of oat β-glucan on weight loss and hormones associated with appetite regulation. In a 3-month parallel trial, sixty-six overweight females were randomised into one of three 2 MJ energy-deficit diets: a control and two interventions including 5–6 g or 8–9 g β-glucan. Anthropometric and metabolic variables (blood glucose level, insulin, total cholesterol (TC), LDL, HDL, TAG and leptin), together with markers of appetite regulation (cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), ghrelin, peptide YY (PYY) and PYY3-36) were measured at baseline and at 3 months. After 3 months, all groups lost weight (P < 0·001) and showed a reduced waist circumference (P < 0·001). The study sample also showed reductions in TC, LDL, HDL, leptin, PYY, GLP-1 values (all P < 0·001) and an increase in CCK levels (P < 0·001). No significant differences were noted between the groups for all outcome values except PYY levels (P = 0·018). In broad terms, the addition of oat β-glucan did not enhance the effect of energy restriction on weight loss in mildly overweight women, although wide variations in observed results suggests that individual responsiveness may be an issue.

The evidence of the effect of the age at introduction of new foods during infancy on the development of asthma and allergic rhinitis is inconsistent and scarce. We set out to study these associations. A prospective birth cohort of infants with increased HLA-DQB1-conferred risk for type 1 diabetes was recruited in 1996–2000. The families completed at home a record on the age at introduction of new foods. Persistent asthma and allergic rhinitis were assessed at the age of 5 years with an International Study of Asthma and Allergies in Childhood-type questionnaire. The Cox proportional hazards regression analyses were adjusted for parental asthma and allergic diseases, and several perinatal and sociodemographical factors. Out of the 1293 children, 77 (6·0 %) developed persistent asthma; and out of the 1288 children, 185 (14·4 %) developed allergic rhinitis by the age of 5 years. Early age at introduction of oats was associated with a reduced risk of persistent asthma (hazard ratio (HR; 95 % CI) for the first and mid-tertiles compared with the latest tertile was 0·36 (0·15, 0·85) and 0·37 (0·22, 0·62), respectively, P < 0·001). Early age at introduction of fish was dose dependently associated with a decreased risk of allergic rhinitis (HR (95 % CI) for the first and mid-tertiles compared with the latest tertile was 0·34 (0·22, 0·54) and 0·45 (0·28, 0·70), respectively, P < 0·001). The present finding that age at introduction of oats is inversely and independently associated with development of persistent asthma is novel. We confirmed the earlier observation that the age at introduction of fish is inversely related to the risk of allergic rhinitis. Clinical implications remain to be determined.

The purpose of the present study was to analyse vegetable intake by the Korean population based on different meal formats. Twenty-four-hour dietary recall data from the Korean National Health and Nutrition Examination Survey were used to assess daily vegetable intake and consumption ratio of vegetables for different meal types/dining locations. Analysis was stratified by sex and age group. Daily vegetable intake increased from 293·5 g in 1998 to 305·7 g in 2001 and to 335·9 g in 2005. Findings were similar in men and women, as well as in each age group. Analyses for each meal type revealed that vegetable intake during breakfast did not substantially change, but vegetable intake increased during lunch and dinner. While vegetable consumption ratio during breakfast decreased, it increased during lunch and snack time. Men and women showed similar change in the analysis for meal types and dining locations. There were some differences between the age groups in daily vegetable intake depending on the meal type. Another notable observation was the increasing change of vegetable intake during lunch and during meals eaten at cafeterias and restaurants in all the age groups. Analysis of vegetable consumption ratio showed an increased consumption in cafeterias, restaurants, and other places and decreased vegetable intake at home for those aged 16–64 years with time. Since this change may be related to improvements in socioeconomic status, it will be necessary to further investigate difference in vegetable intake based on socioeconomic levels within the population.

Maternal nutritional status before and during pregnancy is important for the growth and development of the fetus. The effects of pre-pregnancy nutrition (estimated by maternal size) are well documented. There is little information in today's Western society on the effect of maternal nutrition during pregnancy on the fetus. The aim of the study was to describe dietary patterns of a cohort of mothers during pregnancy (using principal components analysis with a varimax rotation) and assess the effect of these dietary patterns on the risk of delivering a small-for-gestational-age (SGA) baby. The study was a case–control study investigating factors related to SGA. The population was 1714 subjects in Auckland, New Zealand, born between October 1995 and November 1997, about half of whom were born SGA ( ≤ 10th percentile for sex and gestation). Maternal dietary information was collected using FFQ after delivery for the first and last months of pregnancy. Three dietary patterns (traditional, junk and fusion) were defined. Factors associated with these dietary patterns when examined in multivariable analyses included marital status, maternal weight, maternal age and ethnicity. In multivariable analysis, mothers who had higher ‘traditional’ diet scores in early pregnancy were less likely to deliver a SGA infant (OR = 0·86; 95 % CI 0·75, 0·99). Maternal diet, particularly in early pregnancy, is important for the development of the fetus. Socio-demographic factors tend to be significantly related to dietary patterns, suggesting that extra resources may be necessary for disadvantaged mothers to ensure good nutrition in pregnancy.

Diets rich in flavonoids may reduce the risk of developing colorectal cancer. Flavonoids are widely distributed in foods of plant origin, though in the UK tea is the main dietary source. Our objective was to evaluate any independent associations of total dietary and non-tea intake of four flavonoid subclasses and the risk of developing colorectal cancer in a tea-drinking population with a high colorectal cancer incidence. A population-based case–control study (264 cases with histologically confirmed incident colorectal cancer and 408 controls) was carried out. Dietary data gathered by FFQ were used to calculate flavonoid intake. Adjusted OR and 95 % CI were estimated by logistic regression. No linear association between risk of developing colorectal cancer and total dietary flavonol, procyanidin, flavon-3-ol or flavanone intakes was found, but non-tea flavonol intake was inversely associated with colorectal cancer risk (OR 0·6; 95 % CI 0·4, 1·0). Stratification by site of cancer and assessment of individual flavonols showed a reduced risk of developing colon but not rectal cancer with increasing non-tea quercetin intake (OR 0·5; 95 % CI 0·3, 0·8; Ptrend < 0·01). We concluded that flavonols, specifically quercetin, obtained from non-tea components of the diet may be linked with reduced risk of developing colon cancer.

Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. To develop interventions discouraging consumption, more insight is needed about cognitive and environmental predictors related to the decrease in SSB consumption. The present paper aims (1) to describe the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up and (2) to study whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. Information on possible predictors and SSB intake at baseline and 4-month follow-up was provided by 348 Dutch adolescents (aged 12–13 years) through online questionnaires that were completed at school. Multilevel logistic regression and mediation analyses were used to determine direct and indirect associations between predictors and behaviour. The present results show that a high perceived behavioural control to decrease intake at baseline was associated with a decrease in consumption of SSB between baseline and follow-up (OR = 0·53). Low availability and a stricter family food rule were associated with a decrease in SSB consumption between baseline and follow-up (OR = 2·39, 0·54). The association between availability and decrease in SSB consumption was for 68 % mediated by perceived behavioural control to drink less. In conclusion, interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.

A cross-sectional study was carried out in order to compare intestinal microbiological and immunological biomarkers with blood glucose and lipids, satiety-related hormones and inflammatory biomarkers characterising differences between obese and normal weight subjects. Faecal and blood samples were obtained from twenty obese subjects with an average BMI of 32·9 kg/m2 and twenty normal weight subjects with an average BMI of 23·3 kg/m2. Blood insulin, TAG and leptin were significantly elevated, whereas concentrations of HDL and ghrelin were significantly decreased in the obese subjects. Inflammatory status in the obese subjects was characterised by a trend for elevated blood C-reactive protein (CRP; P = 0·06) and IL-6 (P = 0·02). The faecal microbial composition differed between the groups; less sulphate-reducing bacteria (P = 0·05) and a trend for less Bacteroides (P = 0·07) were measured for overweight subjects. Furthermore, an inverse correlation was demonstrated between faecal Bacteroides levels and waist circumference (P = 0·05). The faecal microbial metabolites differed between the groups; increased concentrations of branched-chain fatty acids, phenolics, valeric acid, di- and hydroxy acids were described in the obese subjects. No differences between the measured intestinal inflammatory biomarkers were detected. However, systemic inflammation (CRP and IL-6) was correlated with the faecal concentrations of phenolics and lactic acid (P < 0·05 and 0·05, and P < 0·01 and 0·05, respectively). In summary, weight-related differences were observed both in the intestinal microbial composition and its activity. The role of intestinal signals, such as phenolics and lactic acid in the development of weight-related problems, needs to be studied further.

The xyn2 gene of a filamentous mesophilic fungus, Trichoderma reesei, coding xylanase 2 (Xyn2) was previously expressed in Pichia pastoris. In the present study, the recombinant Xyn2 was prepared from a 15 litre fermenter, and subsequently characterised. It has been confirmed to have a molecular mass of 21 kDa, an optimal pH of 6·0 and an optimal temperature of 60°C. When tested using oat-spelt xylan, it showed a Km and catalytic rate constant (kcat) of 1·1 mg/ml and 512·4/s, respectively. Analysis of the products from oat-spelt xylan degradation confirmed that the enzyme was an endoxylanase with xylotriose and xylobiose as the main degradation products. The unprocessed Xyn2 was supplemented to a xylan-containing diet to determine its influences on performance and nutrient digestibilities by weaned pigs. Results showed that the average body-weight gain increased 16·9 % when piglets received Xyn2 at a concentration of 500 U/kg diet. There also was a positive (0·05 < P < 0·10) effect on the digestibility values of crude protein, ash, Ca and acid-detergent fibre with Xyn2 supplementation. The potential benefits of Xyn2 in the nutrition of weaned pigs should make it an alternative applicant for industrial xylanase production.

The objectives of the present study were to assess the intake of different food groups in French children aged 3–17 years (n 1455), and to analyse trends since a dietary survey undertaken 8 years ago. Dietary intake was evaluated using data from the 2006–7 cross-sectional INCA2 national dietary survey (étude Individuelle Nationale sur les Consommations Alimentaires), based on a 7 d food record. Dietary intake (percentage of subjects consuming the food group and amount eaten) was assessed for thirty-nine food categories. We observed variations in food consumption by age, sex, North–South regional gradient, seasonal period and educational level of the responding parent. Trends in dietary intake between 1999 and 2007 were determined by comparing the INCA1 (n 1126) and the INCA2 surveys. Both surveys had been carried out using the same methodology. The findings showed a decrease in energy intake in children aged 3–14 years, due to a reduction in the consumption of foods of animal origin and sweetened products. In adolescents aged 15–17 years, energy intake remained rather stable; during this 8-year period, the consumption of meat decreased, whereas the consumption of savoury snacks such as sandwiches and hamburgers significantly increased. These trends occurred during a time of growing concern about overweight and the associated co-morbidities in France. A number of public health measures were implemented over this period to improve dietary habits and physical activity patterns in children and adults. The periodic monitoring of dietary patterns through the INCA surveys is an essential part of the surveillance network in France.

Obesity affects one in three American adult women and is associated with overall mortality and major morbidities. A composite diet index to evaluate total diet quality may better assess the complex relationship between diet and obesity, providing insights for nutrition interventions. The purpose of the present investigation was to determine whether diet quality, defined according to the previously validated Framingham nutritional risk score (FNRS), was associated with the development of overweight or obesity in women. Over 16 years, we followed 590 normal-weight women (BMI < 25 kg/m2), aged 25 to 71 years, of the Framingham Offspring and Spouse Study who presented without CVD, cancer or diabetes at baseline. The nineteen-nutrient FNRS derived from mean ranks of nutrient intakes from 3 d dietary records was used to assess nutritional risk. The outcome was development of overweight or obesity (BMI ≥ 25 kg/m2) during follow-up. In a stepwise multiple logistic regression model adjusted for age, physical activity and smoking status, the FNRS was directly related to overweight or obesity (P for trend = 0·009). Women with lower diet quality (i.e. higher nutritional risk scores) were significantly more likely to become overweight or obese (OR 1·76; 95 % CI 1·16, 2·69) compared with those with higher diet quality. Diet quality, assessed using a comprehensive composite nutritional risk score, predicted development of overweight or obesity. This finding suggests that overall diet quality be considered a key component in planning and implementing programmes for obesity risk reduction and treatment recommendations.